Cognitive-communication predictors of employment outcomes 1 and 5 years posttraumatic brain injury

Objective: To examine changes in functional memory, problem solving, comprehension, expression, and social communication over the first 2 years posttraumatic brain injury (TBI) and the ability of each to predict return to work (RTW) outcomes at 1 year and 5 years postinjury. Design: Secondary analysis of data from a multicenter longitudinal cohort study. Setting: Acute inpatient rehabilitation facilities and community follow-up. Participants: A total of 3543 individuals between 16 and 60 years of age who were competitively employed at the time of TBI and had completed year 1, year 2, and year 5 postinjury follow-ups. Main Outcome Measures: Year 1 and year 5 RTW status (± competitively employed) at the time of study completion. Results: Greater function across each of the 5 cognitive-communication abilities was associated with RTW success at 1 year and 5 years post-TBI. At discharge, these 5 abilities showed comparable odds of predicting later employment. At year 1 and year 2 followups, independence with problem solving was the most predictive of employment 5 years post-TBI, followed by social interaction, memory, expression, and comprehension. Conclusions: An increased rehabilitation focus on functional memory, problem solving, comprehension, expression, and social interaction post-TBI has the potential to improve RTW outcomes.