Work disability following traumatic brain injury

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.