J Head Trauma Rehabil Vol. 29, No. 5, pp. 443–450 Copyright c  2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Return to Work Following Mild Traumatic Brain Injury Minna W ¨ aljas, PsyLic; Grant L. Iverson, PhD; Rael T. Lange, PhD; Suvi Liimatainen, MD, PhD; Kaisa M. Hartikainen, MD, PhD; Prasun Dastidar, MD, PhD; Seppo Soimakallio, MD, PhD; Juha ¨ Ohman, MD, PhD Objective: To examine factors relating to return to work (RTW) following mild traumatic brain injury (mTBI). Participants: One hundred and nine patients (Age: M = 37.4 years, SD = 13.2; 52.3% women) who sustained an mTBI. Design: Inception cohort design with questionnaires and neuropsychological testing completed approx- imately 3 to 4 weeks postinjury. Setting: Emergency Department of Tampere University Hospital, Finland. Main Outcome Measures: Self-report (postconcussion symptoms, depression, fatigue, and general health) and neurocog- nitive measures (attention and memory). Results: The cumulative RTW rates were as follows: 1 week = 46.8%, 2 weeks = 59.6%, 3 weeks = 67.0%, 4 weeks = 70.6%, 2 months = 91.7%, and 1 year = 97.2%. Four variables were significant predictors of the number of days to RTW: age, multiple bodily injuries, intracranial abnormality at the day of injury, and fatigue ratings (all P < .001). The largest amount of variance accounted for by these variables in the prediction of RTW was at 30 days following injury (P < .001, R 2 = 0.504). Participants who returned to work fewer than 30 days after injury (n = 82, 75.2%) versus more than 30 days (n = 27, 24.8%) did not differ on demographic or neuropsychological variables. Conclusions: The vast majority of this cohort returned to work within 2 months. Predictors of slower RTW included age, multiple bodily injuries, intracranial abnormality at the day of injury, and fatigue. Key words: mild traumatic brain injury, outcome, return to work M OST individuals recover rapidly and return to their everyday activities soon after sustaining a mild traumatic brain injury (mTBI). 1,2 However, some Author Affiliations: Department of Neurosurgery, Tampere University Hospital, Tampere, Finland (Ms W ¨ aljas and Dr ¨ Ohman); University of Tampere Medical School, Tampere, Finland (Ms W ¨ aljas and Drs Hartikainen, Dastidar, Soimakallio, and ¨ Ohman); Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts (Dr Iverson); Defense and Veterans Brain Injury Center, Bethesda, Maryland (Dr Lange); Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Lange); Department of Neurosciences and Rehabilitation and Emergency Department Acuta, Tampere University Hospital, Tampere, Finland (Dr Liimatainen); and Medical Imaging Centre of Pirkanmaa Hospital District, Finland (Drs Dastidar and Soimakallio). This research was funded by Competitive Research Funding of the Pirkanmaa Hospital District, Tampere University Hospital. This study was done as part of the first author’s PhD thesis research program. The authors thank Pasi Jolma (MD, PhD) for recruiting the patients. This study was presented at the third Federal Interagency Conference on Trau- matic Brain Injury, Washington, DC, June 13-15, 2011. Dr Lange notes that the views expressed in this article are those of the authors and do not reflect the official policy of the Department of Defense or US Government. The authors declare no conflicts of interest. Corresponding Author: Minna W ¨ aljas, PsyLic, Tampere University Hospi- tal, Department of Neurosurgery, PO Box 2000, FIN-3521 Tampere, Finland (minna.waljas@gmail.com). DOI: 10.1097/HTR.0000000000000002 suffer persistent symptoms for a prolonged period af- ter mTBI, which interferes with their return to work (RTW). 3 The risk factors for poor outcome and specifi- cally for delayed RTW after mTBI are diverse, complex, and not well-understood. 4 Traditional brain injury severity variables (eg, dura- tion of loss of consciousness [LOC], Glasgow Coma Score [GCS]) 2 or postinjury cognitive impairment have shown limited usefulness in predicting outcome after mTBI. 5,6 Some studies, 7–12 but not all, 13–15 have reported that mTBI patients with trauma-related intracranial abnormalities are more likely to have worse outcome than those with uncomplicated mTBIs (pa- tients with no intracranial abnormalities). Other factors such as duration of posttraumatic amnesia, 2 personality characteristics, pre- and postinjury physical functioning, psychological status, protracted litigation, employment status, substance abuse problems, and presence of extracranial injuries are considered potential correlates of outcome. 16 Nolin and Heroux 17 emphasized the importance of focusing on subjective complaints that arise following the injury. In their study, only the total number of symptoms reported at follow-up was related to vocational status. Patient characteristics, injury severity indicators, and cognitive functioning were not associated with vocational status after mTBI. 17 Return to work is an important outcome measure of TBI. It has been emphasized as a key component for Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 443