A comparison of acute and postdischarge predictors of employment 2 years after traumatic brain injury

Objective: To examine whether adding postdischarge psychosocial predictors to premorbid and injury-related variables improved the capacity to predict employment 2 years after rehabilitation for traumatic brain injury (TBI). Design: Data were collected prospectively at 6 and 24 months after discharg e from rehabilitation. Logistic regression analyses examined predictors of employment status. Setting: Inpatient and community TBI rehabilitation service attached to a m ajor Australian teaching hospital. Participants: Fifty-five patients with TBI, aged 16 or older, who were cons ecutively admitted to a brain injury unit with complete longitudinal data a nd who agreed to participate in the study. Intervention: Measured injury severity (Glasgow Coma Scale scores, posttrau matic amnesia): functional independence (Functional Assessment Measure cogn itive subscale) at admission and discharge from rehabilitation; self-report of employment (premorbid, postdischarge): postdischarge psychosocial statu s at 6 months and 2 years (Community Integration Questionnaire, General Hea lth Questionnaire, Trauma Complaints List, Overt Aggression Scale. Alcohol Use Disorders Inventory Test, Satisfaction with Life Scale). Main Outcome Measures: Employment status (employed, unemployed) was used to reflect vocational outcome. Predictor variables comprised premorbid work s tatus, injury-related variables (age, injury severity). and postdischarge v ariables (employ ment, community integration, psychologic, cognitive status ). Results: Adding postdischarge predictors to premorbid and acute variables s ignificantly improved the ability to predict work status 2 years after reha bilitation. Age at the time of injury, premorbid employment status, work st atus, and psychologic distress 6 months postdischarge were significant pred ictors of employment. Conclusions: It is important to consider postdischarge psychologic well-bei ng. in conjunction with premorbid and acute factors, in vocational interven tions after TBI.