Return to productivity following traumatic brain injury: Cognitive, psychological, physical, spiritual, and environmental correlates

Purpose. The purpose of this study was to investigate the determinants and correlates of return to productivity (RTP) defined here as return to paid employment and/or school four years following traumatic brain injury (TBI). Method. Participants included 46 people with TBI, part of a prospective, cohort study, and 14 friend/family member controls all employed and/or in school at time of injury or inception into the study. Variables were selected for investigation based on two models of recovery. Demographic and injury severity data including time to recover free recall were collected at time of injury, on admission to a trauma unit. Data on other variables (neuropsychological, psychological, physical, spiritual, environmental) were collected concurrent with productivity status at a mean of 4.3 years post-TBI. Results. Time to recover free recall (measured acutely), neuropsychological status, pain severity, depression, and the use of maladaptive coping behaviours were all related to productivity status (p < 0.05). When these variables were entered into exploratory, planned hierarchical logistic regression models time to free recall, pain, and maladaptive coping remained in the models with depression only dropping out because of the high correlation with pain (r > 0.80). Conclusions. Injury severity (time to free recall), physical status (pain), and psychological status (depression, coping) are important to understanding differences in productivity outcomes. Addressing pain, depression and coping in rehabilitation programs may have a positive impact on outcomes.