Libeson Lauren, Ross Pamela, Downing Marina, Ponsford Jennie
Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia.
Disabil Rehabil. 2022 Oct;44(21):6325-6332. doi: 10.1080/09638288.2021.1965229. Epub 2021 Sep 9.
To quantify employment stability of individuals with traumatic brain injury (TBI) who received comprehensive vocational rehabilitation (VR) using different measures to identify difficulties experienced and factors associated with employment stability.
72 individuals with predominantly moderate-severe TBI were interviewed. Neuropsychological assessment scores were collected. Three employment stability measures were used: number of post-injury employers, duration with employer and average weekly hours. Descriptive and predictive analyses were performed.
90.2% remained employed at time of interview (Mean = 4.83 years post-injury). However, participants worked significantly fewer hours, 63.9% had changed roles or employers at least once and only 51% achieved their pre-injury level of responsibility. 61% reported a high level of employer support. Self-reported difficulties included physical sequelae, memory problems and fatigue. Post-injury testing found impaired memory (34.4%) and processing speed (49.2%). After accounting for time since injury, demographic and employment variables (older age, male gender, higher pre-injury skill-level, higher level of employer support), higher level of injury-related difficulties and lower level of cognitive function significantly predicted employment stability.
Injury-related difficulties impact employment long-term, necessitating ongoing work modifications. Individualised VR is important, not only to facilitate return to work but to support long-term employment stability after TBI.Implications for rehabilitationBeing male was associated with working more hours, and having faster processing speed, lower levels of fatigue and ongoing physical sequelae were associated with a longer duration with the same employer.Initial return to work is often the first step on a long journey as injury-related difficulties can continue to impact work in the-long term and require lasting modifications to duties and working hours.VR should include ongoing follow-up to facilitate work modifications and support both the employer and the employee in adjusting to these.VR should be individualised to support the impact of the unique cognitive and physical limitations experienced by each individual with TBI, based on the needs and employment demands of each workplace.
量化接受综合职业康复（VR）的创伤性脑损伤（TBI）患者的就业稳定性，采用不同方法识别他们所经历的困难以及与就业稳定性相关的因素。
对72名主要为中度至重度TBI的患者进行了访谈。收集了神经心理学评估分数。使用了三种就业稳定性指标：受伤后雇主数量、在雇主处工作的时长以及平均每周工作小时数。进行了描述性和预测性分析。
90.2%的患者在访谈时仍有工作（受伤后平均4.83年）。然而，参与者的工作时长显著减少，63.9%的人至少更换过一次工作角色或雇主，只有51%的人达到了受伤前的责任水平。61%的人报告得到了雇主的高度支持。自我报告的困难包括身体后遗症、记忆问题和疲劳。受伤后的测试发现存在记忆受损（34.4%）和处理速度受损（49.2%）。在考虑受伤时间、人口统计学和就业变量（年龄较大、男性、受伤前技能水平较高、雇主支持程度较高）后，与损伤相关的困难程度较高和认知功能水平较低显著预测了就业稳定性。
与损伤相关的困难对长期就业有影响，需要持续进行工作调整。个性化的VR很重要，不仅有助于重返工作岗位，还能支持TBI后长期的就业稳定性。康复的意义男性与工作时长较多相关，处理速度较快、疲劳程度较低以及存在持续的身体后遗症与在同一雇主处工作的时间较长相关。最初重返工作岗位往往只是漫长旅程的第一步，因为与损伤相关的困难可能会长期持续影响工作，需要对职责和工作时长进行持久调整。VR应包括持续的随访，以促进工作调整，并支持雇主和员工适应这些调整。VR应个性化，以支持每个TBI患者所经历的独特认知和身体限制的影响，这基于每个工作场所的需求和就业要求。
