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Return to Pre-Injury Work Following Mild Traumatic Brain Injury

  • Michael Kahan (a1) (a2), Kelly M. Jones (a1), Shivanthi Balalla (a1), Kathryn McPherson (a3) (a4), Elisabeth Stedman (a2) and Valery L. Feigin (a1)...


Objective: Adults are at risk for unemployment following a moderate-severe traumatic brain injury (TBI). Less is known about employment patterns following mild TBI. This study aims to examine patterns of return to pre-injury job in adults following mild TBI over a 12-month post injury period, and to investigate factors associated with return to work. Methods: It is a prospective longitudinal study of 205 adults (aged ≥16 years at injury) identified as part of a larger population-based incidence study in the Waikato, New Zealand. In-person assessments were completed at baseline (within 14 days) and 1-, 6-, and 12-month post-injury. Results: A total of 159 (77.6%) adults returned to their pre-injury job at baseline and 185 (90.2%) returned within 12 months. Of those who did not return to their pre-injury job at baseline (n = 46), younger age at injury (≤30 years, p = .02) and poor overall neurocognitive functioning at 1-month (p = .02) was associated with non-return to pre-injury job at 12 months. Conclusion: In a sample of employed adults, the majority returned to their pre-injury job shortly after injury. Cognitive functioning and younger age at time of injury may be associated with delayed return to work. Interventions to support younger workers may facilitate their return to work.


Corresponding author

Address for correspondence: Michael Kahan, Laura Ferguson Trust, PO Box 12089 Hamilton, New Zealand. E-mail:


