Work Limitations 4 Years After Mild Traumatic Brain Injury: A Cohort Study

Abstract Objective To explore employment status, work limitations, and productivity loss after mild traumatic brain injury (TBI). Design Inception cohort study over 4 years. Setting General community. Participants Adults (N=245; >16y at the time of injury) who experienced a mild TBI and who were employed prior to their injury. Interventions Not applicable. Main Outcome Measures Details of the injury, demographic information, and preinjury employment status were collected from medical records and self-report. Symptoms and mood were assessed 1 month postinjury using the Rivermead Post-Concussion Symptom Questionnaire and the Hospital Anxiety and Depression Scale. Postinjury employment status and work productivity were assessed 4 years postinjury using the Work Limitations Questionnaire. Results Four years after mild TBI, 17.3% of participants had exited the workforce (other than for reasons of retirement or to study) or had reduced their working hours compared with preinjury. A further 15.5% reported experiencing limitations at work because of their injury. Average work productivity loss was 3.6%. The symptom of taking longer to think 1 month postinjury significantly predicted work productivity loss 4 years later (β=.47, t =3.79, P ≤.001). Conclusions Although changes in employment status and difficulties at work are likely over time, the results indicate increased unemployment rates, work limitations, and productivity loss in the longer term after a mild TBI. Identification of cognitive difficulties 1 month after TBI in working aged adults and subsequent interventions to address these difficulties are required to facilitate work productivity.