Ten-Year Employment Patterns of Working Age Individuals after Moderate to Severe Traumatic Brain Injury: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

Jeffrey P. Cuthbert, Christopher R. Pretz, Tamara Bushnik, Robert T. Fraser, Tessa Hart, Stephanie A. Kolakowsky-Hayner, James F. Malec, Therese M. O'Neil-Pirozzi, Mark Sherer

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective To describe the 10-year patterns of employment for individuals of working age discharged from a Traumatic Brain Injury Model Systems (TBIMS) center between 1989 and 2009. Design Secondary data analysis. Setting Inpatient rehabilitation centers. Participants Patients aged 16 to 55 years (N=3618) who were not retired at injury, received inpatient rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and had at least 3 completed follow-up interviews at postinjury years 1, 2, 5, and 10. Interventions Not applicable. Main Outcomes Measure Employment. Results Patterns of employment were generated using a generalized linear mixed model, where these patterns were transformed into temporal trajectories of probability of employment via random effects modeling. Covariates demonstrating significant relations to growth parameters that govern the trajectory patterns were similar to those noted in previous cross-sectional research and included age, sex, race/ethnicity, education, preinjury substance misuse, preinjury vocational status, and days of posttraumatic amnesia. The calendar year in which the injury occurred also greatly influenced trajectories. An interactive tool was developed to provide visualization of all postemployment trajectories, with many showing decreasing probabilities of employment between 5 and 10 years postinjury. Conclusions These results highlight that postinjury employment after moderate to severe traumatic brain injury (TBI) is a dynamic process, with varied patterns of employment for individuals with specific characteristics. The overall decline in trajectories of probability of employment between 5 and 10 years postinjury suggests that moderate to severe TBI may have unfavorable chronic effects and that employment outcome is highly influenced by national labor market forces. Additional research targeting the underlying drivers of the decline between 5 and 10 years postinjury is recommended, as are interventions that target influencing factors.

Original languageEnglish (US)
Pages (from-to)2128-2136
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Volume96
Issue number12
DOIs
StatePublished - Dec 1 2015

Fingerprint

Inpatients
Traumatic Brain Injury
Rehabilitation Research
Rehabilitation Centers
Amnesia
Wounds and Injuries
Research
Linear Models
Rehabilitation
Outcome Assessment (Health Care)
Interviews
Education
Growth

Keywords

  • Brain injuries
  • Employment
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Ten-Year Employment Patterns of Working Age Individuals after Moderate to Severe Traumatic Brain Injury : A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study. / Cuthbert, Jeffrey P.; Pretz, Christopher R.; Bushnik, Tamara; Fraser, Robert T.; Hart, Tessa; Kolakowsky-Hayner, Stephanie A.; Malec, James F.; O'Neil-Pirozzi, Therese M.; Sherer, Mark.

In: Archives of Physical Medicine and Rehabilitation, Vol. 96, No. 12, 01.12.2015, p. 2128-2136.

Research output: Contribution to journalArticle

Cuthbert, Jeffrey P. ; Pretz, Christopher R. ; Bushnik, Tamara ; Fraser, Robert T. ; Hart, Tessa ; Kolakowsky-Hayner, Stephanie A. ; Malec, James F. ; O'Neil-Pirozzi, Therese M. ; Sherer, Mark. / Ten-Year Employment Patterns of Working Age Individuals after Moderate to Severe Traumatic Brain Injury : A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study. In: Archives of Physical Medicine and Rehabilitation. 2015 ; Vol. 96, No. 12. pp. 2128-2136.
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abstract = "Objective To describe the 10-year patterns of employment for individuals of working age discharged from a Traumatic Brain Injury Model Systems (TBIMS) center between 1989 and 2009. Design Secondary data analysis. Setting Inpatient rehabilitation centers. Participants Patients aged 16 to 55 years (N=3618) who were not retired at injury, received inpatient rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and had at least 3 completed follow-up interviews at postinjury years 1, 2, 5, and 10. Interventions Not applicable. Main Outcomes Measure Employment. Results Patterns of employment were generated using a generalized linear mixed model, where these patterns were transformed into temporal trajectories of probability of employment via random effects modeling. Covariates demonstrating significant relations to growth parameters that govern the trajectory patterns were similar to those noted in previous cross-sectional research and included age, sex, race/ethnicity, education, preinjury substance misuse, preinjury vocational status, and days of posttraumatic amnesia. The calendar year in which the injury occurred also greatly influenced trajectories. An interactive tool was developed to provide visualization of all postemployment trajectories, with many showing decreasing probabilities of employment between 5 and 10 years postinjury. Conclusions These results highlight that postinjury employment after moderate to severe traumatic brain injury (TBI) is a dynamic process, with varied patterns of employment for individuals with specific characteristics. The overall decline in trajectories of probability of employment between 5 and 10 years postinjury suggests that moderate to severe TBI may have unfavorable chronic effects and that employment outcome is highly influenced by national labor market forces. Additional research targeting the underlying drivers of the decline between 5 and 10 years postinjury is recommended, as are interventions that target influencing factors.",
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AU - Cuthbert, Jeffrey P.

