de Koning Myrthe E, Scheenen Myrthe E, van der Horn Harm J, Timmerman Marieke E, Hageman Gerard, Roks Gerwin, Spikman Jacoba M, van der Naalt Joukje
From the Department of Neurology (M.E.d.K., H.J.v.d.H., J.v.d.N.), Department of Neuropsychology (M.E.S., J.M.S.), and Department of Psychometrics and Statistics (M.E.T.), University of Groningen, University Medical Center Groningen; Department of Neurology (G.H.), Medical Spectrum Twente, Enschede; and Department of Neurology (G.R.), Elisabeth Tweesteden Hospital Tilburg, the Netherlands.
Neurology. 2017 Oct 31;89(18):1908-1914. doi: 10.1212/WNL.0000000000004604. Epub 2017 Oct 6.
To study return to work (RTW) after mild traumatic brain injury (mTBI) at several intervals after injury and to predict RTW on the basis of occupational factors in addition to demographic, personality, and injury-related factors at 6 and 12 months after injury.
This was a prospective cohort study (UPFRONT study, n = 1,151) of patients with mTBI admitted to the emergency department. Patients received questionnaires at 2 weeks and 3, 6, and 12 months after injury. RTW was divided into 3 levels: complete (cRTW), partial (pRTW), and no RTW.
Rates of cRTW increased from 34% at 2 weeks to 77% at 12 months after injury, pRTW varied from 8% to 16% throughout the year. Logistic regression (complete vs incomplete RTW) demonstrated that apart from previously identified predictors such as demographics (e.g., age and education) and injury characteristics (e.g., cause and severity of injury) and indicators of psychological distress, occupational factors were of influence on work resumption after 6 months (area under the curve [AUC] = 0.82), At 12 months, however, the model was based solely on the presence of extracranial injuries and indicators of maladaptation after injury (AUC = 0.81).
RTW after mTBI is a gradual process, with varying levels of RTW throughout the first year after injury. Different predictors were relevant for short- vs long-term work resumption, with occupational factors influencing short-term RTW. However, for both short- and long-term RTW, posttraumatic complaints and signs of psychological distress early after injury were relevant predictors, allowing early identification of patients at risk for problematic work resumption.
研究轻度创伤性脑损伤（mTBI）患者伤后不同时间间隔的重返工作情况，并在伤后6个月和12个月时，基于人口统计学、人格和损伤相关因素之外的职业因素预测重返工作情况。
这是一项对急诊科收治的mTBI患者进行的前瞻性队列研究（UPFRONT研究，n = 1151）。患者在伤后2周、3个月、6个月和12个月时接受问卷调查。重返工作分为3个水平：完全重返（cRTW）、部分重返（pRTW）和未重返工作。
伤后2周时cRTW率为34%，至伤后12个月时增至77%，pRTW率全年在8%至16%之间波动。逻辑回归（完全重返工作与未完全重返工作）表明，除了先前确定的预测因素，如人口统计学因素（如年龄和教育程度）、损伤特征（如损伤原因和严重程度）以及心理困扰指标外，职业因素在伤后6个月对恢复工作有影响（曲线下面积[AUC] = 0.82）。然而，在12个月时，该模型仅基于颅外损伤的存在以及伤后适应不良指标（AUC = 0.81）。
mTBI后的重返工作是一个渐进的过程，伤后第一年的重返工作水平各不相同。短期和长期恢复工作的相关预测因素不同，职业因素影响短期重返工作。然而对于短期和长期重返工作而言，伤后早期的创伤后症状和心理困扰迹象都是相关的预测因素，有助于早期识别有恢复工作问题风险的患者。
