1
Introduction
Acquired brain injuries and their subsequent consequences can represent a challenge for social reintegration measures, especially in the workplace.
The knowledge regarding epidemiology of patients with acquired brain injuries is progressively being refined. In France, the incidence of stroke represented more than 100,000 patients in 2009 ; for hospitalized patients with traumatic brain injury (TBI) the incidence is estimated at 155,000/year, including 8500 severe cases . However, in these populations it remains very difficult to refine the proportion of working-age population.
The return-to-work (RTW) rate after a brain injury varies greatly in the international literature . The heterogeneity in these RTW rates can partly be explained by the differences in socioeconomics, cultures, healthcare systems or support measures that differ according to the different countries. The national literature remains quite scarce on the subject , and justifies further studies.
2
Material and methods
The present study is a monocenter, retrospective study, conducted at the Physical Medicine and Rehabilitation Center (PMPR) of Saint-Hélier, in Rennes, France. In addition to a classic rehabilitation program, the Center also offers the support of a professional reintegration unit (CIP), with 2 persons in charge of professional reintegration, trained as occupational therapists, who work with social workers. The CIP operates in a manner similar to French recommendations for an early RTW (DPI) . The CIP works with people with brain injury according to their requests and RTW needs and upon a medical prescription. The patients not requiring any support from the CIP unit are the ones who recovered sufficiently to return to work without specific adjustments or the ones oriented towards retirement, or conversely patients faced with a negative progression, preventing the notion of returning to work. We chose to study patients with brain injury followed by the CIP.
The study inclusion criteria were: patients with acquired brain injury, regardless of the etiology, aged between 18 and 60 at the time of this injury, admitted between 2008 and 2010 and followed in their rehabilitation process by the CIP unit. Exclusion criteria were patients presenting with inflammatory, degenerative or congenital brain lesions.
We collected the data from medical charts and CIP files, as well as data from phone interviews conducted with each patient using a guided questionnaire. These phone interviews took place during the year 2012, in order to have at least a 2-year follow-up for all patients. The pre-injury data collected in the files were age of the patient at the time of the injury, sex, presence of family support at the time of the injury (presence of a third party, informed at least partly, of the medical elements and outcomes of the patients), study level according to the INSEE educational attainment grid, pre-injury professional status (employee, independent worker, student or in professional training, unemployed and seeking employment), the patient’s last job: white collar (“intellectual” job) or blue collar (“manual” activity). Data on the brain injury concerned the nature of the acquired brain injury: for stroke, the type of stroke (ischemic or hemorrhagic) and its location (left or right hemisphere, bilateral, or in the posterior fossa); for traumatic brain injury (TBI), the initial Glasgow Coma Scale (GCS), and the context of occupational injury.
In 2012, the phone interviews focused on the patient’s family status, professional situation and nature of the work, and eventual RTW modalities.
The statistical analysis was performed with the StatView ® software. The population was described as means and standard deviations. For qualitative data the Chi 2 test was used with a significant threshold set at 0.05.
Regarding quantitative data, the analysis used non-parametric Mann Whitney and Wilcoxon tests with P = 0.05 as the significant threshold.
2
Material and methods
The present study is a monocenter, retrospective study, conducted at the Physical Medicine and Rehabilitation Center (PMPR) of Saint-Hélier, in Rennes, France. In addition to a classic rehabilitation program, the Center also offers the support of a professional reintegration unit (CIP), with 2 persons in charge of professional reintegration, trained as occupational therapists, who work with social workers. The CIP operates in a manner similar to French recommendations for an early RTW (DPI) . The CIP works with people with brain injury according to their requests and RTW needs and upon a medical prescription. The patients not requiring any support from the CIP unit are the ones who recovered sufficiently to return to work without specific adjustments or the ones oriented towards retirement, or conversely patients faced with a negative progression, preventing the notion of returning to work. We chose to study patients with brain injury followed by the CIP.
The study inclusion criteria were: patients with acquired brain injury, regardless of the etiology, aged between 18 and 60 at the time of this injury, admitted between 2008 and 2010 and followed in their rehabilitation process by the CIP unit. Exclusion criteria were patients presenting with inflammatory, degenerative or congenital brain lesions.
