A-132 Long-Term Vocational Outcomes Following Cognitive Rehabilitation for Mild Traumatic Brain Injury (mTBI): 5-Year Follow-Up of a Cohort from the SCORE Randomized Clinical Trial

Objective Vocational functioning was examined in a cohort of military service members 5 years after completing a randomized, 4-arm controlled trial (RCT) exploring the efficacy of cognitive rehabilitation (CR) for persistent cognitive symptoms following mTBI. Methods Inception cohort design included 69 of the 103 participants (67%) who completed both the study intervention and a 6-week follow-up, contacted by phone at 5-year follow-up. Outcome measures included post-concussive symptoms, emotional distress, functional cognitive complaints, and occupational status. Participants were dichotomized into good and poor occupational outcome groups (Good — returned to duty or retired at the end of the term of service; Poor — medically retired or found unfit for duty by a medical evaluation board). Results Results of a 2X4 contingency table analysis (good/poor occupational outcome by CR treatment group) found 44% of the sample had good occupational outcomes at 5 years. Good outcomes did not significantly differ by CR treatment arm: psychoeducation 56%, computer-directed 18%, therapist-directed 43%, therapist-directed plus psychotherapeutic intervention 50%, χ2(3) = 4.213, p = 0.239. Logistic regression predicting occupational outcome by CR treatment arm found no significant findings of treatment arm (Computer vs. Psychoeducation β = −1.755, p = 0.059; Therapist-directed vs Psychoeducation β = −0.514, p = 0.434; Integrated vs. Psychoeducation β = −0.251, p = 0.716). Psychoeducation treatment arm was coded as the reference group. Conclusions Contrary to our hypotheses, long-term vocational outcomes were lower than expected, despite reductions in overall post-concussive complaints, functional cognitive difficulties, and emotional distress, underscoring the complexity of vocational functioning in post-deployment service members.