AU - Pretz, Christopher R.

AU - Bushnik, Tamara

AU - Fraser, Robert T.

AU - Hart, Tessa

AU - Kolakowsky-Hayner, Stephanie A.

AU - Malec, James F.

AU - O'Neil-Pirozzi, Therese M.

AU - Sherer, Mark

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N2 - Objective To describe the 10-year patterns of employment for individuals of working age discharged from a Traumatic Brain Injury Model Systems (TBIMS) center between 1989 and 2009. Design Secondary data analysis. Setting Inpatient rehabilitation centers. Participants Patients aged 16 to 55 years (N=3618) who were not retired at injury, received inpatient rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and had at least 3 completed follow-up interviews at postinjury years 1, 2, 5, and 10. Interventions Not applicable. Main Outcomes Measure Employment. Results Patterns of employment were generated using a generalized linear mixed model, where these patterns were transformed into temporal trajectories of probability of employment via random effects modeling. Covariates demonstrating significant relations to growth parameters that govern the trajectory patterns were similar to those noted in previous cross-sectional research and included age, sex, race/ethnicity, education, preinjury substance misuse, preinjury vocational status, and days of posttraumatic amnesia. The calendar year in which the injury occurred also greatly influenced trajectories. An interactive tool was developed to provide visualization of all postemployment trajectories, with many showing decreasing probabilities of employment between 5 and 10 years postinjury. Conclusions These results highlight that postinjury employment after moderate to severe traumatic brain injury (TBI) is a dynamic process, with varied patterns of employment for individuals with specific characteristics. The overall decline in trajectories of probability of employment between 5 and 10 years postinjury suggests that moderate to severe TBI may have unfavorable chronic effects and that employment outcome is highly influenced by national labor market forces. Additional research targeting the underlying drivers of the decline between 5 and 10 years postinjury is recommended, as are interventions that target influencing factors.

AB - Objective To describe the 10-year patterns of employment for individuals of working age discharged from a Traumatic Brain Injury Model Systems (TBIMS) center between 1989 and 2009. Design Secondary data analysis. Setting Inpatient rehabilitation centers. Participants Patients aged 16 to 55 years (N=3618) who were not retired at injury, received inpatient rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and had at least 3 completed follow-up interviews at postinjury years 1, 2, 5, and 10. Interventions Not applicable. Main Outcomes Measure Employment. Results Patterns of employment were generated using a generalized linear mixed model, where these patterns were transformed into temporal trajectories of probability of employment via random effects modeling. Covariates demonstrating significant relations to growth parameters that govern the trajectory patterns were similar to those noted in previous cross-sectional research and included age, sex, race/ethnicity, education, preinjury substance misuse, preinjury vocational status, and days of posttraumatic amnesia. The calendar year in which the injury occurred also greatly influenced trajectories. An interactive tool was developed to provide visualization of all postemployment trajectories, with many showing decreasing probabilities of employment between 5 and 10 years postinjury. Conclusions These results highlight that postinjury employment after moderate to severe traumatic brain injury (TBI) is a dynamic process, with varied patterns of employment for individuals with specific characteristics. The overall decline in trajectories of probability of employment between 5 and 10 years postinjury suggests that moderate to severe TBI may have unfavorable chronic effects and that employment outcome is highly influenced by national labor market forces. Additional research targeting the underlying drivers of the decline between 5 and 10 years postinjury is recommended, as are interventions that target influencing factors.

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