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Predictors of Employment Outcomes in Veterans With Traumatic Brain Injury

A VA Traumatic Brain Injury Model Systems Study

Dillahunt-Aspillaga, Christina PhD; Nakase-Richardson, Risa PhD; Hart, Tessa PhD; Powell-Cope, Gail PhD; Dreer, Laura E. PhD; Eapen, Blessen C. MD; Barnett, Scott D. PhD; Mellick, Dave MA; Haskin, Adam BS; Silva, Marc A. PhD

Section Editor(s): Nakase-Richardson, Risa PhD, FACRM; Stevens, Lillian Flores PhD, LCP

The Journal of Head Trauma Rehabilitation: July/August 2017 - Volume 32 - Issue 4 - p 271–282
doi: 10.1097/HTR.0000000000000275
Original Articles

Objectives: To examine the length of time to return to work (RTW) among service members and veterans (SM/V) with traumatic brain injury (TBI) and to identify variables predictive of RTW.

Setting: Department of Veterans Affairs Polytrauma Rehabilitation Centers (VA PRC).

Participants: SM/V enrolled in the VA PRC Traumatic Brain Injury Model Systems database who were of 18 to 60 years of age and admitted with the diagnosis of TBI.

Design: Prospective observational cohort study.

Main Outcome Measures: Employment status at 1-year postinjury follow-up; Time to Employment (ie, number of days it took to RTW) as documented during 1-year postinjury follow-up.

Results: The final sample (n = 293) included male (96%) SM/V with severe TBI (69%). Approximately 21% of the sample participants were employed at 1 year postinjury. Younger individuals who self-identified as nonminority returned to work sooner. Significant associations were observed for time to employment for cause of injury and injury severity.

Conclusions: Few SM/V with moderate to severe TBI returned to work at 1 year postinjury. Predictors such as younger age at the time of injury, minority status, and severity of TBI affected time to and probability of RTW. Findings from this study have important implications for rehabilitation planning and service delivery across the continuum of recovery.

University of South Florida, Rehabilitation and Mental Health Counseling Program, Tampa (Dr Dillahunt-Aspillaga); HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans Hospital, Tampa, Florida (Drs Dillahunt-Aspillaga, Nakase-Richardson, Powell-Cope, Barnett, and Silva); Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Defense and Veterans Brain Injury Center, Tampa, Florida (Drs Nakase-Richardson, Barnett, and Silva and Mr Haskin); MHBS, James A. Haley Veterans Hospital, Tampa, Florida (Drs Nakase-Richardson, Barnett, and Silva); Department of Medicine, University of South Florida, Tampa (Dr Nakase-Richardson); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Hart); South Texas Veterans Health Care System, Polytrauma Rehabilitation Center, San Antonio (Dr Eapen); Departments of Physical Medicine and Rehabilitation and Ophthalmology, The University of Alabama, Birmingham (Dr Dreer); Traumatic Brain Injury Model Systems National Data and Statistical Center, Craig Hospital, Englewood, Colorado (Mr Mellick); General Dynamics Health Solutions, Tampa, Florida (Mr Haskin); and Department of Psychology, University of South Florida, Tampa, Florida (Dr Silva).

Corresponding Author: Christina Dillahunt-Aspillaga, PhD, HSR&D Center of Innovation on Disability and Rehabilitation Research, 8900 Grand Oak Circle, Tampa, FL 33637 ( and

The Polytrauma Rehabilitation Center Traumatic Brain Injury (TBI) Model System collaboration is funded through an Interagency Agreement between the Department of Veterans Affairs and the Department of Education, National Institute on Disability, Independent Living, and Rehabilitation Research. This research is sponsored by VHA Central Office VA TBI Model System Program of Research, and Subcontract from General Dynamics Health Solutions (W91YTZ-13-C-0015) from the Defense and Veterans Brain Injury Center, US Army Medical Research and Material Command (USAMRMC), U.S. Department of Veterans Affairs grants (1 I50 HX001233-01, W81XWH-13-2-0095), and U.S. Department of Defense Congressionally Directed Medical Research Programs.

The authors acknowledge Courtney Lynn, MS, and Jeffery Garafano, MS, for their contributions.

The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official Department of Defense position or any other federal agency, policy, or decision unless so designated by other official documentation.

The authors declare no conflicts of interest.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.