Mild Traumatic Brain Injury and Return to Work

The authors of this current study set out to evaluate motor vehicle accident survivors who suffered mild traumatic brain injury (MTBI) and assessed their return to work (RTW) status. The researchers studied the 50 subjects by assessing the severity of injury, cognitive functioning, social interaction, and discharge disposition.

The sample was evaluated at the initial assessment within one month of injury; a follow up examination occurred 6 to 9 months post-injury. 21 patients (42%) returned to work by the follow-up examination. Of those only 12% returned to their regular work duties, while the remaining 30% returned with modified work arrangements. Of the 29 patients who did not return to work, 86% reported physical difficulties, 7% described cognitive impairments, and 7% had both.

The researchers then compared the group that returned to work to the group of subjects that did not. The authors found no difference in injury severity. The level of cognitive functioning did not differ at the initial assessment, but at the follow-up a 10% improvement appeared among those who returned to work. Therefore, a certain criteria for using cognitive functioning scores as a predictor emerged. The authors suggest:

“The high rate of incompletion at baseline suggests that testing occurred too soon after injury to accurately assess information processing capacity…That the completion rate on the PASAT-R showed great improvement at the follow-up for both groups is consistent with claims of improved cognitive endurance over time…Thus findings from our study indicated that while measures of information processing should not be used as predictors of RTW within the first month post-injury, at 6 to 9 months such measures could be used to identify those with continuing MTBI symptoms.”

Predictably, at the follow-up, those who had returned to work were successfully interacting in a social context, while social withdrawal scores increased for those who hadn’t returned to the work environment. Interestingly, 80% of those discharged to any sort of rehab facility (as opposed to home) did not return to work. There is an assumption that rehabilitation facilities offer social interaction outside the nuclear family, and a more structured day. The authors point out, however, that rehabilitation may not improve a patient’s psychosocial adjustment—they continue in a sick role with dependence on health care professionals.

In concluding, the authors found that social interaction, jobs with greater decision-making latitude, and discharge home were positively related to RTW for this group of patients.

The authors urge further study of MTBI, in particular return to work because, “survivors, like those in our sample, tend to be in their early 30s. At this age the inability to work has serious social and economic consequences for both the individual and society."

Ruffolo CF, Friedland JF, Dawson DR, et al. Mild traumatic brain injury from motor vehicle accidents: factors associated with return to work. Archives of Physical Medicine and Rehabilitation 1999; 80:392-398.

 

 

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