A systematic review and meta-analysis of return to work after mild Traumatic brain injury

Purpose To perform a systematic review and meta-analysis of return to work (RTW) times for adult patients with mild traumatic brain injury (mTBI). Methods Six databases and six trials registries were searched. Inclusion: studies reporting RTW, > 30 patients, adults, with mTBI. Exclusion final measurement RTW < 30 days after injury, first measurement > 1 year. Results Of 978 records, 14 eligible studies were identified. Two included patients exclusively in paid employment pre-injury; four included paid employment, students, homemakers or other activities; seven included pre-injury occupational status described but unclear; one included patients whose pre-injury occupational status not described. Three reported average RTW, 12 reported proportions of patients RTW at pre-specified time-points (1 both). Average RTW times varied from 13 to 93 days. At 1 month the proportion of patients RTW (three pooled studies) was 0.56 (95% CI 0.30-0.79), at 6 months (six studies) 0.83 (0.74-0.89), at 12 months (seven studies) 0.89 (0.83-0.93). Conclusions More than half of patients with mTBI have returned to work by 1 month after injury, and more than 80% by 6 months. Most studies had poor internal validity. Reporting of outcomes in mTBI is variable, and this accounted for some of the heterogeneity found in this review.

Source: Bloom B, Thomas S, Ahrensberg JM, Weaver R, Fowler A, Bestwick J, Harris T, Pearse R, Brain Injury, Vol. 32 (13/14), p.1623-1636, 2018.

Interdisciplinary Approaches to Facilitate Return to Driving and Return to Work in Mild Stroke: A Position Paper

Purpose Adults with mild stroke face substantial challenges resuming valued roles in the community. The term "mild" provides false representation of the lived experience for many adults with mild stroke who may continue to experience persistent challenges and unmet needs. Rehabilitation practitioners can identify and consequently intervene to facilitate improved independence, participation, and quality of life by facilitating function and reducing the burden of lost abilities among adults with mild stroke. Methods The Health and Wellness Task Force identified 2 important, and often interdependent, goals that frequently arise among adults living with mild stroke that must be addressed to facilitate improved community reintegration: (1) return to driving and (2) return to work. Adults with mild stroke may not be receiving adequate rehabilitative services to facilitate community reintegration for several reasons but primarily because current practice models are not designed to meet such needs of this specific population. Thus, the Health and Wellness Task Force convened to review current literature and practice trends to (1) identify opportunities based on the evidence of assessment and interventions, for return to driving and return to work; and (2) identify gaps in the literature that must be addressed to take advantage of the opportunities. Conclusions Based on findings, the task force proposes a new interdisciplinary practice model for adults with mild stroke who are too often discharged from the hospital to the community without needed services to enable successful return to driving and work.

Source: Burns S, Schwartz P, Scott JK, Devos SL, Kovic H, Hong M, Akinwuntan I, Archives of Physical Medicine & Rehabilitation, Vol.99 (11), p. 2378-2388, 2018 Nov.

Workplace accommodations following work-related mild traumatic brain injury: what works?

Purpose Individuals who have experienced a work-related mild traumatic brain injury face a variety of challenges when returning to work. Research has demonstrated that the implementation of workplace accommodations can reduce the incidence of workplace disability. Few studies investigate work-related mild traumatic brain injury from injured workers' perspectives, and none examine workplace accommodations in detail. This study explores the types of accommodations that individuals receive, and the factors that influence how they are provided and to whom.Methods This study is a qualitative secondary data analysis of 12 telephone interviews. ATLAS.ti software was used to facilitate coding and thematic analysis was used to analyze the data. Results This study makes explicit various accommodations identified as being useful or required by individuals on return to work. Participants identified a gradual return to work, and modified duties, among other accommodations. Components of the workplace social and structural environment, and the occupational context influenced how accommodations were provided and to whom. Conclusions Obtaining appropriate support is of great importance to injured employees, their employers, insurers, and healthcare providers. Stakeholders should be aware of how to successfully identify and access appropriate workplace accommodations to support injured workers on return to work. Implications for rehabilitation   Return to Work Accommodations • Workplace accommodations reduce the incidence of workplace disability. • Workplace accommodations can be formal or informal. • Participants identified a gradual return to work, modified duties, self-directed compensatory strategies, and allowances for medical appointments, among other accommodations, as being useful or required. • Stakeholders, including healthcare providers involved in rehabilitation, should be aware of how to successfully identify and implement these accommodations to ensure injured workers are supported on return to work.