We collected the data from medical charts and CIP files, as well as data from phone interviews conducted with each patient using a guided questionnaire. These phone interviews took place during the year 2012, in order to have at least a 2-year follow-up for all patients. The pre-injury data collected in the files were age of the patient at the time of the injury, sex, presence of family support at the time of the injury (presence of a third party, informed at least partly, of the medical elements and outcomes of the patients), study level according to the INSEE educational attainment grid, pre-injury professional status (employee, independent worker, student or in professional training, unemployed and seeking employment), the patient’s last job: white collar (“intellectual” job) or blue collar (“manual” activity). Data on the brain injury concerned the nature of the acquired brain injury: for stroke, the type of stroke (ischemic or hemorrhagic) and its location (left or right hemisphere, bilateral, or in the posterior fossa); for traumatic brain injury (TBI), the initial Glasgow Coma Scale (GCS), and the context of occupational injury.
In 2012, the phone interviews focused on the patient’s family status, professional situation and nature of the work, and eventual RTW modalities.
The statistical analysis was performed with the StatView ® software. The population was described as means and standard deviations. For qualitative data the Chi 2 test was used with a significant threshold set at 0.05.
Regarding quantitative data, the analysis used non-parametric Mann Whitney and Wilcoxon tests with P = 0.05 as the significant threshold.
3
Results
In all, 85 patients were recruited, aged 18 to 60, admitted between 2008 and 2010, after acquired brain injury and followed by the CIP unit. Data from this global population of patients with brain injury are detailed in the first column of Table 1 . Seventy of the 85 patients (82%) had a job at the time of the brain injury. Injury etiologies were: TBI (34 patients), stroke (31 patients), brain tumor (13 patients), 2 brain anoxia cases, 1 acute disseminated encephalomyelitis, 1 subdural empyema, 1 central pontine myelinolysis, 1 Locked-in-Syndrome and 1 thrombophlebitis.
| Total population, n = 85 | Interviewed patients, n = 76 | P | ||||
|---|---|---|---|---|---|---|
| Number/average | Available data | Return to work ( n = 43), number/average | Unemployed ( n = 33), number/average | Available data | ||
| Age (years) at the time of the lesion | 39.6 | 85 | 40.7 | 38.2 | 76 | 0.58 |
| Gender | 85 | 76 | ||||
| Male | 63 (74%) | 32 (42%) | 25 (33%) | NS | ||
| Female | 22 (26%) | 11 (14%) | 8 (11%) | |||
| Family support | 83 | 75 | 0.79 | |||
| Yes | 64 (77%) | 34 (45%) | 25 (33%) | |||
| No | 19 (23%) | 8 (11%) | 8 (11%) | |||
| Attainment level | 83 | 74 | NS | |||
| Secondary school | 8 (9%) | 2 (3%) | 5 (7%) | |||
| Technical school | 38 (46%) | 15 (20%) | 17 (23%) | |||
| Graduate degree | 37 (45%) | 25 (34%) | 10 (13%) | |||
| Professional status | 85 | 76 | > 0.99 | |||
| Blue collar workers | 56 (66%) | 28 (37%) | 21 (27%) | |||
| White collar workers | 29 (34%) | 15 (20%) | 12 (16%) | |||
| Professional categories | 85 | 76 | 0.009 | |||
| Employee | 62 (73%) | 37 (49%) | 19 (25%) | |||
| Self-employed | 8 (9%) | 4 (5%) | 3 (4%) | |||
| Training | 3 (4%) | 1 (1%) | 2 (3%) | |||
| Unemployed | 12 (14%) | 1 (1%) | 9 (12%) | |||
| Pathology | 85 | 76 | NS | |||
| Stroke | 31 (37%) | 18 (24%) | 10 (13%) | |||
| TBI | 34 (40%) | 17 (22%) | 15 (20%) | |||
| Tumor | 13 (15%) | 4 (5%) | 5 (7%) | |||
| Others | 7 (8%) | 4 (5%) | 3 (4%) | |||
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