Traumatisme crânien cérébral léger (TCCL)

Juin 2021

Perceived Injustice After Mild Traumatic Brain Injury.

Purpose To examine perceived injustice and its associations with self-reported symptoms and return to work at 3 months after injury in a prospectively recruited sample of patients with mild traumatic brain injury (mTBI). Methods Design: Observational study. Setting: TBI outpatient unit. Participants: Adult patients aged 18 to 68 years with mTBI (n = 100) or orthopedic injury ([OI]; n = 34). Main Measures: The Injustice Experience Questionnaire (IEQ) and its associations with the Rivermead Post Concussion Questionnaire (RPQ), Beck Depression Inventory-Second Edition (BDI-II), PTSD Checklist-Civilian Version (PCL-C), and Pain Visual Analog Scale (PVAS). Information on injury-related characteristics, compensation seeking and litigation, and return-to-work status was also collected. Results Median IEQ total score was 3 (range, 0-23) in the mTBI group and 2.5 (range, 0-25) in the OI group. In the mTBI group, IEQ was significantly correlated with RPQ (rs = 0.638, P < .01), BDI-II (rs = 0.612, P < .01), PCL-C (rs = 0.679, P < .01), and PVAS (rs = 0.232, P < .05). The association between IEQ and PCL-C (rs =0.797, P < .01) and BDI-II (rs = 0.395, P < .05) was also found in the OI group. In both groups, patients who were still on sick leave at 3 months after injury tended to report higher perceived injustice (IEQ total score) than patients who had returned to work or studies. However, this difference did not reach statistical significance.Conclusions Perceived injustice is associated with self-reported symptoms in patients with mTBI. Our results suggest that perceived injustice could be a relevant construct to consider in clinical management of patients with mTBI. Also, perceived injustice could be a potential target for psychological interventions promoting recovery after mTBI.

Source: Mäki K, Nybo T, Hietanen M, Huovinen A, Marinkovic I, Isokuortti H, Melkas S, The Journal of head trauma rehabilitation, 2021 Jun 15

Avril 2021

Traumatic microbleeds in mild traumatic brain injury are not associated with delayed return to work or persisting post-concussion symptoms

Purpose The main objective of this prospective cohort study was to evaluate whether traumatic microbleeds (TMBs) are a significant prognostic factor of return to work (RTW), post-traumatic symptoms and overall recovery in patients with mild traumatic brain injury (MTBI). Methods One hundred and thirteen (n=113) patients with MTBI were recruited from the Helsinki University Hospital emergency units. All patients underwent multicontrast 3T MRI imaging 3-17 days after MTBI. Patients were evaluated in the Traumatic Brain Injury Outpatient Clinic of Helsinki University Hospital one month after injury. Post-concussion symptoms were assessed with Post-Concussion Symptom Questionnaire (RPQ) and overall recovery with Glasgow Outcome Scale Extended (GOS-E). Their time to RTW was continuously measured up to one year after MTBI. Results Median RTW was 9 days (IQR 4 - 30) after MTBI and full RTW rate after one year was 98%. Patients with TMBs (n=22) did not have more post-concussion symptoms (median RPQ 10.0 vs. 7.0, p=0.217) or worse overall recovery (58% vs. 56% with GOS-E = 8, p=0.853) compared to patients without TMBs (n=91). There was no significant difference in time to RTW (13.5 vs. 7.0 days, p=0.063). Conclusions In this study, patients with TMBs did not have delayed RTW nor more post-concussion symptoms compared to other patients with MTBI. TMBs in MTBI do not seem to be a significant prognostic factor of RTW.

Source: Huovinen A, Marinkovic I, Isokuortti H, Korvenoja A, Mäki K, Nybo T, Raj R, Melkas S, Journal of neurotrauma, 2021 Apr 13

Mars 2021

Returning to work or working on one's rehabilitation: Social identities invoked by impaired workers and professionals in health care and employment services

Purpose For persons with a long-term illness or impairment, return-to-work decisions involve considerations about work capacity, opportunities in the labour market, the impact of injuries, further treatment requirements, physical and cognitive rehabilitation, and mental health recovery. These considerations are undertaken by the affected individuals as well as by professionals in health care and employment services. Methods Drawing upon institutional theories of organisations, especially the understanding that institutional logics provide different social identities to injured individuals, we study rehabilitation processes following multi-trauma or traumatic brain injury (TBI) within the Scandinavian welfare model. We identify which social identities are activated in professionals' considerations and in the stories of the injured individuals. The aim is to understand how professionals' reasoning about the clients' problems influences return-to-work processes. Results Our primary finding is that the wageworker identity, invoked by the injured individuals themselves, is subordinated by the professionals to the logic of profession and the associated patient identity. Consequently, not only is impaired people's anti-discrimination right to reasonably adjusted work ignored, ignored is also a possible resource in the rehabilitation process. Additionally, individuals who view themselves as wageworkers tend to be left unserved.

Source: Andreassen TA, Solvang PK, Sociology of health & illness, 2021 Feb 26

Février 2021

Designing an intervention process that embeds work-focussed interventions within inpatient rehabilitation: An intervention mapping approach

Purpose Returning to work is a goal for many people after brain injury. The failure to return to work after injury brings both economic and personal (quality of life) costs to those living with stroke or brain injury, their families, and society. This study explored the barriers to providing work-focused interventions during hospital-based rehabilitation and co-created solutions with rehabilitation providers to increase the provision of work-focused intervention during inpatient rehabilitation. Methods This study used an Intervention Mapping approach (a six-step protocol that guides the design of complex interventions) based on an action research methodology. Focus group data, in addition to best evidence from systematic reviews, practice guidelines and key articles were combined with theoretical models for changing behaviour and clinician experience. This was then systematically operationalised into an intervention process using consensus among clinicians. The process was further refined through piloting and feedback from key stakeholders, and group consensus on the final process. Results A detailed five phase return to work intervention process for inpatient rehabilitation was developed. The key features of the process include; having one key allied health clinician to coordinate the process, choosing assessments based on pre-injury work demands, emphasising the importance of core work skills and considering the most appropriate service for referral at the conclusion of rehabilitation. Conclusion We used a systematic approach, guided by the intervention mapping approach and behaviour change theory to tailor existing workfocused interventions to the inpatient setting.

Source: O'Keefe S, Stanley M, Sansonetti D, Schneider EJ, Kras M, Morarty J, Lannin NA, Australian occupational therapy journal, 2021 Feb; Vol. 68 (1), pp. 65-77