Source: Gourdeau J, Fingold A, Colantonio A, Mansfield E, Stergiou-Kita M, Disability and Rehabilitation, p. 1-10, 2018 Nov.

A systematic review and meta-analysis of return to work after mild Traumatic brain injury

Purpose To perform a systematic review and meta-analysis of return to work (RTW) times for adult patients with mild traumatic brain injury (mTBI). Methods Six databases and six trials registries were searched. Inclusion: studies reporting RTW, > 30 patients, adults, with mTBI. Exclusion: final measurement RTW < 30 days after injury, first measurement > 1 year. Results Of 978 records, 14 eligible studies were identified. Two included patients exclusively in paid employment pre-injury; four included paid employment, students, homemakers or other activities; seven included pre-injury occupational status described but unclear; one included patients whose pre-injury occupational status not described. Three reported average RTW, 12 reported proportions of patients RTW at pre-specified time-points (1 both). Average RTW times varied from 13 to 93 days. At 1 month the proportion of patients RTW (three pooled studies) was 0.56 (95% CI 0.30-0.79), at 6 months (six studies) 0.83 (0.74-0.89), at 12 months (seven studies) 0.89 (0.83-0.93). Conclusions More than half of patients with mTBI have returned to work by 1 month after injury, and more than 80% by 6 months. Most studies had poor internal validity. Reporting of outcomes in mTBI is variable, and this accounted for some of the heterogeneity found in this review.

Source: Bloom B, Thomas S, Ahrensberg JM, Weaver R, Fowler A, Bestwick J, Harris T, Pearse R, Brain Injury, p. 1-14, 2018 Oct.

Return to Pre-Injury Work Following Mild Traumatic Brain Injury

Purpose Adults are at risk for unemployment following a moderate-severe traumatic brain injury (TBI). Less is known about employment patterns following mild TBI. This study aims to examine patterns of return to pre-injury job in adults following mild TBI over a 12-month post injury period, and to investigate factors associated with return to work. Methods It is a prospective longitudinal study of 205 adults (aged ≥16 years at injury) identified as part of a larger population-based incidence study in the Waikato, New Zealand. In-person assessments were completed at baseline (within 14 days) and 1-, 6-, and 12-month post-injury. Results A total of 159 (77.6%) adults returned to their pre-injury job at baseline and 185 (90.2%) returned within 12 months. Of those who did not return to their pre-injury job at baseline (n = 46), younger age at injury (≤30 years, p =.02) and poor overall neurocognitive functioning at 1-month (p =.02) was associated with non-return to pre-injury job at 12 months. Conclusions In a sample of employed adults, the majority returned to their pre-injury job shortly after injury. Cognitive functioning and younger age at time of injury may be associated with delayed return to work. Interventions to support younger workers may facilitate their return to work.

Source: Jones KM, Balalla S, Feigin VL, Kahan M, Stedman E, McPherson K, Brain Impairment, Vol. 19 (2), p.153-165, 2018 Sep.

