Return to work after major trauma

Abstract

Objective : To quantify the prevalence of return to work after major trauma, and to investigate the determinants of postinjury work status.

Design : Prospective cohort study.

Setting : University Medical Centre Utrecht, a level 1 trauma centre in the Netherlands.

Method : All severely injured (ISS > 16) adult (age = 16+) trauma survivors admitted from January 1999 to December 2000 who were full-time employed at the time of the injury were selected for follow-up (n = 214). Response rate was 93%. Outcome was assessed at a mean of 15 months (SD = 1.5) after injury. Multivariate logistic regression analyses identified determinants at hospital discharge and at follow-up.

Results : Following injury 58.4% of the patients (n = 125) were able to return to full-time employment, 21.5% had a part-time job, and 20.1% did not return to work. Univariate analysis yielded the following significant determinants of postinjury work status: age, comorbidity, injury severity score, brain injury, spinal cord injury, length of stay in an intensive care unit, hospital stay, discharge destination, percentage of permanent impairment (according to the fourth American Medical Association guide (AMA)), limitations in activities of daily living and cognitive complaints. Logistic regression analyses (23% explained variance) identified spinal cord injury, duration of hospital stay, discharge destination and age as determinants of return to work at hospital discharge. At follow-up, determinants of return to work included AMA, activities of daily living, cognitive complaints and being discharged home (51% explained variance).

Conclusions : Around 60% of the patients returned to their pre-injury work status after major trauma. The return to work rate was only partly explained by disability at follow-up. Independent determinants of return to work differ with the time of assessment.

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References

Oppermann JD Interpreting the meaning individuals ascribe to returning to work after traumatic brain injury: a qualitative approach . Brain Inj 2004; 18: 941—55 .

Andries F. , Wevers CW , Wintzen AR et al. Vocational perspectives and neuromuscular disorders . Int J Rehabil Res 1997; 20: 255—73 .

Morris JA, Jr. , Sanchez AA , Bass SM , MacKenzie EJ Trauma patients return to productivity . J Trauma 1991; 31: 827—33 .

Krause JS , Kewman D. , DeVivo MJ et al. Employment after spinal cord injury: an analysis of cases from the Model Spinal Cord Injury Systems . Arch Phys Med Rehabil 1999; 80: 1492—500 .

Yasuda S. , Wehman P. , Targett P. , Cifu D. , West M. Return to work for persons with traumatic brain injury . Am J Phys Med Rehabil 2001; 80: 852—64 .

MacKenzie EJ , Morris JA, Jr. , Jurkovich GJ et al. Return to work following injury: the role of economic, social, and job-related factors . Am J Public Health 1998; 88: 1630—37 .

MacKenzie EJ , Shapiro S. , Smith RT , Siegel JH , Moody M. , Pitt A. Factors influencing return to work following hospitalization for traumatic injury . Am J Public Health 1987; 77: 329—34 .

van der Sluis CK , Eisma WH , Groothoff JW , ten Duis HJ Long-term physical, psychological and social consequences of severe injuries . Injury 1998 ; 29: 281—85 .

Redmill DA , McIlwee A. , McNicholl B. , Templeton C. Long term outcomes 12 years after major trauma . Injury 2006; 37: 243—46 .

10.

Vles WJ , Steyerberg EW , Essink-Bot ML , van Beeck EF , Meeuwis JD , Leenen LP Prevalence and determinants of disabilities and return to work after major trauma . J Trauma 2005; 58: 126—35 .

11.

Michaels AJ , Michaels CE , Smith JS , Moon CH , Peterson C. , Long WB Outcome from injury: general health, work status, and satisfaction 12 months after trauma . J Trauma 2000; 48: 841—48 .

12.

Anke AG , Stanghelle JK , Finset A. , Roaldsen KS , Pillgram-Larsen J. , Fugl-Meyer AR Long-term prevalence of impairments and disabilities after multiple trauma . J Trauma 1997; 42: 54—61 .

13.

Kivioja AH , Myllynen PJ , Rokkanen PU Is the treatment of the most severe multiply injured patients worth the effort? A follow-up examination 5 to 20 years after severe multiple injury . J Trauma 1990; 30: 480—83 .

14.

Grotz M. , Hohensee A. , Remmers D. , Wagner TO , Regel G. Rehabilitation results of patients with multiple injuries and multiple organ failure and long-term intensive care . J Trauma 1997; 42: 919—26 .

15.

Meerding WJ , IJzelenberg W, Koopmanschap MA, Severens JL, Burdorf A. Health problems lead to considerable productivity loss at work among workers with high physical load jobs . J Clin Epidemiol 2005; 58: 517—23 .

16.

