Indicators of long-term return to work after severe traumatic brain injury: A cohort study
Indicators of long-term return to work after severe traumatic brain injury: A cohort study
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DOI：
10.1016/j.rehab.2018.08.003
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发表时间：
2019-01-01
影响因子：
4.6
通讯作者：
Luaute, J.
中科院分区：
文献类型：
--
作者：
Wang, V;Fort, E.;Luaute, J.
背景：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。长期职业整合（超过 5 年）的影响很少被研究。目的：目的是评估严重 TBI 后的长期 RTW 和相关因素。材料和方法：对 2005 年至 2009 年严重 TBI 后入院的一组 16 至 60 岁个体进行回顾性分析，并进行前瞻性随访。通过医疗档案和系统电话访谈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 (PR) 和 95% 置信区间 (CI)。使用比例风险模型来研究 RTW 延迟，估计风险比 (HR)。 结果：在 91 名受试者中（平均 [SD] 年龄 28.5 [11.3] 岁；79% 为男性），63.7% 的人在平均约 20 个月后返回工作岗位，57.1% 的人在调查时仍在工作。多变量分析中与 RTW 显着相关的因素包括较高的教育水平（调整后的 PR，1.53；95% CI，1.15 至 2.03）、不存在运动障碍（调整后的 PR，1.82；1.12 至 2.95）和行为障碍（调整后的 PR，1.26；1.01 至 1.60），以及残疾工人状况（调整后的 PR，1.26；1.01 至 1.60）。 1.01 至 1.60）（多元分析模型的可能性 53.1）。 RTW 延迟与健康保险付款（调整后 HR，0.40；95% CI，0.22 至 0.71）、运动残疾（调整后 HR，0.34；0.15 至 0.76）、教育水平低（调整后 HR，2.20；1.06 至 4.56）以及扩展格拉斯哥结果量表中度残疾（调整后 HR， 0.49；0.27 至 0.91）（多变量分析模型的可能性为 335.5）。结论：患有最严重 TBI 的个人能够 RTW 并继续工作。这项研究强调了 RTW 涉及的多个决定因素以及社会环境因素的作用。 (C) 2018 年由 Elsevier Masson SAS 出版。
Background: 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.Objective: The objective was to assess long-term RTW and the associated factors after severe TBI.Material and methods: 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).Results: 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).Conclusion: 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. (C) 2018 Published by Elsevier Masson SAS.