Most research into vocational re-integration following severe acquired brain injury (ABI) has focused on returning to pre-injury employment. While there is significant demand for new employment post-ABI, much less is known about this return-to-work (RTW) pathway.
Objective
To compare and contrast the clinical profiles and outcomes achieved through vocational rehabilitation (VR) following severe ABI according to RTW pathway.
Methods
Secondary data analysis of the Vocational Intervention Program efficacy trial (VIP1.0). Participants with severe ABI undertaking a VR program were re-classified into two RTW pathway groups: return to pre-injury employment (Fast-Track; FT) or obtaining new employment (New-Track; NT). Competitive employment status (Yes/No) and clinician ratings of disability and participation were collected pre- and post-intervention and at 3-month follow-up.
Results
47 (46%) participants undertook a FT pathway and 55 (54%) a NT pathway. Compared to FT, NT participants were less educated, more likely to be single, further post-injury, already attempted to RTW unsuccessfully post-injury, and less likely to complete the VR intervention. For both pathways, employment rates improved from pre- to post-intervention and remained stable at follow-up. While FT was associated with high RTW success (post-intervention: 89%; follow-up: 88%), a significant minority of NT participants also achieved competitive employment (post-intervention: 34%; follow-up: 45%). FT participants were also rated as demonstrating greater improvements in work-related participation from pre- to post-intervention than NT.
Conclusions
Despite its challenges, VR interventions targeting new employment can lead to beneficial RTW outcomes for many individuals unable to return to their previous employer following severe ABI.
McDonaldMWBlackSECoplandDA, et al.Cognition in stroke rehabilitation and recovery research: consensus-based core recommendations from the second stroke recovery and rehabilitation roundtable. Int J Stroke2019; 14: 774–782.
3.
Donker-CoolsBHPMDaamsJGWindH,et al.Effective return-to-work interventions after acquired brain injury: a systematic review. Brain Inj2016; 30: 113–131.
4.
de KoningMESpikmanJMCoersA, et al.Pathways of care the first year after moderate and severe traumatic brain injury—discharge destinations and outpatient follow-up. Brain Inj2015; 29: 423–429.
5.
GrauwmeijerEHeijenbrok-KalMHHaitsmaIK,et al.A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury. Arch Phys Med Rehabil2012; 93: 993–999.
6.
WagnerLISweetJButtZ, et al.Measuring patient self-reported cognitive function: development of the functional assessment of cancer therapy-cognitive function instrument. J Support Oncol2009; 7: W32–W39.
7.
McRaePHallabLSimpsonG. Navigating employment pathways and supports following brain injury in Australia: client perspectives. Aust J Rehabil Couns2016; 22: 76–92.
8.
MatérneMLundqvistL-OStrandbergT. Opportunities and barriers for successful return to work after acquired brain injury: a patient perspective. Work2017; 56: 125–134.
9.
BloomBThomasSAhrensbergJM, et al.A systematic review and meta-analysis of return to work after mild traumatic brain injury. Brain Inj2018; 32: 1623–1636.
10.
SigurdardottirSAndelicNWehlingE, et al.Return to work after severe traumatic brain injury: a national study with a one-year follow-up of neurocognitive and behavioural outcomes. Neuropsychol Rehabil2020; 30: 281–297.
11.
GormleyMDevanaboyinaMAndelicN, et al.Long-term employment outcomes following moderate to severe traumatic brain injury: a systematic review and meta-analysis. Brain Inj2019; 33: 1567–1580.
12.
WatanabeS. Vocational rehabilitation for clients with cognitive and behavioral disorders associated with traumatic brain injury. Work2013; 45: 273–277.
13.
KendallEMuenchbergerHGeeT. Vocational rehabilitation following traumatic brain injury: a quantitative synthesis of outcome studies. J Vocat Rehabil2006; 25: 149–160.
14.
Van DeynseHIlunga KazadiCKimpeE, et al.Predictors of return to work after moderate-to-severe traumatic brain injury: a systematic review of current literature and recommendations for future research. Disabil Rehabil2022; 44: 5750–5757.
15.
TateRLSimpsonGKMcRaeP, et al.Traumatic brain injury. In: EscorpizoRBrageSHomaD (eds) Handbook of vocational rehabilitation and disability evaluation: application and implementation of the ICF. New York (NY): Springer, 2015, pp. 263–294.
16.
FlemingJMToothLHassellM,et al.Prediction of community integration and vocational outcome 2–5 years after traumatic brain injury rehabilitation in Australia. Brain Inj1999; 13: 417–431.
17.
SimpsonGKMcRaePHallabL, et al.Participation in competitive employment after severe traumatic brain injury: new employment versus return to previous (pre-injury) employment. Neuropsychol Rehabil2020; 30: 995–1012.
18.
ThorJAMazlanMWaranV. Employment status after traumatic brain injury and the effect of concomitant injuries on return to work. Brain Inj2021; 35: 949–956.
19.
van VelzenJvan BennekomCEdelaarM, et al.How many people return to work after acquired brain injury?: a systematic review. Brain Inj2009; 23: 473–488.
20.
CuthbertJPPretzCRBushnikT, et al.Ten-Year employment patterns of working age individuals after moderate to severe traumatic brain injury: a national institute on disability and rehabilitation research traumatic brain injury model systems study. Arch Phys Med Rehabil2015; 96: 2128–2136.
