University Lyon, Claude Bernard Lyon 1 University, Ifsttar, Umrestte, UMR T_9405, 69373 Lyon, France.
Lyon Neuroscience Research Centre CNRS UMR5292, Inserm U1028, IMPACT Team, University Claude-Bernard Lyon 1, 69000 Lyon, France.
Ann Phys Rehabil Med. 2019 Jan;62(1):28-34. doi: 10.1016/j.rehab.2018.08.003. Epub 2018 Sep 5.
Return to work (RTW) is a major objective in the rehabilitation of individuals with severe traumatic brain injury (TBI). Implications for long-term occupational integration (beyond 5 years) have rarely been studied.
The objective was to assess long-term RTW and the associated factors after severe TBI.
Retrospective analysis of a cohort of individuals 16 to 60 years old admitted to hospital after severe TBI from 2005 to 2009 and followed prospectively. Medical and occupational data were collected from medical files and by systematic telephone interview to assess outcome at a minimum of 6 years post-trauma. Factors associated with RTW were investigated by multivariable regression analysis, estimating prevalence ratios (PRs) and 95% confidence intervals (CIs). A proportional hazards model was used to study RTW delay, estimating hazard ratios (HRs).
Among the 91 individuals included (mean [SD] age 28.5 [11.3] years; 79% male), 63.7% returned to work after a mean of about 20 months, and 57.1% were still working at the time of the survey. Factors significantly associated with RTW on multivariable analysis were higher educational level (adjusted PR, 1.53; 95% CI, 1.15 to 2.03), absence of motor disability (adjusted PR, 1.82; 1.12 to 2.95) and behavioural disorder (adjusted PR, 1.26; 1.01 to 1.60), as well as disabled worker status (adjusted PR, 1.26; 1.01 to 1.60) (likelihood of the multivariate analysis model 53.1). Delayed RTW was associated with health insurance payments (adjusted HR, 0.40; 95% CI, 0.22 to 0.71), motor disability (adjusted HR, 0.34; 0.15 to 0.76), low educational level (adjusted HR, 2.20; 1.06 to 4.56) and moderate disability on the Extended Glasgow Outcome Scale (adjusted HR, 0.49; 0.27 to 0.91) (likelihood of the multivariate analysis model 335.5).
Individuals with the most severe TBI are able to RTW and remain in work. This study highlights the multiple determinants involved in RTW and the role of socioenvironmental factors.
重返工作岗位（RTW）是严重创伤性脑损伤（TBI）患者康复的主要目标。很少有研究涉及长期职业融入（5 年以上）的影响。
评估严重 TBI 后的长期 RTW 及其相关因素。
对 2005 年至 2009 年因严重 TBI 住院并接受前瞻性随访的 16 至 60 岁患者队列进行回顾性分析。从病历和系统电话访谈中收集医疗和职业数据，以评估创伤后至少 6 年的结果。通过多变量回归分析研究与 RTW 相关的因素，估计患病率比（PR）和 95%置信区间（CI）。使用比例风险模型研究 RTW 延迟，估计风险比（HR）。
在 91 名纳入的患者中（平均[SD]年龄 28.5[11.3]岁；79%为男性），63.7%在平均约 20 个月后重返工作岗位，57.1%在调查时仍在工作。多变量分析中与 RTW 显著相关的因素包括较高的教育水平（调整后 PR，1.53；95%CI，1.15 至 2.03）、无运动障碍（调整后 PR，1.82；95%CI，1.12 至 2.95）和行为障碍（调整后 PR，1.26；95%CI，1.01 至 1.60）以及残疾工人身份（调整后 PR，1.26；95%CI，1.01 至 1.60）（多变量分析模型的可能性为 53.1）。RTW 延迟与医疗保险支付（调整后 HR，0.40；95%CI，0.22 至 0.71）、运动障碍（调整后 HR，0.34；95%CI，0.15 至 0.76）、低教育水平（调整后 HR，2.20；95%CI，1.06 至 4.56）和扩展格拉斯哥结局量表上的中度残疾（调整后 HR，0.49；95%CI，0.27 至 0.91）相关（多变量分析模型的可能性为 335.5）。
最严重的 TBI 患者能够重返工作岗位并继续工作。本研究强调了 RTW 涉及的多种决定因素以及社会环境因素的作用。