Fear Avoidance and Clinical Outcomes from Mild Traumatic Brain Injury

Purpose Characterizing psychological factors that contribute to persistent symptoms after mild traumatic brain injury (MTBI) can inform early intervention. To determine whether fear avoidance, a known risk factor for chronic disability after musculoskeletal injury, is associated with worse clinical outcomes from MTBI, adults were recruited from four outpatient MTBI clinics and assessed at their first clinic visit (mean = 2.7, standard deviation = 1.5 weeks post-injury) and again four to five months later. Methods Of 273 patients screened, 102 completed the initial assessment, and 87 returned for the outcome assessment. The initial assessment included a battery of questionnaires that measure activity avoidance and associated fears. Endurance, an opposite behavior pattern, was measured with the Behavioral Response to Illness Questionnaire. The multi-dimensional outcome assessment included measures of post-concussion symptoms (British Columbia Postconcussion Symptom Inventory), functional disability (World Health Organization Disability Assessment Schedule-12 2.0), return to work status, and psychiatric complications (MINI Neuropsychiatric Interview). Results A single component was retained from principal components analysis of the six avoidance subscales. In generalized linear modeling, the avoidance composite score predicted symptom severity (95% confidence interval [CI] for B = 1.22–6.33) and disability (95% CI for B = 2.16–5.48), but not return to work (95% CI for B = −0.68–0.24). The avoidance composite was also associated with an increased risk for depression (odds ratio [OR] = 1.76, 95% CI = 1.02–3.02) and anxiety disorders (OR = 1.89, 95% CI = 1.16–3.19). Conclusions Endurance behavior predicted the same outcomes, except for depression. In summary, avoidance and endurance behavior were associated with a range of adverse clinical outcomes from MTBI. These may represent early intervention targets.

Purpose: Silverberg ND, Panenka WJ, Iverson GL, Journal of Neurotrauma, Vol. 35 (16), p.1864-1873, 2018 Aug.

The relationship between post-traumatic growth and return to work following mild traumatic brain injury

Purpose To investigate the prevalence of post-traumatic growth (PTG) following mild traumatic brain injury (mTBI) and to examine whether PTG is associated with vocational status. Methods Archival data from a random sample of 74 individuals who sustained mTBI (mean age: 43.23; male, 55%) were obtained from a larger sample of litigating patients who were referred for a neuropsychological examination. Factors associated with return to work were ascertained using a multiple regression analysis. The demographic variables age, sex, and education were added to the first block, whilst relating to others, new possibilities, personal strength, spiritual change, and appreciation of life, as measured by the Posttraumatic Growth Inventory (PTGI), were added in the second block. Results Approximately 31% of the sample exhibited moderate levels of PTG, as defined by endorsing a 3 or more on each item of the PTGI, with the most common aspects of PTG being appreciation of life, relating to others, and personal strength. The multiple regression analysis revealed that new possibilities and personal strength were independently associated with return to work. Conclusions Results of this study suggest that there is evidence for the development of PTG among individuals with mTBI. These findings have important implications for rehabilitation planning, individual and family adjustment, and the prediction of long-term outcome as it pertains to return to work in particular. Return to work is an integral component of rehabilitation following mild traumatic brain injury (mTBI) and should not be overlooked. Results of this study indicate that post-traumatic growth (PTG) can be used to inform intervention approaches that seek to promote growth and resiliency post-injury. Informing patients about the prospects of a positive post-injury recovery trajectory could help manage the individual's expectations of recovery.

Source: Sekely A, Zakzanis KK, Disability and Rehabilitation, 2018 May.

Workplace and non-workplace mild traumatic brain injuries in an outpatient clinic sample: A case-control study

Purpose Individuals who are injured in the workplace typically have a greater risk of delayed return to work (RTW) and other poor health outcomes compared to those not injured at work. It is not known whether these differences hold true for mild traumatic brain injuries (MTBI). The present study examined differences associated with workplace and non-workplace MTBI upon intake to a specialty MTBI clinic, their outcomes, and risk factors that influence RTW. Methods Slow-to-recover participants were recruited from consecutive referrals to four outpatient MTBI clinics from March 2015 to February 2017. Two clinics treat Worker’s Compensation claimants and two clinics serve patients with non-work related injuries in the publically funded health care system. Results Of 273 eligible patients, 102 completed an initial study assessment (M age = 41.2 years, SD age = 11.7; 54% women) at an average of 2–3 months post injury. Participants were interviewed about their MTBI and completed a battery of standardized questionnaires and performance validity testing. Outcomes, including RTW, were assessed via telephone follow-up 4–5 months later. Workplace injuries comprised 45.1% of the sample. The workplace MTBI group had a greater proportion of men and lower education levels compared to the non-workplace MTBI group. The two groups had a comparable post-concussion symptom burden and performance validity test failure rate. Workplace MTBI was associated with greater post-traumatic stress symptoms. Fifteen patients (14.7%) were lost to follow-up. There were no workplace/non-workplace MTBI differences in RTW outcome at 6–7 months post injury. Of the entire sample, 42.5% of patients had full RTW, 18.4% had partial RTW, and 39.1% had no RTW. Greater post-concussion symptom burden was most predictive of no RTW at follow-up. Conclusions There was no evidence that the workplace and non-workplace MTBI groups had different risk factors associated with prolonged work absence. Despite systemic differences in compensation and health care access, the workplace and non-workplace MTBI groups were similar at clinic intake and indistinguishable at follow-up, 6–7 months post injury

