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Indicators of long-term return to work after severe traumatic brain injury: A cohort study - 25/01/19

Doi : 10.1016/j.rehab.2018.08.003 
V. Wang a, E. Fort a, M. Beaudoin-Gobert b, , A. Ndiaye a, C. Fischer c, A. Bergeret a, d, B. Charbotel a, d, J. Luauté b, e
a University Lyon, Claude Bernard Lyon 1 University, Ifsttar, Umrestte, UMR T_9405, 69373 Lyon, France 
b Lyon Neuroscience Research Centre CNRS UMR5292, Inserm U1028, IMPACT Team, University Claude-Bernard Lyon 1, 69000 Lyon, France 
c Functional Neurology and Epileptology Department, Neurology Hospital, Hospices Civils de Lyon, 69394 Lyon, France 
d Occupational Diseases and Occupational Medicine Department, Lyon Sud Hospital Centre, Hospices Civils de Lyon, 69495 Pierre-Bénite, France 
e Physical Medicine and Rehabilitation Department, Henry-Gabrielle Hospital, Hospices Civils de Lyon, 69610 Pierre Bénite, France 

Corresponding author. Lyon Neuroscience Research Centre CNRS UMR5292, Inserm U1028, IMPACT Team,University Claude-Bernard Lyon 1, 69000 Lyon, France.Lyon Neuroscience Research Centre CNRS UMR5292, Inserm U1028, IMPACT Team,University Claude-Bernard Lyon 1Lyon69000France

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Highlights

In this population of severe traumatic brain injury (TBI), more than 60% of the patients returned to work.
This study provides an original set of data in a population of severe TBI patients, including a large range of independent variables.
Results of the multivariate analysis highlight the role of environmental factors in the long-term outcome of severe TBI.

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Abstract

Background

Return to work (RTW) is a major objective in the rehabilitation of individuals with severe traumatic brain injury (TBI). Implications for long-term occupational integration (beyond 5 years) have rarely been studied.

Objective

The objective was to assess long-term RTW and the associated factors after severe TBI.

Material and methods

Retrospective analysis of a cohort of individuals 16 to 60 years old admitted to hospital after severe TBI from 2005 to 2009 and followed prospectively. Medical and occupational data were collected from medical files and by systematic telephone interview to assess outcome at a minimum of 6 years post-trauma. Factors associated with RTW were investigated by multivariable regression analysis, estimating prevalence ratios (PRs) and 95% confidence intervals (CIs). A proportional hazards model was used to study RTW delay, estimating hazard ratios (HRs).

Results

Among the 91 individuals included (mean [SD] age 28.5 [11.3] years; 79% male), 63.7% returned to work after a mean of about 20 months, and 57.1% were still working at the time of the survey. Factors significantly associated with RTW on multivariable analysis were higher educational level (adjusted PR, 1.53; 95% CI, 1.15 to 2.03), absence of motor disability (adjusted PR, 1.82; 1.12 to 2.95) and behavioural disorder (adjusted PR, 1.26; 1.01 to 1.60), as well as disabled worker status (adjusted PR, 1.26; 1.01 to 1.60) (likelihood of the multivariate analysis model 53.1). Delayed RTW was associated with health insurance payments (adjusted HR, 0.40; 95% CI, 0.22 to 0.71), motor disability (adjusted HR, 0.34; 0.15 to 0.76), low educational level (adjusted HR, 2.20; 1.06 to 4.56) and moderate disability on the Extended Glasgow Outcome Scale (adjusted HR, 0.49; 0.27 to 0.91) (likelihood of the multivariate analysis model 335.5).

Conclusion

Individuals with the most severe TBI are able to RTW and remain in work. This study highlights the multiple determinants involved in RTW and the role of socioenvironmental factors.

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Keywords : Return to work, Traumatic brain injury, Occupational outcome, Job stability, Vocational rehabilitation


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Vol 62 - N° 1

P. 28-34 - janvier 2019 Retour au numéro
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