Patients with traumatic brain injury (TBI) are significantly more likely to collect work disability benefits, with the likelihood increasing alongside the severity of the injury, according to a study published in Neurology. Researchers found that work disability remained elevated for up to five years post-injury, even in cases considered less severe.
The population-based, longitudinal study, conducted in Sweden between 2005 and 2016, analyzed data from 98,256 patients with TBI matched against a control group of 981,191 individuals without TBI. TBI severity was categorized based on the level of care received: hospitalization of two days or less with no neurosurgery (93% of cases), hospitalization of three or more days without neurosurgery (6%), and neurosurgery (<1%).
The study revealed that individuals with TBI were more prone to transitioning from non-work disability to work disability compared to those without TBI. At 30 days post-injury, 5.5% of those with care lasting two days or less, 29% of those hospitalized for three or more days without surgery, and 43% of those undergoing neurosurgery were receiving work disability benefits, compared to just 0.5% of the control group. These rates remained elevated at five years, with 7.1%, 10.9%, and 12.9% respectively, compared to 4% in the control group.
Researchers noted a delayed, yet persistent, increase in work disability even among those with less severe TBI. “Although more severe injuries had the highest early disability rates, individuals with less severe TBI showed a delayed but persistent increase in work disability,” stated study authors Andrea Klang, MD, and Elham Rostami, MD, PhD, of Uppsala University in Sweden.
Over the five-year follow-up period, 26% of individuals without TBI experienced at least one episode of work disability, compared to 45% of those with care lasting two days or less, 67% of those hospitalized for three or more days without neurosurgery, and 72% of those who underwent neurosurgery.
The study also identified several pre-injury factors associated with work disability. Older age, female sex, pre-existing psychiatric disorders, and blue-collar occupations were linked to increased risk, particularly in milder injuries. Higher education levels were associated with a lower risk of transitioning to work disability in those with the least severe injuries, while city residence showed a similar protective effect for those hospitalized for three days or more.
The average duration of work disability over five years was 526 days for those with care lasting two days or less, and 1,201 days for those who underwent neurosurgery. The most common causes of work disability varied by injury severity. Among those with less severe injuries and those hospitalized for three or more days without neurosurgery, illnesses like cancer, pain, and fatigue were frequently cited. However, diagnoses directly related to TBI were the most common cause of work disability among those who underwent neurosurgery, accounting for 40% of cases.
Klang and Rostami emphasized the need for individualized, long-term rehabilitation that addresses both the impairments resulting from TBI and pre-existing socio-demographic and medical conditions. “These findings support the view of TBI as a chronic condition rather than a short-term event,” they stated. They recommend clinicians monitor patients beyond the acute phase, even those with milder injuries, and provide targeted rehabilitation and vocational support to individuals identified as high-risk, particularly those with psychiatric comorbidities or a history of work disability.
Neurologist Rab Nawaz Khan, Consultant Neurologist at Aneurin Bevan University Health Board in Wales, commented on the study’s findings, noting the persistence of disability even in milder cases and the importance of addressing psychosocial factors. “Physicians can help most by treating return to work as a structured medical goal, not an afterthought,” Khan stated. He advocated for early screening for common post-TBI symptoms like sleep problems, depression, and cognitive fatigue, as well as a graded return-to-work plan with clear accommodations.