Source: Terry DP, Iverson GL, Panenka W, Colantonio A, Silverberg ND, PLoS ONE, Vol. 13 (5), p.1-17, 2018 Jun.

Rehabilitation Trajectories and Outcomes in Individuals With Mild Traumatic Brain Injury and Psychiatric Histories: A TRACK-TBI Pilot Study

Purpose To determine differences in rehabilitation trajectories and return to work (RTW) and social outcomes in individuals with mild traumatic brain injury (mTBI) with and without significant psychiatric histories at index hospitalization. Methods Three level 1 trauma centers participating in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) consortium. A total of 305 individuals with index mTBI enrolled in the TRACK-TBI pilot project. Design Secondary analysis of data from the TRACK-TBI pilot study. Main Measures Chart review and patient/family interview at emergency department (ED) admission, ED clinical data, ED discharge plan, functional interview data at 3- and 6-month outcomes, Trail Making Tests, the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index, the California Verbal Learning Test, Second Edition, and the Craig Handicap Assessment and Reporting Technique. Results Controlling for neurological history and CT lesion at ED admission, participants with and without psychiatric histories did not differ in terms of treatment, return to work, or reported social function. Individuals with psychiatric histories demonstrated lower processing speed and reported reduced satisfaction with occupational function at outcome. Conclusions Individuals with mTBI and psychiatric histories may require specialized rehabilitation planning to address increased risk for cognitive difficulties and occupational dissatisfaction at outcome. CT lesion may independently influence outcomes.

Source: Bertisch H, Satris G, Temkin N, Barber J, Manley GT, Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Investigators, The Journal of Head Trauma Rehabilitation, 2018 May.

Workplace and non-workplace mild traumatic brain injuries in an outpatient clinic sample: A case-control study

Purpose Individuals who are injured in the workplace typically have a greater risk of delayed return to work (RTW) and other poor health outcomes compared to those not injured at work. It is not known whether these differences hold true for mild traumatic brain injuries (MTBI). The present study examined differences associated with workplace and non-workplace MTBI upon intake to a specialty MTBI clinic, their outcomes, and risk factors that influence RTW. Methods Slow-to-recover participants were recruited from consecutive referrals to four outpatient MTBI clinics from March 2015 to February 2017. Two clinics treat Worker's Compensation claimants and two clinics serve patients with non-work related injuries in the publically funded health care system. Results Of 273 eligible patients, 102 completed an initial study assessment (M age = 41.2 years, SD age = 11.7; 54% women) at an average of 2-3 months post injury. Participants were interviewed about their MTBI and completed a battery of standardized questionnaires and performance validity testing. Outcomes, including RTW, were assessed via telephone follow-up 4-5 months later. Workplace injuries comprised 45.1% of the sample. The workplace MTBI group had a greater proportion of men and lower education levels compared to the non-workplace MTBI group. The two groups had a comparable post-concussion symptom burden and performance validity test failure rate. Workplace MTBI was associated with greater post-traumatic stress symptoms. Fifteen patients (14.7%) were lost to follow-up. There were no workplace/non-workplace MTBI differences in RTW outcome at 6-7 months post injury. Of the entire sample, 42.5% of patients had full RTW, 18.4% had partial RTW, and 39.1% had no RTW. Greater post-concussion symptom burden was most predictive of no RTW at follow-up. Conclusions There was no evidence that the workplace and non-workplace MTBI groups had different risk factors associated with prolonged work absence. Despite systemic differences in compensation and health care access, the workplace and non-workplace MTBI groups were similar at clinic intake and indistinguishable at follow-up, 6-7 months post injury.

