Research Reports - Community integration in workers with delayed recovery from mild traumatic brain injury
BMC Neurol. 2015 Oct 9;15(1):194. doi: 10.1186/s12883-015-0432-z.
Mollayeva T(1,)(2), Shapiro CM(3,)(4), Mollayeva S(5,)(6), Cassidy JD(7,)(8),
BACKGROUND: Delayed recovery in persons after mild traumatic brain injury (mTBI)
is poorly understood. Community integration (CI) is endorsed by persons with
neurological disorders as an important outcome. We aimed to describe CI and its
associated factors in insured Ontario workers with delayed recovery following
METHODS: A cross-sectional study of insured workers in the chronic phase
following mTBI was performed at a rehabilitation hospital in Ontario, Canada.
Sociodemographic, occupational, injury-related, clinical, and claim-related data
were collected from self-reports, medical assessments, and insurers' referral
files. Community Integration Questionnaire (CIQ) scores were compared using
analysis of variance or Spearman's correlation tests. Stepwise multivariable
linear regression models were used to evaluate the associations with CI.
RESULTS: Ninety-four workers with mTBI (45.2 ± 9.9 years old, 61.2 % male) at
197 days post-injury (interquartile range, 139-416 days) were included. The CIQ
total and subscale scores were similar to those reported in more severe TBI
samples. The CIQ scores were moderately to strongly correlated with various
sociodemographic, claim-related, and clinical variables. In the multivariable
regression analysis, several covariates accounted for 36.4 % of the CIQ variance
in the final fully adjusted model.
DISCUSSION: This study evaluated CI in workers with mTBI, and analyzed its
associated variables. Analysis revealed insomnia, head or neck pain, being
married or in a relationship, time since injury, and a diagnosis of
possible/probable malingering were independently associated with limited CI.
CONCLUSIONS: Workers with delayed recovery from mTBI experience difficulty with
CI. Insomnia is a particularly relevant covariate, explaining the greater part of
its variance. To enhance participation, care should focus on clinical and