21.
FabianoRJCreweN. Variables associated with employment following severe traumatic brain injury. Rehabil Psychol1995; 40: 223–231.
22.
WangVFortEBeaudoin-GobertM, et al.Indicators of long-term return to work after severe traumatic brain injury: a cohort study. Ann Phys Rehabil Med2019; 62: 28–34.
23.
SimpsonGKMcRaePGatesTM, et al.Is the vocational intervention program effective in enhancing return to work after severe acquired brain injury? A controlled trial. Ann Phys Rehabil Med2023; 66: 101787.
24.
SimpsonGKDaherMHodgkinsonA,et al.Comparing the injury profile, service use, outcomes, and comorbidities of people with severe TBI across urban, regional, and remote populations in New South Wales: a multicentre study. J Head Trauma Rehabil2016; 31: E26–E38.
HonanCAMcDonaldSTateR, et al.Outcome instruments in moderate-to-severe adult traumatic brain injury: recommendations for use in psychosocial research. Neuropsychol Rehabil2019; 29: 896–916.
27.
McCauleySRLevinHSVanierM, et al.The neurobehavioural rating scale-revised: sensitivity and validity in closed head injury assessment. J Neurol Neurosurg Psych2001; 71: 643–651.
28.
BurgessPWAldermanNWilsonBA, et al.The Dysexecutive Questionnaire. In: WilsonBAAldermanNBurgessPW (eds) Behavioural assessment of the dysexecutive syndrome. Bury St. Edmunds, U.K.: Thames Valley Test Company, 1996.
29.
BurgessPWAldermanNEvansJ, et al.The ecological validity of tests of executive function. J Int Neuropsychol Soc1998; 4: 547–558.
30.
BennettPCOngBPonsfordJ. Measuring executive dysfunction in an acute rehabilitation setting: using the dysexecutive questionnaire (DEX). J Int Neuropsychol Soc2005; 11: 376–385.
31.
BennettPCOngBPonsfordJ. Assessment of executive dysfunction following traumatic brain injury: comparison of the BADS with other clinical neuropsychological measures. J Int Neuropsychol Soc2005; 11: 606–613.
32.
RappaportMHallKMHopkinsK, et al.Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil1982; 63: 118–123.
33.
WilliamsMWSmithEL. Clinical utility and psychometric properties of the disability rating scale with individuals with traumatic brain injury. Rehabil Psychol2017; 62: 407–408.
34.
TateRLSimpsonGKSooCA,et al.Participation after acquired brain injury: clinical and psychometric considerations of the Sydney psychosocial reintegration scale (SPRS). J Rehabil Med2011; 43: 609–618.
35.
TateRLPfaffAVeerabangsaA,et al.Measuring psychosocial recovery after brain injury: change versus competency. Arch Phys Med Rehabil2004; 85: 538–545.
36.
FlemingerSLeighEEamesP, et al.HoNOS-ABI: a reliable outcome of neuropsychiatric sequelae to brain injury?Psychiatr Bull2005; 29: 53–55.
37.
MorelJGBokossaMCNeerchalNK. Small sample correction for the variance of GEE estimators. Biom J2003; 45: 395–409.
38.
PettyJMcLennanVKendallE,et al.Scoping review of return-to-work interventions for persons with traumatic brain injury. Disabil Rehabil2024; 46: 3243–3255.
McRaePKobelCLukersmithS,et al.What does it take to get somebody back to work after severe acquired brain injury? Service actions within the vocational intervention program (VIP 2.0). Int J Environ Res Public Health2022; 19: 9548.
41.
TrexlerLEParrottDRMalecJF. Replication of a prospective randomized controlled trial of resource facilitation to improve return to work and school after brain injury. Arch Phys Med Rehabil2016; 97: 204–210.
42.
WatkinCPhillipsJRadfordK. What is a ‘return to work’ following traumatic brain injury? Analysis of work outcomes 12 months post TBI. Brain Inj2020; 34: 68–77.
43.
SpitzGMahmooeiBHRossP, et al.Characterizing early and late return to work after traumatic brain injury. J Neurotrauma2019; 36: 2533–2540.
44.
MurrayAWatterKMcLennanV, et al.Identifying models, processes, and components of vocational rehabilitation following acquired brain injury: a systematic scoping review. Disabil Rehabil2022; 44: 7641–7654.
45.
WagnerAKHammondFMSasserHC,et al.Return to productive activity after traumatic brain injury: relationship with measures of disability, handicap, and community integration. Arch Phys Med Rehabil2002; 83: 107–114.
46.
MurphyLChamberlainEWeirJ, et al.Effectiveness of vocational rehabilitation following acquired brain injury: preliminary evaluation of a UK specialist rehabilitation programme. Brain Inj2006; 20: 1119–1129.
47.
TyermanA. Vocational rehabilitation after severe traumatic brain injury: iI-specialist interventions and outcomes. J Occup Psychol Employ Disabil2000; 2: 13–20.
48.
O’BrienL. Achieving a successful and sustainable return to the workforce after ABI: a client-centred approach. Brain Inj2007; 21: 465–478.
49.
GatesTMDaherMMcRaeP,et al.Validation of the work-ability support scale in individuals seeking to return to work after severe acquired brain injury. Disabil Rehabil2023; 46: 3164–3175.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