Source: Terry DP, Iverson GL, Panenka W, Colantonio A, Silverberg ND, Plos One, Vol. 13 (6), 2018 Jun.

Work Productivity Loss After Mild Traumatic Brain Injury

Purpose To examine the completeness of return to work (RTW) and the degree of productivity loss in individuals who do achieve a complete RTW after mild traumatic brain injury (MTBI). Design Multisite prospective cohort. Setting Outpatient concussion clinics. Participants Patients (N=79; mean age, 41.5y; 55.7% women) who sustained an MTBI and were employed at the time of the injury. Participants were enrolled at their first clinic visit and assessed by telephone 6 to 8 months postinjury. Results Structured interview of RTW status, British Columbia Postconcussion Symptom Inventory (BC-PSI), Lam Employment Absence and Productivity Scale (LEAPS), Mini International Neuropsychiatric Interview, and brief pain questionnaire. Participants who endorsed symptoms from ≥3 categories with at least moderate severity on the BC-PSI were considered to meet International Classification of Diseases, 10th Revision criteria for postconcussional syndrome. RTW status was classified as complete if participants returned to their preinjury job with the same hours and responsibilities or to a new job that was at least as demanding. Results Of the 46 patients (58.2%) who achieved an RTW, 33 (71.7%) had a complete RTW. Participants with complete RTW had high rates of postconcussional syndrome (44.5%) and comorbid depression (18.2%), anxiety disorder (24.2%), and bodily pain (30.3%). They also reported productivity loss on the LEAPS, such as “getting less work done” (60.6%) and “making more mistakes” (42.4%). In a regression model, productivity loss was predicted by the presence of postconcussional syndrome and a comorbid psychiatric condition, but not bodily pain. Conclusions Even in patients who RTW after MTBI, detailed assessment revealed underemployment and productivity loss associated with residual symptoms and psychiatric complications.

Source: Silverberg ND, Panenka WJ, Iverson GL, Archives of Physical Medicine & Rehabilitation, Vol. 99(2), p.250-256, 2018 Feb. 

Cognitive Behavioral Intervention Compared to Telephone Counseling Early after Mild Traumatic Brain Injury: A Randomized Trial

Purpose Many patients do not return to work (RTW) after mild traumatic brain injury (mTBI) because of persistent complaints that are often resistant to therapy in the chronic phase. Recent studies suggest that psychological interventions should be implemented early post-injury to prevent patients from developing chronic complaints. Methods This study is a randomized, controlled trial that examines the effectiveness of a newly developed cognitive behavioral therapy (CBT) intervention (CBTi) compared to telephonic counseling (TC) in at-risk mTBI patients (patients with high reports of early complaints). Patients underwent either five sessions of CBT treatment or five phone conversations starting 4-6 weeks post-trauma. The main outcome measure was RTW 6 and 12 months post-trauma. Secondary measures comprised functional outcome at 6 and 12 months, and depression, anxiety, and reported post-traumatic complaints at 3, 6, and 12 months post-injury. Results After excluding dropouts, CBTi consisted of 39 patients and TC of 45 patients. No significant differences were found with regard to RTW, with 65% of CBTi patients and 67% of TC patients reporting a RTW at previous level. However, TC patients reported fewer complaints at 3 (8 vs. 6; p = 0.010) and 12 months post-injury (9 vs. 5; p = 0.006), and more patients in the TC group showed a full recovery 12 months post-injury compared to the CBTi group (62% vs. 39%). Conclusions The results of this study suggest that early follow-up of at-risk patients can have a positive influence on patients' well-being, and that a low-intensive, low-cost telephonic intervention might be more effective than a CBT intervention at improving outcome in at-risk patients.

