Journal Club Discussion #13: Predictors of Paid Employment After Stroke, TBI & SCI

Hey readers! We have been reading a lot of journal articles about pediatrics lately, but I know that lots of you are interested in stroke, traumatic brain injury (TBI), and spinal cord injury (SCI) as well. So, this week we will be reading an article called “Cognitive, Emotional, and Physical Functioning as Predictors of Paid Employment in People with Stroke, Traumatic Brain Injury, and Spinal Cord Injury” by Alex W. K. Wong, Cynthia Chen, Carolyn M. Baum, Robert K. Heaton, Berrit Goodman, and Allen W. Heinemann. AOTA members can access the article here.

Background Info

Return to employment rates after stroke, TBI and SCI are significantly lower than pre-injury employment rates. For this reason, return to employment is often a focus of rehabilitation for patients with neurological conditions. Furthermore, employment is associated with financial, social and personal well-being (Wong et al., 2019). Additionally, inability to return to employment after injury may lead to “adverse psychosocial outcomes, such as problems with housing, social communication, and depression symptoms” (Wong et al., 2019, n.p.).

According to Wong et al. (2019), return to work rates are as follows:

  • Stroke: 37% full-time, 29% part-time
  • TBI: 55% 3 years post-injury
  • SCI: 12% 1 year post-injury and 34% 20 years post-injury

The goal of this study was to describe characteristics of individuals who returned to work post-injury while considering factors such as full-time versus part-time work and whether or not the individual returned to the previous employer or a new employer (Wong et al., 2019). The second goal of this study was to determine whether there are physical, emotional, or cognitive functioning determinants that predict return to employment in individuals with stroke, TBI and SCI.

Methods & Participants

First, a few definitions. The authors defined “employment” as full-time or part-time work. Cognition was separated into three subsections: functional, fluid, and crystallized.

149 individuals with stroke, 155 individuals with TBI, and 176 individuals with SCI were recruited for this study. All participants resided within the community, were age 18-62, were at least 1 year post-injury, and spoke English. Read more about eligibility criteria for each condition in the article!

The researchers utilized a questionnaire to assess occupational outcomes at work (see Appendix I). The Quality of Life in Neurological Disorders – Upper Extremity item bank was used to asses upper extremity function. The NIH Toolbox Emotional Battery was used to assess negative affect, social satisfaction, and psychological well-being. To assess cognition, the researchers used 5 tests of fluid cognition and 2 tests of crystallized cognition from the NIHTB Cognition Battery as well as The Executive Function Performance Test to assess functional cognition.

The Results

Out of 480 participants, only 25% returned to work post-injury. Of these individuals, “18% returned to work with their previous employer” (Wong et al., 2019, n. p.). If participants returned to work 1 year or longer post-injury, most worked with a new employer. “33% worked full time,…48% worked part time, [and] 19% worked with their previous employer (p<.001)” (Wong et al., 2019, n. p.).

Some factors that significantly predicted greater likelihood of employment included:

  • being married or having a partner
  • earning a college education
  • fluid and functional cognition (sequencing and inhibitory control)

What I Think

The authors state that an implication for OT practitioners is to include interventions to develop cognitive skills among individuals with stroke, TBI and SCI in order to support return to paid employment. I think that this is really important to think about as an OT. If the patient’s goal is to return to full-time employment after neurological injury, then we as OTs should know the specific aspects of function that predict return to work. Then, we will know exactly what we should work on with the patient in order to support their return to employment. I was surprised that years since injury, physical functioning, and emotional functioning did not have an impact on return to work rates.

Question of the Week: What are some cognitive interventions that you do with patients (in practice or in fieldwork) to support them in returning to work after stroke, TBI or SCI? Comment below!

Citation: Wong, A. W. K., Chen, C., Baum, C. M., Heaton, R. K., Goodmann, B., & Heinemann, A. W. (2019). Cognitive, emotional, and physical functioning as predictors of paid employment in people with stroke, traumatic brain injury, and spinal cord injury.” American Journal of Occupational Therapy, 73. doi: 10.5014/ajot.2019.031203

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