Neurocognitive status and return to work after moderate to severe traumatic brain injury.

Purpose/Objective: To examine the relationship of cognitive status to employment outcomes at 1-year post moderate-severe traumatic brain injury (TBI), using a brief telephone-administered instrument. Research Method/Design: Prospective longitudinal study in which 320 people with moderate-severe TBI, all employed at injury, were enrolled during inpatient rehabilitation and evaluated at 1-year postinjury. Follow-up measures included whether and when participants had returned to work (RTW), and cognitive status assessed with the Brief Test of Adult Cognition by Telephone (BTACT). Multivariable logistic regression and survival analyses were used to assess the contribution of BTACT (overall and subscale scores) to employment outcomes, controlling for covariates with known associations to those outcomes, including demographic variables, injury severity, and driving status. Results: Fewer than 40% of participants (n = 124) were employed at 1-year follow-up. BTACT scores were strongly associated with RTW even after controlling for known covariates. Females had faster and higher rates of RTW compared to males. Resumption of driving and injury severity were also related to RTW. Conclusions/Implications: Neurocognitive status is a potentially modifiable factor with an important relationship to RTW following TBI. Vocational rehabilitation efforts should provide cognitive remediation or compensation as well as addressing transportation barriers. As a brief telephone-based assessment, the BTACT offers a new and efficient tool for evaluation of episodic memory and executive function. Impact and Implications It is important to assess modifiable factors for their relationship to return to work (RTW) following moderate to severe traumatic brain injury (TBI). Cognitive impairments are potentially modifiable and strongly related to RTW; thus, vocational rehabilitation should incorporate evidence-based cognitive remediation or compensation as well as addressing other modifiable obstacles such as transportation limitations. A brief, telephone-based assessment of episodic memory and executive function has the potential to add significantly to the evaluation of readiness to return to work at 1 year following moderate to severe TBI.