Factors Associated with Return to Work Postinjury: Can the Modified Rankin Scale Be Used to Predict Return to Work? ANIRUDH KOHLI, M.D.,* EDWARD CHAO, M.D.,* DANIEL SPIELMAN, B.A.,* DORDANEH SUGANO, B.S.,* ABHISHEK SRIVASTAVA, M.D.,* ANAND DAYAMA, M.D.,* ANDREW LEDERMAN, M.D.,† MICHELLE STERN, M.D.,† SRINIVAS H. REDDY, M.D.,* SHELDON TEPERMAN, M.D.,* MELVIN E. STONE, JR., M.D.* From the *Department of Surgery, and the †Department of Physical Medicine and Rehabilitation, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York The ability to return to work (RTW) postinjury is one of the primary goals of rehabilitation. The modified Rankin Scale (mRS) is a validated simple scale used to assess the functional status of stroke patients during rehabilitation. We sought to determine the applicability of mRS in pre- dicting RTW postinjury in a general trauma population. The trauma registry was queried for patients, aged 18 to 65 years, discharged from 2012 to 2013. A telephone interview for each patient included questions about employment status and physical ability to determine the mRS. Patients who had RTW postinjury were compared with those who had not (nRTW). Two hundred and thirty-four patients met the inclusion criteria. Of these, 171 (72.5%) patients RTW and 63 (26.7%) did nRTW. Patients who did nRTW were significantly older, had longer length of stay and higher rates of in-hospital complications. Multivariate analysis revealed that older patients were less likely to RTW (odds ratio 5 0.961, P 5 0.011) and patients with a modified Rankin score £2 were 15 times more likely to RTW (odds ratio 5 14.932, P < 0.001). In conclusion, an mRS £2 was in- dependently associated with a high likelihood of returning to work postinjury. This is the first study that shows applicability of the mRS for predicting RTW postinjury in a trauma population. I NJURY CAN LEAD to devastating physical impairments that have lasting effects on a patient’s ability to return to work (RTW). 1 Postinjury RTW has often been measured as a primary outcome to assess the efficacy of comprehensive and multidisciplinary rehabilitation programs. 2 Patients that RTW have been demonstrated to have a higher degree of life satisfaction, overall quality of life, and economic independence. 3, 4 More- over, from a psychosocial standpoint, they experience decreased social isolation, reduced anxiety, as well as lower rates of substance abuse. 5 With these outcomes in mind, being able to identify the factors that are re- sponsible for increased RTW after injury is of para- mount importance. Several studies have looked at factors predicting return to preinjury functional status and RTW. How- ever, these studies have several limitations, in partic- ular, they are usually injury specific and, therefore, lack broader applicability given the narrow focus of their study populations. 6–8 The ability of a scoring system to predict RTW has also been previously evaluated. In neurological inpatients, both cognitive and functional scores, such as the Glasgow Outcome Scale and Functional Independence Measure, were assessed at discharge for their association with RTW and other postrehabilitation outcomes. 2 These scales or scoring systems have individually been validated in various brain injury models; however, they were not designed to be applied to patients with general trau- matic injuries affecting the whole body in addition to or separate from traumatic brain injury. 9 The modified Rankin Scale (mRS) is another vali- dated and simple measure of functional outcome, often used to assess rehabilitation outcomes after stroke (Fig. 1). 10, 11 Numerous studies have shown that a higher mRS is associated with more severe types of Poster presentation at the 28th Eastern Association for the Surgery of Trauma Annual Scientific Assembly, January 13–17, 2015, Lake Buena Vista, Florida. A.K., M.E.S., D.S., Do.Su., A.D, and M.S. designed the study. D.S. and Do.Su. were responsible for data acquisition. A.S., D.S., A.D, and Do.Su. performed the statistical analysis. A.K., M.E.S., M.S., E.C., S.R., S.T., and A.L. contributed to data analysis and interpretation. A.K., E.C., M.E.S., M.S., S.R., A.D, and S.T., wrote the manuscript. Address correspondence and reprint requests to Melvin E. Stone, JR, M.D., Department of Surgery, Jacobi Medical Center–Albert Einstein College of Medicine, 40 West 116th Street #A712, New York, NY 10026. E-mail: melvinomd@gmail.com. Level of Evidence: Level III, Therapeutic/care management study. 95