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Prediction of functional and employment outcome one year after Traumatic Brain Injury: A Structural Equation Modelling approach

Vortrag auf dem Zwanzigsten Rehabilitationswissenschaftlichen Kolloquium vom 14. bis 16. März 2011 in Bochum

Sammelwerk / Reihe:

Nachhaltigkeit durch Vernetzung


Schönberger, Michael; Ponsford, Jennie; Olver, John [u. a.]


Deutsche Rentenversicherung Bund (DRV Bund)


Berlin: Eigenverlag, 2011, Seite 353-355





Traumatic brain injury (TBI) is the leading cause of disability amongst young adults (Langlois et al., 2008). TBI can cause lasting physical, cognitive, and emotional sequelae (Draper, Ponsford, 2008; Jorge, Robinson, 2003) as well as behavioural changes (Kelly et al., 2008). These functional changes are associated with poor employment outcome (Pagulayan, 2008). In order to improve outcome after TBI, it is important to understand the factors that predict outcome. These factors appear to be related to each other, and their effect on outcome might be mediated by other predictors. However, we are not aware of any study that has tested a comprehensive model predicting outcome after TBI that embraces the complex interrelationships between the predictor variables. The current study aimed to develop, test and optimise a comprehensive structural equation model predicting functional as well as employment outcome after TBI, based on the existing literature and taking the interrelationships amongst predictor variables and amongst outcome variables into account.


Participants were n equal 949 adolescents and adults (74 percent male; median age 25.7 years, range 14 to 74; median duration of post-traumatic amnesia 17 days, range smaller than 1 to 183) who were admitted to Epworth Hospital, Melbourne for rehabilitation after TBI and who were part of the labour force at the time of injury. For the present study, follow-up data routinely collected one year post-injury was used. Functional outcome one year post-injury was measured with the Structured Outcome Questionnaire (SOQ). Participants were asked to indicate whether they had, since the injury, experienced changes in the domains of cognition, behaviour and emotion. Employment outcome was dichotomized into paid work/student versus other (unemployment, not in labour force, etcetera). Demographic and injury-related information was gathered from participants' hospital files.


At follow-up, 56 percent of the participants were in paid work or students. On the SOQ, between 25 percent and 67 percent of the participants reported changes on the different items. Forgetfulness (67 percent) and irritability (61 percent) were reported most frequently. A modified structural equation model, displayed in Figure 1, was well supported by the observed data (CFI equal .99, RMSEA equal .03). As can be seen, both direct and mediating relationships between predictor and outcome variables were found, with injury severity (PTA) being the strongest and most consistent predictor of outcome. Pre-injury psychiatric disorders predicted employment outcome indirectly via its association with post-injury cognitive and mood changes. The observed variables that indicate the mood, cognitive and behavioural change factors were entered into the SEM, but are omitted from this figure. Curved lines represent correlations; straight lines represent regression coefficients. Correlations and standardized regression coefficients are displayed.

The SEM developed in this study improves our understanding of the complex interplay between the predictors of outcome after TBI, as well as between the different aspects of outcome. Even though gender, pre-injury psychiatric disorders and spinal injuries were not directly related to post-injury employment, these predictors were related to employment outcome via their association with pre-injury education and employment and with post-injury mood changes. For clinicians, it is especially important to be aware of the association between pre-existing psychiatric disorders and outcome and the importance of specialised interventions for individuals with such conditions. More research is needed on who benefits from which rehabilitative intervention at which point in time. Long-term support offers might be warranted especially for those at risk of poor psychosocial outcome. Further research can build on the model developed in this study and expand it.

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Sammelwerk '20. Rehabilitationswissenschaftliches Kolloquium: Nachhaltigkeit durch Vernetzung' | REHADAT-Literatur


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Deutsche Rentenversicherung Bund (DRV Bund)
Forschungsportal der Deutschen Rentenversicherung

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Informationsstand: 29.03.2011

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