Tate DG Workers' disability and return to work . Am J Phys Med Rehabil 1992; 71: 92—96 .

17.

Bergeron E. , Rossignol M. , Osler T. , Clas D. , Lavoie A. Improving the TRISS methodology by restructuring age categories and adding comorbidities . J Trauma 2004; 56: 760—67 .

18.

Pollak AN , McCarthy ML , Bess RS , Agel J. , Swiontkowski MF Outcomes after treatment of high-energy tibial plafond fractures . J Bone Joint Surg Am 2003; 85-A: 1893—900 .

19.

McCarthy ML , MacKenzie EJ , Edwin D. , Bosse MJ , Castillo RC , Starr A. Psychological distress associated with severe lower-limb injury . J Bone Joint Surg Am 2003 ; 85-A: 1689—97 .

20.

Baker SP , O'Neill B. , Haddon W., Jr. , Long WB The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care . J Trauma 1974; 14: 187—96 .

21.

van Roijen L. , Essink-Bot ML , Koopmanschap MA , Bonsel G. , Rutten FF Labor and health status in economic evaluation of health care. The Health and Labor Questionnaire . Int J Technol Assess Health Care 1996; 12: 405—15 .

22.

American Medical Association. Guides to the evaluation of permanent impairment. AMA , 1996.

23.

Kempen GI , Miedema I. , Ormel J. , Molenaar W. The assessment of disability with the Groningen Activity Restriction Scale. Conceptual framework and psychometric properties . Soc Sci Med 1996; 43: 1601—10 .

24.

Suurmeijer TP , Doeglas DM , Moum T. et al. The Groningen Activity Restriction Scale for measuring disability: its utility in international comparisons . Am J Public Health 1994; 84: 1270—73 .

25.

McLean A., Jr. , Dikmen SS , Temkin NR Psychosocial recovery after head injury . Arch Phys Med Rehabil 1993; 74: 1041—46 .

26.

Eurostat. Employment rates in Europe. Eurostat , 2000. Accessed from http://epp.eurostat.ec.europa.eu

27.

Holbrook TL , Anderson JP , Sieber WJ , Browner D. , Hoyt DB Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project . J Trauma 1999; 46: 765—71 .

28.

Krause JS Years to employment after spinal cord injury . Arch Phys Med Rehabil 2003; 84: 1282—89 .

29.

Wehman P. , Targett P. , West M. , Kregel J. Productive work and employment for persons with traumatic brain injury: what have we learned after 20 years ? J Head Trauma Rehabil 2005; 20: 115—27 .

30.

McCarthy ML , McAndrew MP , MacKenzie EJ et al. Correlation between the measures of impairment, according to the modified system of the American Medical Association, and function . J Bone Joint Surg Am 1998; 80: 1034—42 .

31.

Holtslag HR , Buskens E. , Rommers GM , Prevo Ajh , van der Werken C. Long-term outcome after lower extremity injuries in severely injured patients . Eur J Trauma 2006; 32: 365—73 .

32.

Brooks N. , McKinlay W. , Symington C. , Beattie A. , Campsie L. Return to work within the first seven years of severe head injury . Brain Inj 1987; 1: 5—19 .

33.

Doeglas D. , Suurmeijer T. , Krol B. , Sanderman R. , van Leeuwen M. , van Rijswijk M. Work disability in early rheumatoid arthritis . Ann Rheum Dis 1995; 54: 455—60 .

34.

van der Naalt J. , van Zomeren AH , Sluiter WJ , Minderhoud JM One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work . J Neurol Neurosurg Psychiatry 1999; 66: 207—13 .

35.

Schonherr MC , Groothoff JW , Mulder GA , Eisma WH Vocational perspectives after spinal cord injury . Clin Rehabil 2005 ; 19: 200—208 .

36.

Seekamp A. , Regel G. , Tscherne H. Rehabilitation and reintegration of multiply injured patients: an outcome study with special reference to multiple lower limb fractures . Injury 1996; 27: 133—38 .

37.

Tomassen PC , Post MW , van Asbeck FW. Return to work after spinal cord injury . Spinal Cord 2000; 38: 51—55 .

38.

Parziale JR Disability evaluation of extremity fractures . Phys Med Rehabil Clin N Am 2001; 12: 647—57 .

39.

Lysgaard AP , Fonager K. , Nielsen CV Effect of financial compensation on vocational rehabilitation . J Rehabil Med 2005; 37: 388—91 .

40.

British Society of Rehabilitation Medicine. Vocational rehabilitation. British Society of Rehabilitation Medicine , 2006. Accessed from www.bsrm.co.uk

41.

Prasad M. , Wahlqvist P. , Shikiar R. , Shih YC A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective . Pharmacoeconomics 2004; 22: 225—44 .