Work Limitations 4 Years After Mild Traumatic Brain Injury: A Cohort Study

Objective: To explore employment status, work limitations, and productivity loss after mild traumatic brain injury (TBI).

Design: Inception cohort study over 4 years.

Setting: General community.

Participants: Adults (N=245; >16y at the time of injury) who experienced a mild TBI and who were employed prior to their injury.

Interventions: Not applicable.

Main outcome measures: Details of the injury, demographic information, and preinjury employment status were collected from medical records and self-report. Symptoms and mood were assessed 1 month postinjury using the Rivermead Post-Concussion Symptom Questionnaire and the Hospital Anxiety and Depression Scale. Postinjury employment status and work productivity were assessed 4 years postinjury using the Work Limitations Questionnaire.

Results: Four years after mild TBI, 17.3% of participants had exited the workforce (other than for reasons of retirement or to study) or had reduced their working hours compared with preinjury. A further 15.5% reported experiencing limitations at work because of their injury. Average work productivity loss was 3.6%. The symptom of taking longer to think 1 month postinjury significantly predicted work productivity loss 4 years later (β=.47, t=3.79, P≤.001).

Conclusions: Although changes in employment status and difficulties at work are likely over time, the results indicate increased unemployment rates, work limitations, and productivity loss in the longer term after a mild TBI. Identification of cognitive difficulties 1 month after TBI in working aged adults and subsequent interventions to address these difficulties are required to facilitate work productivity.