Employment Stability for People with Traumatic Brain Injury Predicted by Vocational Rehabilitation, Rurality, and Transportation Independence.

OBJECTIVE: Characterize the effects of vocational rehabilitation (VR), rural residence, and transportation independence on patterns of employment in the first 10-years after traumatic brain injury (TBI). DESIGN: Observational study using longitudinal data from TBI Model Systems National Database (TBIMS-NDB) collected at time of TBI, and 1-, 2-, 5-, and 10-years post-injury. SETTING: Rehabilitation centers involved in the TBIMS-NDB. PARTICIPANTS: Adults with a TBI that required acute inpatient rehabilitation, enrolled from 1999-2011 with at least three timepoints of employment data and who were surveyed on use of VR in the first 10 years post-injury (N=5,019). INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Employment patterns 1-10 years post-injury: stable employment (19.1%), inconsistent employment (33.4%), consistent unemployment (47.5%). RESULTS: VR was most utilized by people with inconsistent employment (28.7%), compared to those stably employed (19.5%) and consistently unemployed (14.7%), F(2,5018)=60.77. Multinomial logistic regressions indicate VR increases the odds of some workforce reengagement (OR=1.760; CI=1.493,2.076), but not consistent employment, compared to consistent unemployment. Rurality reduces odds of inconsistent employment compared to consistent unemployment (OR=0.792; CI=0.687,0.913). Transportation independence increases chances of employment (Stable OR =27.383; CI=21.924,34.200; p<0.001; Inconsistent OR=6.569; CI=5.550,7.776; p<0.001). CONCLUSIONS: VR services are important to assist individuals in returning to work after TBI, particularly for individuals who have difficulties retaining consistent employment. Results show rural residents experience higher rates of consistent unemployment and independent access to transportation is associated with the best employment outcomes. These results suggest the need for long-term VR services to assist individuals in returning to work, and especially for individuals who have difficulties retaining employment. Adopting novel VR approaches that align with the designation of TBI as a chronic health condition can improve the accessibility and effectiveness of VR, lead to strategies which improve employment outcomes in rural communities, and establish sustainable transportation resources that promote long-term employment success.