Abstract:
AIM
The principle aim of this thesis was to develop a system to predict employment after Traumatic Brain
Injury (TBI).
METHODS
This thesis consists of three studies; a systematic review of the predictors of employment following
TBI; a descriptive qualitative study investigating the factors that individuals with TBI and professionals
delivering rehabilitation perceived to be the influences of employment after TBI; and a quantitative
study evaluating the association between fatigue, employment, and depression following TBI.
FINDINGS
1. The systematic review found that the most consistent predictors of employment outcome
following TBI were; age and education at time of injury, pre-injury employment status, and
levels of impairments. The maximum variance in employment outcome explained by any study
included in the systematic review was 42%. This review also identified that the majority of
predictive research focused on factors intrinsic to the individual with TBI without sufficient
attention to social influences or the individual‘s environment.
2. The descriptive study found participants considered it was how factors intrinsic to the
individual with TBI interacted with both social and work related environmental factors that
influenced employment outcome. As such, employment was reported to be the product of the
individual with TBI‘s interaction with their environment. All stakeholder groups involved
proposed fatigue to be a key influence of employment after TBI, a variable not identified in the
systematic review.
3. The quantitative study of this thesis found that fatigue explained additional variance in
employment outcome to predictors identified in the systematic review. This study also found
that reports of fatigue and depression were highly associated.
CONCLUSION
Accurate prediction of employment for people after TBI based upon early functional indicators and
demographic features remains problematic. Findings here suggest this could be because the
interaction of factors intrinsic to the individual with TBI with their environment influences employment
outcome. A case is made for a biopsychosocial model of disability, as opposed to an impairment only
model, in considering employment issues following TBI. In keeping with a biopsychosocial approach,
findings are then examined with reference to future research and clinical interventions to enable RTW
following TBI.