Coping, Complaints and early work resumption after mild-to-moderate traumatic brain injury: Preliminary results of the Upfront study

To investigate the nature and severity of complaints two weeks post trauma in a cohort of mild to moderate Traumatic Brain Injury (TBI) patients, and to determine the relation with return to work (RTW). Furthermore, it was explored whether an active versus a passive coping style is related to the severity of perceived complaints and the rate of RTW. Methods Multicenter prospective longitudinal cohort study of mild to moderate TBI patients admitted to the Emergency Departments. Brain injury severity was determined using the Glasgow Coma Scale (GCS) on admission. Patients received a questionnaire 2 weeks post trauma covering complaints (Dutch modified Rivermead Postconcussion Questionnaire), return to work and coping styles (Utrecht Coping List). Results The questionnaire was completed by 217 patients, with a mean age of 45.3 years (SD 19.6, range 16-91) and GCS scores ranging from 9-15 with 95% classified as mild TBI (GCS 13-15). Two weeks post injury 83% of all patients reported complaints. On average, patients reported 6 complaints, most frequently headache, dizziness, increased fatigability and sleepiness. Of those patients who were employed or following an education at the time of the injury, 52% partly or completely resumed their occupational activities or studies. The participants that resumed their work or studies reported a significantly lower amount of complaints compared to the non resumers (4 vs. 8, t(147)= 5.49, p<.001). Of the resumers, almost half (46%) reported 2 or more complaints. Concerning the premorbid coping profiles, the passive coping style was associated with a higher number of perceived complaints (r =.187, p <.001). A relation between an active coping style and the rate of RTW 2 weeks post injury was not found. Conclusions. Two weeks following mTBI the majority of the patients experiences complaints. Premorbid coping styles were associated with perceived complaints: patients with a passive coping style reported a higher number of complaints. In this relatively acute phase, more than half of the patients have resumed their previous activities. This implies that despite complaints, almost half of these early resumers are continuing their work or studies while not being fully recovered. Follow-up of these patients is necessary to assess if this early RTW pattern is predictive of long term work sustainability.