Source: Scheenen ME, Visser-Keizer AC, de Koning ME, van der Horn HJ, van de Sande P, van Kessel M, van der Naalt J, Spikman JM, Journal of Neurotrauma, Vol. 34 (19), p.2713-2720, 2017 Oct.

Prediction of work resumption and sustainability up to 1 year after mild traumatic brain injury

Purpose To study return to work (RTW) after mild traumatic brain injury (mTBI) at several intervals after injury and to predict RTW on the basis of occupational factors in addition to demographic, personality, and injury-related factors at 6 and 12 months after injury. Methods This was a prospective cohort study (UPFRONT study, n = 1,151) of patients with mTBI admitted to the emergency department. Patients received questionnaires at 2 weeks and 3, 6, and 12 months after injury. RTW was divided into 3 levels: complete (cRTW), partial (pRTW), and no RTW. Results Rates of cRTW increased from 34% at 2 weeks to 77% at 12 months after injury, pRTW varied from 8% to 16% throughout the year. Logistic regression (complete vs incomplete RTW) demonstrated that apart from previously identified predictors such as demographics (e.g., age and education) and injury characteristics (e.g., cause and severity of injury) and indicators of psychological distress, occupational factors were of influence on work resumption after 6 months (area under the curve [AUC] = 0.82), At 12 months, however, the model was based solely on the presence of extracranial injuries and indicators of maladaptation after injury (AUC = 0.81). Conclusions RTW after mTBI is a gradual process, with varying levels of RTW throughout the first year after injury. Different predictors were relevant for short- vs long-term work resumption, with occupational factors influencing short-term RTW. However, for both short- and long-term RTW, posttraumatic complaints and signs of psychological distress early after injury were relevant predictors, allowing early identification of patients at risk for problematic work resumption.

Source: de Koning ME, Scheenen ME, van der Horn HJ, Timmerman ME, Hageman G, Roks G, Spikman JM, van der Naalt J, Neurology, 2017 Oct.

Three versus seven days to return-to-work after mild traumatic brain injury: a randomized parallel-group trial with neuropsychological assessment

Purpose Although most patients with a mild traumatic brain injury (mTBI) recover within days to weeks, some experience persistent physical, cognitive and emotional symptoms, often described as post-concussion syndrome (PCS). The optimal recovery time including return-to-work (RTW) after mTBI is unclear. Methods In this single-centre parallel-group trial, patients assigned three days (3D-group) or seven days (7D-group) sick leave were compared with a comprehensive neuropsychological test battery including the Post-Concussion Symptom Scale (PCSS) within one week, after three and 12 months post-injury. The influence of the effective time until RTW on post-concussional symptoms and cognitive performance was analysed. Results The 3D-group rated significantly higher mean scores in some PCSS symptoms, tended to fulfil diagnosis criteria of PCS more often and showed better cognitive performance in several neuropsychological test scores than the 7D-group at all three time-points of follow-up. Overall, patients returned to work 11.35 d post-injury, thus distinctly above both recommended sick leaves. There was a trend for longer sick leave in patients randomized into the 3D-group. Further analyses revealed that the group with an absolute RTW within one week showed lower symptom severity in fatigue at 3 and 12 months, less PCS and faster performance in fine motor speed at 12 months than the group with an absolute RTW after one week. Conclusions Our data underline the heterogeneity of mTBI and show that acute and sub-acute symptoms are not prognostic factors for neuropsychological outcome at one year. Later, ability to work seems to be prognostic for long-term occurrence of PCS.

Source: Studerus-Germann AM, Engel DC, Stienen MN, von Ow D, Hildebrandt G, Gautschi OP, International Journal of Neuroscience, Vol. 127 (10), p.900-908, 2017 Oct.

