Little is known about type of work as a risk factor for post-injury disability, despite its relevance to functional independence and return-to-work outcomes. Traditional occupational classifications (professional/managerial, skilled, manual labor, student, unemployed, retired) may not adequately capture the cognitive demands that influence recovery. This study examined whether a cognitive impact–based occupational classification better predicts disability outcomes after traumatic brain injury (TBI) than traditional job-type groupings.

204 post-TBI patients (mean age 47.1 ± 17.4 years; 46% female; median months since injury 5 [IQR: 2–25]) were analyzed. Occupations were categorized as follows: High cognitive impact – roles requiring precision or complex decision-making; Moderate/high impact – safety-sensitive or judgment-intensive roles; Moderate/variable impact – creative or mixed cognitive roles; Minimal/no impact – retired individuals, students, or repetitive-tasks.

Disability was defined as GOSE ≤ 6. Logistic and ordinal regression models evaluated the relationship between occupational category, GOSE outcomes, and Montreal Cognitive Assessment (MoCA) performance, adjusting for age, sex, injury severity, and race/ethnicity.

Overall, 67% of participants were GOSE-disabled. Higher occupational cognitive impact was associated with greater odds of disability (OR = 1.50, 95% CI 1.17–1.94, p = 0.002) despite better cognitive performance on the MoCA (OR = 0.53, 95% CI 0.33–0.84, p = 0.008). The traditional job-type classification yielded a nonsignificant association with disability (OR = 1.22, 95% CI 0.90–1.65).

Occupations with high cognitive demands were independently associated with greater functional disability following TBI, even among individuals with preserved cognitive test performance. These findings suggest that cognitively demanding work may act as a barrier to functional independence and highlight the need for occupation-sensitive approaches in risk assessment and rehabilitation planning.