Psychology, Department of


First Advisor

Debra A. Hope

Date of this Version


Document Type



Capozzoli, M.C. (2018). Predictors of return to work after multidisciplinary rehabilitation evaluation for prolonged post-concussion symptoms. (Unpublished doctoral dissertation). University of Nebraska-Lincoln, Lincoln, NE.


A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Psychology, Under the Supervision of Professor Debra A. Hope. Lincoln, Nebraska: March, 2018

Copyright (c) 2018 Michelle C. Capozzoli


Mild traumatic brain injuries (mTBI) comprise the majority of TBI’s sustained. For most individuals with mTBI, post-injury sequelae resolve within approximately three months after injury, yet a minority experience prolonged post-concussion symptoms (PCS) associated with poor long-term functioning, including inability to return to work (RTW). Research on RTW following mTBI has found moderate support for pre-injury and post-injury factors on employment outcomes, while injury factors have largely demonstrated a weak relationship. However, critical factors that may predict long-term outcome in mTBI are often not included in these studies, such as pre-morbid psychopathology, prior TBI, occupational decision-making latitude, litigation-seeking, and insurance provider. In addition, little is understood about the contribution of multidisciplinary rehabilitation to RTW. The purpose this study was to elucidate pre-injury, injury, post-injury, and rehabilitation factors that predict employment outcomes after mTBI. An archival medical record review was completed with 79 mTBI patients who completed an initial evaluation for multidisciplinary rehabilitation for PCS. RTW status was collected by follow-up telephone interview and served as the primary outcome measure. A total of 58 participants (73.4%) resumed employment when reached at follow-up on average two years and 10 months post-injury. Among several factors considered, three post-injury variables obtained at rehabilitation admission explained 23.1% of the variance in successful RTW: lower self-reported PCS, lower anxiety symptoms, and better performance on a measure of verbal memory recognition. With regard to multidisciplinary rehabilitation factors, only increased number of speech-language pathology therapy sessions was associated with poorer employment outcomes. Overall, findings suggest that anxiety, particularly as it relates to PCS, deserves increased attention in empirical research and rehabilitation efforts. Furthermore, individuals with cognitive symptoms requiring more intensive rehabilitation may be at increased risk of poor employment outcomes.

Advisor: Debra A. Hope

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