Predictors and indicators of return to work following traumatic brain injury in South Africa : findings from a preliminary experimental database

Traumatic brain injury (TBI) affects a substantial portion of the South African population every year. However, there is little empirical evidence available regarding eventual outcome after injury in South Africa. In particular, there is little information regarding the ability of head injured individuals to return to their places of employment following injury, or what factors are most closely related to a successful return to work. This study explored the return to work of a specific group of individuals with TBI, in relation to a number of domains, including : rate and nature of return to work, pre-morbid and accident variables that appeared to be related to return to work, and the relationship between return to work and other aspects of outcome, specifically communicative, cognitive, physical and emotional outcome. The study took the form of a detailed record review of a group of subjects seeking medico-legal compensation, using a specially designed data recording form and computerised database. Results indicated a poor rate of return to work in this sample (32%), with significant changes in work status post-injury. The strongest pre-morbid predictors of outcome were found to be first language and pre-injury educational level, with African language speakers and those with an educational level of matriculation or less being at a significant disadvantage. Numerous communicative and cognitive difficulties were significantly related to a failure to RTW, including difficulties in : motor speech, comprehension, expression, attention, speed of processing, incidental visual memory, cognitive flexibility and insight. These results indicate the multi-factorial nature of outcome following head injury in the sample.