Source:Archives of Physical Medicine and Rehabilitation
Author(s): Noah D. Silverberg, William J. Panenka, Grant L. Iverson
ObjectiveTo examine the completeness of return to work (RTW) and the degree of productivity loss in individuals who do achieve a complete RTW after mild traumatic brain injury (MTBI).DesignMulti-site prospective cohort.SettingOutpatient concussion clinics.ParticipantsSeventy-nine patients (M=41.5 years old, 55.7% female) who sustained an MTBI and were employed at the time of the injury. Participants were enrolled at their first clinic visit and assessed by telephone 6-8 months post-injury.InterventionNone.MeasuresStructured interview of RTW status, British Columbia Postconcussion Symptom Inventory (BC-PSI), Lam Employment Absence and Productivity Scale (LEAPS), MINI Neuropsychiatric Interview, brief pain questionnaire. Participants who endorsed symptoms from three or more categories with at least moderate severity on the BC-PSI were considered to meet International Classification of Diseases-10 criteria for postconcussional syndrome. RTW status was classified as complete if participants returned to their pre-injury job with the same hours and responsibilities or to a new job that was at least as demanding.ResultsOf the 46 (58.2%) patients who achieved a RTW, 33 (71.7%) had a complete RTW. Participants with complete RTW had high rates of postconcussional syndrome (44.5%) and comorbid depression (18.2%), anxiety disorder (24.2%), and bodily pain (30.3%). They also reported productivity loss on the LEAPS, such as "getting less work done" (60.6%) and "making more mistakes" (42.4%). In a regression model, productivity loss was predicted by the presence of postconcussional syndrome and a comorbid psychiatric condition, but not bodily pain.ConclusionEven in patients who RTW after MTBI, detailed assessment revealed underemployment and productivity loss associated with residual symptoms and psychiatric complications.
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