Employment Stability for People with Traumatic Brain Injury Predicted by Vocational Rehabilitation, Rurality, and Transportation Independence
Model System:
TBIReference Type:
Journal articleAccession No.:
Journal:
Archives of Physical Medicine and RehabilitationYear, Volume, Issue, Page(s):
, In Press, In Press, Not yet availablePublication Website:
https://www.sciencedirect.com/science/article/abs/pii/S0003999326007033Abstract:
Objective
To characterize the effects of vocational rehabilitation (VR), rural residence, and transportation independence on patterns of employment in the first 10 years after traumatic brain injury (TBI).
Design
Observational study using longitudinal data from TBI Model Systems National Database (TBIMS-NDB) collected at the time of TBI, and 1, 2, 5, and 10 years postinjury.
Setting
Rehabilitation centers involved in the TBIMS-NDB.
Participants
Adults with a TBI who required acute inpatient rehabilitation, enrolled from 1999 to 2011 with ≥3 time points of employment data and who were surveyed on use of VR in the first 10 years postinjury (N=5019).
Interventions
Not applicable, observational use of secondary data.
Main Outcome Measures
Employment patterns 1-10 years postinjury: stable employment (19.1%), inconsistent employment (33.4%), and consistent unemployment (47.5%).
Results
VR was most utilized by people with inconsistent employment (28.7%), compared with those stably employed (19.5%) and consistently unemployed (14.7%), F(2, 5018)=60.77. Multinomial logistic regressions indicate VR increases the odds of some workforce reengagement (OR, 1.760; CI, 1.493-2.076), but not consistent employment, compared with consistent unemployment. Rurality reduces the odds of inconsistent employment compared with consistent unemployment (odds ratio [OR], 0.792; CI, 0.687-0.913). Transportation independence increases chances of employment (stable OR, 27.383; CI, 21.924-34.200; P<.001; inconsistent OR, 6.569; CI, 5.550-7.776; P<.001).
Conclusions
VR services are important to assist individuals in returning to work after TBI, particularly those who have difficulties retaining consistent employment. Results show rural residents experience higher rates of consistent unemployment, and independent access to transportation is associated with the best employment outcomes. These results suggest the need for long-term VR services to assist individuals in returning to work, and especially those individuals who have difficulties retaining employment. Adopting novel VR approaches that align with the designation of TBI as a chronic health condition can improve the accessibility and effectiveness of VR, lead to strategies that improve employment outcomes in rural communities, and establish sustainable transportation resources that promote long-term employment success.