Journal:Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):15, 96, 12, 2128-2136
Study examined patterns of employment over a 10-year period for working-age individuals discharged from a Traumatic Brain Injury Model Systems (TBIMS) center. Data were analyzed for 3,618 patients with moderate-to-severe traumatic brain injury (TBI), aged 16 to 55 years, who were not retired at injury. The subjects received inpatient rehabilitation at a TBIMS center, were discharged alive between 1989 and 2009, and completed at least 3 follow-up interviews at years 1, 2, 5, and 10 after injury. 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 after injury. These results indicate that post-injury employment after moderate-to-severe 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 after injury suggests that moderate-to-severe TBI may have unfavorable chronic effects and that employment outcome is highly influenced by national labor market forces.