Octobre 2019

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 & Rehabilitation, Vol. 41 (22), p.2669-2675, 2019 Nov.

When Can I Drive? Predictors of Returning to Driving After Total Joint Arthroplasty

Purpose A common question by patients considering total joint arthroplasty (TJA) is when can I return to driving. The ability to return to driving has enormous effect on the independence of the patient, ability to return to work, and other activities of daily living. With advances in accelerated rehabilitation protocols, newer studies have questioned the classic teaching of waiting 6 weeks after TJA. The goal of this prospective study was to determine specific patient predictors for return to driving and create individualized models able to estimate return to driving based on patient risk factors for both total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods From July 2017 to January 2018, 554 primary TKA and 490 primary THA patients were prospectively enrolled to obtain information regarding return to driving. Patients were sent a survey every 2 weeks regarding their return to driving. Additional information regarding vehicle type, transmission, and involvement in motor vehicle accidents was collected. Bivariate analysis was done followed by the creation of a multiple linear regression models to analyze return to driving after TKA and THA. Results The majority (98.2%, 1,025/1,044) of patients returned to driving within 12 weeks of surgery. On average, patients returned to driving at 4.4 and 3.7 weeks for TKA and THA (P < 0.001), respectively. The rate of motor vehicle accidents was 0.7% (7/1,044) within 12 weeks after surgery with no injuries reported. After multivariate analysis, baseline return to driving began at 10.9 days for TKA and 17.1 days for THA. The following predictors added additional time to return to driving for TJA: not feeling safe to drive, limited range of motion, female sex, limitations due to pain, other limitations, discharge to a rehabilitation facility, right-sided procedures, limited ability to break, preoperative anemia, and preoperative use of a cane.Conclusions Important predictors identified for return to driving were sex, joint laterality, limited ability to walk or ability to break, and feeling safe. Surgeons should consider these factors when counseling patients on their postoperative expectations regarding driving after TJA.

Source: Rondon AJ, Tan TL, Goswami K, Shohat N, Foltz C, Courtney PM, Parvizi J, The Journal of the American Academy of Orthopaedic Surgeons, 2019 Sep.

Septembre 2019

The experiences and perceptions of employers and caregivers of individuals with mild-moderate traumatic brain injury in returning to work

Purpose Traumatic brain injury (TBI) has contributed significantly to the burden of health care in many countries. The scarcity of resources in the public sector available for rehabilitation has caused many families to take responsibility for the care and rehabilitation of their family members who sustain a TBI. The roles of employers and caregivers in facilitating the return to work (RTW) process of individuals who sustained a TBI, is now commonly acknowledged. Objective The aim of this study was to explore the perceptions and experiences of employers and caregivers of individuals with mild to moderate traumatic brain injury who are returning to work after completing a vocational rehabilitation program (VR), using the Model of Occupational Self-Efficacy (MOOSE). Methods A qualitative research design was used to explore the experiences and perceptions of caregivers and employers of ten individuals who sustained a mild to moderate brain injury. Semi-structured interviews were completed and data analyzed according to thematic analysis. Results Five themes emerged: Themes one and two describe the employers' and caregivers' experiences and perceptions that hinder the RTW process. Theme three relates to the enabling aspects that the employers and caregivers, as well as the TBI individuals concerned, derive from engaging in the VR process. Themes four and five present the coping strategies that aid the employers and caregivers in playing an ongoing role in the RTW process. All ethical principles with regard to confidentiality, anonymity and informed consent were adhered to in the study. Conclusions Occupational therapists (OT) using the MOOSE should regard employers and caregivers as key role players during therapy. Employers should have a better understanding of TBI and allow for sick leave to be granted to individuals with TBI during the rehabilitation process. Caregivers would benefit from establishing a support network for themselves, and by connecting with employers of the individuals with TBI in order to understand the their work environment.

Source: Soeker MS, Ganie Z, Work, 2019 Sep.

Mai 2019

Advice to Rest for More Than 2 Days After Mild Traumatic Brain Injury Is Associated with Delayed Return to Productivity: A Case-Control Study

Purpose Recent expert agreement statements and evidence-based practice guidelines for mild traumatic brain injury (mTBI) management no longer support advising patients to "rest until asymptomatic," and instead recommend gradual return to activity after 1-2 days of rest. The present study aimed to: (i) document the current state of de-implementation of prolonged rest advice, (ii) identify patient characteristics associated with receiving this advice, and (iii) examine the relationship between exposure to this advice and clinical outcomes. Methods In a case-control design, participants were prospectively recruited from two concussion clinics in Canada's public health care system. They completed self-report measures at clinic intake (Rivermead Post-concussion Symptom Questionnaire, Personal Health Questionnaire-9, and Generalized Anxiety Disorder-7) as well as a questionnaire with patient, injury, and recovery characteristics and the question: "Were you advised by at least one health professional to rest for more than 2 days after your injury?" Results Of the eligible participants (N = 146), 82.9% reported being advised to rest for more than 2 days (exposure group). This advice was not associated with patient characteristics, including gender (95% CI odds ratio = 0.48-2.91), race (0.87-6.28) age (0.93-1.01), a history of prior mTBI(s) (0.21-1.20), or psychiatric problems (0.40-2.30), loss of consciousness (0.23-2.10), or access to financial compensation (0.50-2.92). In generalized linear modeling, exposure to prolonged rest advice predicted return to productivity status at intake (B = -1.06, chi-squared(1) = 5.28, p = 0.02; 64.5% in the exposure group vs. 40.0% in the control were on leave from work/school at the time of clinic intake, 19.8 vs. 24% had partially returned, and 11.6 vs. 24% had fully returned to work/school). The exposure group had marginally (non-significantly) higher post-concussion, depression, and anxiety symptoms. Conclusions mTBI patients continue to be told to rest for longer than expert recommendations and practice guidelines. This study supports growing evidence that prolonged rest after mTBI is generally unhelpful, as patients in the exposure group were less likely to have resumed work/school at 1-2 months post-injury. We could not identify patient characteristics associated with getting prolonged rest advice. Further exploration of who gets told to rest and who delivers the advice could inform strategic de-implementation of this clinical practice.

Source: Silverberg ND, Otamendi T, Frontiers in Neurology, Vol. 10, p. 362, 2019 Apr.