Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, United States of America.
Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2018 Jun 1;13(6):e0198128. doi: 10.1371/journal.pone.0198128. eCollection 2018.
Individuals who are injured in the workplace typically have a greater risk of delayed return to work (RTW) and other poor health outcomes compared to those not injured at work. It is not known whether these differences hold true for mild traumatic brain injuries (MTBI). The present study examined differences associated with workplace and non-workplace MTBI upon intake to a specialty MTBI clinic, their outcomes, and risk factors that influence RTW. Slow-to-recover participants were recruited from consecutive referrals to four outpatient MTBI clinics from March 2015 to February 2017. Two clinics treat Worker's Compensation claimants and two clinics serve patients with non-work related injuries in the publically funded health care system. Of 273 eligible patients, 102 completed an initial study assessment (M age = 41.2 years, SD age = 11.7; 54% women) at an average of 2-3 months post injury. Participants were interviewed about their MTBI and completed a battery of standardized questionnaires and performance validity testing. Outcomes, including RTW, were assessed via telephone follow-up 4-5 months later. Workplace injuries comprised 45.1% of the sample. The workplace MTBI group had a greater proportion of men and lower education levels compared to the non-workplace MTBI group. The two groups had a comparable post-concussion symptom burden and performance validity test failure rate. Workplace MTBI was associated with greater post-traumatic stress symptoms. Fifteen patients (14.7%) were lost to follow-up. There were no workplace/non-workplace MTBI differences in RTW outcome at 6-7 months post injury. Of the entire sample, 42.5% of patients had full RTW, 18.4% had partial RTW, and 39.1% had no RTW. Greater post-concussion symptom burden was most predictive of no RTW at follow-up. There was no evidence that the workplace and non-workplace MTBI groups had different risk factors associated with prolonged work absence. Despite systemic differences in compensation and health care access, the workplace and non-workplace MTBI groups were similar at clinic intake and indistinguishable at follow-up, 6-7 months post injury.
与未在工作中受伤的人相比，在工作场所受伤的人通常面临更大的延迟重返工作岗位 (RTW) 和其他健康状况不佳的风险。目前尚不清楚这些差异是否适用于轻度创伤性脑损伤 (MTBI)。本研究考察了在专门的 MTBI 诊所就诊时与工作场所和非工作场所 MTBI 相关的差异、他们的结局以及影响 RTW 的风险因素。从 2015 年 3 月至 2017 年 2 月，从四个门诊 MTBI 诊所连续转介的患者中招募了恢复缓慢的患者。两个诊所治疗工人赔偿索赔人，两个诊所为公共资助的医疗保健系统中与工作无关的受伤患者提供服务。在 273 名符合条件的患者中，有 102 名在受伤后 2-3 个月平均完成了初步研究评估 (M 年龄= 41.2 岁，SD 年龄= 11.7；54%为女性)。对参与者进行了关于 MTBI 的访谈，并完成了一系列标准化问卷和绩效有效性测试。4-5 个月后通过电话随访评估了 RTW 等结果。工作场所受伤占样本的 45.1%。与非工作场所 MTBI 组相比，工作场所 MTBI 组中男性比例更高，教育程度更低。两组患者的脑震荡后症状负担和绩效有效性测试失败率相当。工作场所 MTBI 与更大的创伤后应激症状有关。有 15 名患者 (14.7%)失访。在受伤后 6-7 个月时，工作场所/非工作场所 MTBI 在 RTW 结果上没有差异。在整个样本中，42.5%的患者完全恢复工作，18.4%的患者部分恢复工作，39.1%的患者没有恢复工作。脑震荡后症状负担越大，随访时无 RTW 的可能性越大。没有证据表明工作场所和非工作场所 MTBI 组在与延长工作缺勤相关的风险因素上存在差异。尽管在补偿和获得医疗保健方面存在系统差异，但工作场所和非工作场所 MTBI 组在诊所就诊时相似，在受伤后 6-7 个月时也没有区别。
