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. 2015 Oct 9:15:194.
doi: 10.1186/s12883-015-0432-z.

Modeling community integration in workers with delayed recovery from mild traumatic brain injury

Tatyana Mollayeva  1   2 , Colin M Shapiro  3   4 , Shirin Mollayeva  5   6 , J David Cassidy  7   8 , Angela Colantonio  9   10
Affiliations

Modeling community integration in workers with delayed recovery from mild traumatic brain injury

Tatyana Mollayeva et al. BMC Neurol. .

Abstract

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 mTBI.

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 non-clinical covariates.

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Figures

Fig. 1
Fig. 1
Flow chart depicting process of selection of participating individuals’ data for analysis. TBI Traumatic brain injury
Fig. 2
Fig. 2
Conceptual framework of the construct of community integration in traumatic brain injury (TBI). Format adapted from Fayer & Hand [73]
Fig. 3
Fig. 3
Fit diagnostics for community integration (a-h)
Fig. 4
Fig. 4
Residuals by regressor for community integration
Fig. 5
Fig. 5
Depiction of multivariate regression analysis for community integration
See this image and copyright information in PMC

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