Return to work predictors after traumatic brain injury in a welfare state

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People who suffer a severe traumatic brain injury (TBI) have difficulties in achieving labour market attachment (LMA) after injury,1 and often require financial support through government initiatives (public assistance benefit).5 In these patients, non‐working status may be associated with a reduced social reintegration6 and a poorer quality of life.4
There are large inconsistencies in predictors of LMA after TBI.1 This could be due to different TBI severities, inclusion criteria and time point of follow‐up.11 Loss to follow‐up leads to potential selection bias17 which may also contribute to the inconsistency of suggested predictors. Finally, only few studies evaluate more than one time point.1 Therefore, longitudinal, population‐based studies on predictors of post‐injury LMA are required.
Suggested factors that predict post‐injury LMA include factors related to the severity of injury and factors related to the functional abilities after injury.11
Preinjury characteristics such as young age,7 male sex,7 vocational status,7 high education,7 marital status7 and no history of psychiatry or substance/alcohol abuse8 also predict post‐injury LMA according to studies performed in the USA. By contrast, European studies show less consistency with regard to preinjury characteristics.2 This could reflect cultural differences11 or be due to low sample sizes in the European studies increasing the risk of false‐negative results.
For all citizens, the Danish welfare system provides equal access to social security and healthcare services. Therefore, preinjury characteristics may have lower impact on the ability to achieve post‐injury LMA in Denmark.
Immediately after injury, the welfare system provides a continuous chain of neurorehabilitation services to people with TBI.23 However, despite national legislation supports homogeneity in rehabilitation services across the country, variations in rehabilitation trajectories exist. This could potentially induce variation in the rehabilitation outcomes, including post‐injury LMA.
This study follows on from our previous studies on the frequency of post‐injury LMA in Denmark.24 The aim of this study was to assess whether preinjury characteristics, factors related to the severity of injury, factors related to the function after injury and factors related to variation in the rehabilitation trajectories were associated with post‐injury LMA in a nationwide, register‐based follow‐up study.

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