Quality of return to work in patients with mild traumatic brain injury: a prospective investigation of associations among post-concussion symptoms, neuropsychological functions, working status and stability

Purpose Although ‘return to work’ (RTW) has been always emphasized for patients with mild traumatic brain injury (MTBI), methodological drawbacks weakened its representativeness. This study thus aims to evaluate the ‘work quality’ (WQ) which originated from ‘working status’ and ‘working stability’ simultaneously, and to further explore the associations among post-concussion symptoms (PCS), neuropsychological functions and WQ. Methods A total of 179 participants, which included 132 patients with MTBI and 47 healthy participants, were prospectively recruited. The work quality index (WQI) was developed to evaluate WQ. All patients were evaluated for their PCS, neuropsychological functions and WQ at two weeks post-injury (T1), while PCS and WQ were recorded by one month post-injury (T2). Results More than half of the patients were not able to retain their pre-injury jobs at T1, while 26% of the patients still failed to regain previous works at T2. Interestingly, WQ was significantly associated with educational levels and physical PCS, such as headache and dizziness. Conclusions Simultaneously considering working status and stability to reveal the quality of RTW is merited. A higher educational level might be a protective factor for successful RTW, and ameliorating physical symptoms is also necessary to get favourable WQ by one month after MTBI.

Source: Chu SY, Tsai YH, Xiao SH, Huang SJ, Yang CC, Brain Injury, Vol. 31 (12), p.1674-1682, 2017 Sept.

Cognition and return to work after mild/moderate traumatic brain injury: A systematic review

Purpose Approximately two percent of the United States population are traumatic brain injury (TBI) survivors. The unemployment rate among them is substantial. Cognitive skills are essential to perform any job.We analyzed the literature on cognitive rehabilitation (CR) related to mild/moderate TBI to learn the influence of cognition on return to work (RTW) post TBI. Methods We conducted a systematic review of the studies on CR related to RTW post TBI that were published between 2000 and 2015. Results We critically reviewed 30 studies that met the inclusion criteria. Ten studies highlighted cognition as a predictor variable, seven studies demonstrated support for cognitive testing in RTW assessments, and 13 studies showed the efficacy of CR in facilitating RTW post TBI. Conclusions Cognition plays a significant role in predicting and facilitating RTW in patients with TBI.

Source: Mani K, Cater B, Hudlikar A, Work, 2017 Sep.

Work productivity loss after mild traumatic brain injury

Purpose To examine the completeness of return to work (RTW) and the degree of productivity loss in individuals who do achieve a complete RTW after mild traumatic brain injury (MTBI). Design Multi-site prospective cohort. Setting Outpatient concussion clinics. Participants Seventy-nine patients (M=41.5 years old, 55.7% female) who sustained an MTBI and were employed at the time of the injury. Participants were enrolled at their first clinic visit and assessed by telephone 6-8 months post-injury. Intervention None. Measures Structured interview of RTW status, British Columbia Postconcussion Symptom Inventory (BC-PSI), Lam Employment Absence and Productivity Scale (LEAPS), MINI Neuropsychiatric Interview, brief pain questionnaire. Participants who endorsed symptoms from three or more categories with at least moderate severity on the BC-PSI were considered to meet International Classification of Diseases-10 criteria for postconcussional syndrome. RTW status was classified as complete if participants returned to their pre-injury job with the same hours and responsibilities or to a new job that was at least as demanding. Results Of the 46 (58.2%) patients who achieved a RTW, 33 (71.7%) had a complete RTW. Participants with complete RTW had high rates of postconcussional syndrome (44.5%) and comorbid depression (18.2%), anxiety disorder (24.2%), and bodily pain (30.3%). They also reported productivity loss on the LEAPS, such as "getting less work done" (60.6%) and "making more mistakes" (42.4%). In a regression model, productivity loss was predicted by the presence of postconcussional syndrome and a comorbid psychiatric condition, but not bodily pain. Conclusions Even in patients who RTW after MTBI, detailed assessment revealed underemployment and productivity loss associated with residual symptoms and psychiatric complications.

Source: Silverberg ND, Panenka WJ, Iverson GL, Archives of Physical Medicine and Rehabilitation, 2017 Jul.