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.