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Belanger, H.G., Curtiss, G., Demery, J.A, Lebowitz, B.K., & Vanderploeg, R.D. (2005). Factors moderating neuropsychological outcomes following mild traumatic brain injury: A meta-analysis. Journal of International Neuropsycholgical Society, 11, 215227.
Cancelliere, C., Kristman, V.L., Cassidy, J.D., Hincapié, C.A., Côté, P., Boyle, E., . . . Borg, J. (2014). Systematic review of return to work after mild traumatic brain injury: Results of the international collaboration of mild traumatic brain injury prognosis. Archives Physical Medicine Rehabilitation, 95 (Suppl. 3), S201–S209.
Carroll, L.J., Cassidy, J.D., Holm, L., Kraus, J., & Coronado, V.G., WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. (2004). Methodological issues and research recommendations for mild traumatic brain injury: The WHO collaborating centre task force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 43 (Suppl), 113125.
Colantonio, A., Salehi, S., Kristman, V., Cassidy, J.D., Carter, A., Vartanian, O., . . . Vernich, L. (2016). Return to work after work-related traumatic brain injury. Neurorehabilitation, 39 (3), 389399.
Corrigan, J.D., Bogner, J.A., Mysiw, W.H., Clinchot, D., & Fugate, L. (2001). Life Satisfaction after traumatic brain injury. Journal of Head Trauma Rehabilitation, 16 (6), 543555.
Dikmen, S., Machamer, J., & Temkin, N.R. (2016). Mild traumatic brain injury: Longitudinal study of cognition, functional status, and post-traumatic symptoms. Journal of Neurotrauma, 34 (8),
Dikmen, S., Temkin, N.R., Machamer, J.E., Holubkov, A., Fraser, R.T., & Winn, H.R. (1994). Employment following traumatic head injuries. Archives of Neurology, 51, 177186.
Drake, A.L., Gray, N., Yoder, S., Pramuka, M., & Llewellyn, M. (2000). Factors predicting return to work following mild traumatic brain injury: A discriminant analysis. The Journal of Head Trauma Rehabilitation, 15 (5), 11031112.
Feigin, V.F., Theadom, A., Barker-Collo, S.L., Starkey, N., McPhersonKahan, M. Kahan, M., . . . Ameratunga, S. (2013). Incidence of traumatic brain injury in New Zealand: A population-based study. Lancet Neurology, 12, 5364.
Friedland, J.F., & Dawson, D.F. (2001). Function after motor vehicle accidents prospective study of mild head injury and postraumatic stress. Journal of Nervous and Mental Disease, 189, 426434.
Greenspan, A.I., Wrigley, J.M., Kresnow, M., Branche-Dorsey, C.M., & Fine, P.R. (1996). Factors influencing failure to return to work due to traumatic brain injury. Brain Injury, 10 (3), 207218.
Greenwald, B., Burnett, D., & Miller, M. (2003). Congenital and acquired brain injury: Epidemiology and pathophysiology. Archives Physical Medicine Rehabilitation, 84 (Suppl. 1), S3–S7.
Gualtieri, C.T. (2008). A computerized test battery sensitive to mild and severe brain injury. Medscape Journal of Medicine, 10 (4), 90.
Gualtieri, C.T., & Johnson, L.G. (2006). Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Archives of Clinical Neuropsychology, 21, 623643.
Hyder, A., Winderlick, C., Puvanachandra, P., Gururaj, G., & Kobusingye, O. (2007). The impact of traumatic brain injuries: A global perspective. NeuroRehabilitation, 22, 341353.
Ip, R.Y., Dornan, J., & Schentag, C. (1995). Traumatic brain injury: Factors predicting return to work or school. Brain Injury, 9, 517532.
Iverson, G., Lange, R., Gaetz, M., & Zasler, N. (2013a). Mild traumatic brain injury. In Zasler, N., Katz, D.R., Zafonte, R., Arciniegas, D.M., Bullock, M., & Kreutzer, J. (Eds.), Brain injury medicine principles and practices (2nd ed., pp. 434469). New York: Demos Medical Publishing.
Iverson, G.l., Silverberg, N.D., Lange, R.T., & Zasler, N.D. (2013b). Conceptualising outcome from mild traumatic brain injury. In Zasler, N., Katz, D., Zafonte, R., Arciniegas, D., Bullock, M., & Kreutzer, J. (Eds.), Brain injury medicine principles and practices (2nd ed., pp. 470497). New York: Demos Medical Publishing.
Kreutzer, J.S., Marwitz, J.H., Walker, W., Sander, A., Sherer, M., Bogner, J., Fraser, R., & Bushnik, T. (2003). Moderating factors in return to work and job stability after traumatic brain injury. Journal of Head Trauma and Rehabilitation, 18 (2), 128138.
Maas, A.I., Stocchett, N., & Bullock, R. (2008). Moderate and severe traumatic brain injury in adults. Lancet Neurology, 7 (8), 728741.
Mathias, J.L., Beall, J.A., & Bigler, E.D. (2004). Neuropsychological and information processing deficits following mild traumatic brain injury. Journal of the International Neuropsychological Society, 10 (2), 286297.
McCrimmon, S., & Oddy, M. (2006). Return to work following moderate-to-severe traumatic brain injury. Brain Injury, 20 (10), 10371046.
Ownsworth, T., & McKenna, K. (2004). Investigation of factors related to employment outcome following traumatic brain injury: A critical review and conceptual model. Disability and Rehabilitation, 26 (13), 765784.
Ponsford, J., Willmott, C., Rothwell, A., Kelly, A.M., Nelms, R., & Ng, K.T. (2004). Use of the Westmead PTA scale to monitor recovery of memory after mild head injury. Brain Injury 18, 603614.
Rao, V., & Lyketsos, C. (2000). Neuropsychiatric sequelae of traumatic brain Injury. Psychosomatics, 41, 95103.
Sherer, M., Novack, T.A., Sander, A.M., Struchen, M.A., Alderson, A., & Thompson, R.N. (2002). Neuropsychological assessment and employment outcome after traumatic brain injury: A review. The Clinical Neuropsychologist, 16 (2), 157178.
Shores, E.A., Marosszeky, J.E., Sandanam, J., & Batchelor, J. (1986). Preliminary validation of a clinical scale for measuring the duration of post-traumatic amnesia. Medical Journal of Australia, 144, 569572.
Steadman-Pare, D., Colantonio, A., Ratcliff, G., Chase, S., & Vernich, L. (2001). Factors associated with perceived quality of life many years after traumatic brain injury. Journal of Head Trauma Rehabilitation, 16 (4), 330342.
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2, 8184.
Theadom, A., Barker-Collo, S., Feigin, V.L., Starkey, N.J., Parag, V., Jones, K., Dowell, T., & McPherson, K. (2012). The spectrum captured: A methodological approach to studying incidence and outcomes of traumatic brain injury on a population level. Neuroepidemiology, 38, 829.
Theadom, A., Parag, V., Dowell, T., McPherson, K., Starkey, N., Barker-Collo, S., . . . Feigin, V.L. (2016). Persistent problems 1 year after mild traumatic brain injury: A longitudinal population study in New Zealand. British Journal of General Practice, 66, 1623.
Trewin, D., & Pink, B. (2006). Australian and New Zealand Standard classification of occupations. Canberra, Australia: Australian Bureau of Statistics.
Vikane, E., Hellstrøm, T., Røe, C., Bautz-Holter, E., Aßmus, J., & Sture Skouen, J. (2016). Predictors for return to work in subjects with mild traumatic brain injury. Behavioural Neurology, Article ID 8026414, 10 pages.
Wehman, P., Targett, P., West, M., & Kregel, J. (2005). Production work and employment for persons with traumatic brain injury; What have we learned? Journal of Head Trauma and Rehabilitation, 20 (2), 115127.
World Health Organization. (1992). International classification of diseases and related health problems. Tenth Revision. Vol 1: Tabular List. Geneva.



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