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Early Interventions to Preserve Viable Employment Options

The ability to return to a previous job has been shown to be a key predictor of job success following traumatic brain injury (TBI); however this outcome is relatively rare. Although many TBI survivors do appear to have jobs waiting for them, early intervention is crucial for their success, even if actual return to work was not planned until much later. Craig Hospital uses an intervention-consultation approach in which rehabilitation specialists provide individualized consultation to help employers and design customized work reintegration plans with gradual buildup of expectations, endurance and complexity. The study hypothesis was that a work reintegration program focusing on early intervention, a return to preinjury employment, and an intervention-consultation approach will demonstrate higher than typical return to work rates for individuals with TBI within the first year post injury.
Forty-one Craig Hospital patients with TBI who met the criteria for the TBI Model Systems National Database with injury dates between 10/1/1998 and 12/31/2000, and who had the opportunity to return to a preinjury employer were included in the study. Employment outcomes for this group were compared to matched controls from the Colorado TBI Registry and Follow-up System (CTBIRFS) who did not receive the study intervention. Those who received the vocational intervention were 76% male, 85% Caucasian, had an average age of 34 years, and on average had moderate brain injuries.
For those individuals who received the vocational intervention and returned to work, intervention-consultation program included an average of 3.5 hours of evaluation, 4.5 hours of intervention, and 3.8 hours of consultation, for a total of nearly 12 hours of service per client. Many received a variety of work accommodations; the most frequently reported were limiting the number of hours worked per day (69%), limiting the number of days worked per week (66%), providing additional rest breaks (62%), reducing the number of tasks (59%), and partnering with a coworker (52%). For those with limitations in work schedule, the average number of days per week work was limited to was 3.6; and the average number of hours per day work was limited to was 5.2. Many of the accommodations were part of a temporary reintegration plan, and were phased out as warranted by the performance and endurance of the patient resuming work.
A comparative analysis was conducted between the 41 Craig Hospital subjects and the individually matched control subjects from the CTBIRFS matched on: 1) follow-up interview completed at one year post-injury; 2) employed at the time of injury; 3) participation in inpatient rehabilitation following acute hospitalization; 4) gender; 5) Glasgow Coma Scale score; and 6) age. The Craig Hospital vocational program did demonstrate a slightly better return to work rate than that found among matched TBI cases from the CTBIRFS dataset (71% vs. 68%). However, this difference was not statistically significant. A more detailed analysis indicated that the RMRBIS cases were slightly more severe. Also, the CTBIRFS cases received a substantial amount of services in the community, which may have had a direct vocational benefit. While this study fails to demonstrate better employment rates from the RMRBIS program, it does support the potential for high return to work rates in the first year post TBI.

Registry Project Number: 51
Lead Investigator: McLaughlin, E
Lead Center for Project: Craig Hospital
Collaborating Investigators: Harrison-Felix, C, Whiteneck, G, Gerber, D, Morey, C, Cusick, C
Keywords: vocational rehabilitation, employment, intervention, work, traumatic brain injury
Date of Completion: 09/30/2002
Type: Local
Status of Project: Latest Information Shown

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