CITATION
Hart, T., Ketchum, J.M., O’Neil-Pirozzi, T.M., Novack, T.A., Johnson-Greene, D, & Dams-O’Connor, K. (2019). Neurocognitive status and return to work after moderate to severe traumatic brain injury. Rehabilitation Psychology, 64(4), 435-44.
SUMMARY
Paid employment is a goal for many people with moderate to severe TBI and is associated with greater quality of life post-injury. Previous studies focused on non-modifiable, primarily preinjury variables. In this prospective longitudinal study, 320 participants who sustained a moderate to severe TBI (based on length of post-traumatic amnesia) and completed inpatient rehabilitation were assessed at one year post-injury. All participants had been employed before injury. At follow-up, patients were evaluated for whether and when they had returned to work. Cognitive status was assessed using the Brief Test of Adult Cognition by Telephone (BTACT) which yielded a composite score, as well as scores reflecting executive functioning and episodic memory. Using multivariable logistic regression and survival analyses to examine the effect of cognitive status as measured by the BTACT on employment outcomes after controlling for relevant covariates, the authors found that cognitive status was associated with both whether someone had returned to work after moderate-severe TBI and, for those who had, the length of time to return. Notably, fewer than 40% of participants were employed one-year post-injury. Resumption of driving and injury severity both predicted employment outcomes. The authors suggested that not only could brief assessment be used for determining readiness to return to work, it may also assist in identification of cognitive deficits that could be addressed. By focusing on potentially modifiable barriers to return to work, such as cognitive deficits and transportation barriers, vocational rehabilitation may be enhanced.
I CHOSE THIS ARTICLE BECAUSE both return to work and driving are frequently identified as patient goals following traumatic brain injury and have important implications for independent functioning and quality of life. However, as noted by this article, this goal can be a difficult to achieve, with only 40% of patients returning to work by one year post injury. By considering modifiable factors related to return to work, rehabilitation may be more effective in identifying and resolving potential barriers to employment, such as transportation needs or cognitive deficits.
Furthermore, given the current guidance on social distancing and limiting in person contacts, it was useful to consider an option for telephone-based assessment of cognitive status that was efficient, briefly assessed multiple cognitive domains, and was acceptable to patients. Although telephone-based assessment is necessarily limited, it may allow for some identification of ongoing patient needs and serve as an efficient method for ongoing research and clinical assessment.
THIS MONTH’S REHABILITATION SCIENCE SPOTLIGHT was chose by Sarah W. Clark, Ph.D., Rehabilitation Psychology Postdoctoral Fellow at the Central Virginia VA Health Care System, Richmond, Virginia.