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Traumatisme crânien cérébral léger (TCCL)

Mars 2023

Purpose Return to work (RTW) has always been a determinant functional outcome in patients with mild traumatic brain injury (MTBI). However, the quality of long-term RTW was still unclear. This study thus aims to examine long-term work quality and to reveal its associating factors. Methods A total of 110 patients with MTBI was prospectively recruited. Post-concussion symptoms (PCS) and RTW were evaluated by the Checklist of Post-Concussion Symptoms (CPCS) and Work Quality Index (WQI) respectively at one-week and long-term evaluation (M...=...2.90...years, SD...=...1.29) post-injury. Results Only 16% of patients can successfully RTW at one-week post-injury, while 69% of patients have retained their jobs at long-term evaluations. Importantly, 12% of patients had to work under the adverse impacts of PCS at one-week after MTBI, and long-term WQI was significantly associated with PCS at one-week post-injury. Conclusion Almost 1/3 of patients still had unfavorable long-term work quality even though they could return to work. Thus, a careful evaluation of the early PCS endorsement and work quality for patients with MTBI is merited.

© Lai WH; Hsu HH; Yu HT; Xiao SH; Tsai YH; Wang KC; Huang SJ; Lin CP; Yang CC. Applied Neuropsychology. Adult. 1-7, 2023 Mar 07.

Février 2023

Purpose The purpose of this narrative review was to assess work-related mild traumatic brain injury (mTBI) treatment approaches and outcomes. Results Literature indicates that incidence of work-related mTBI is high. Ability to return to work after injury is variable, with differences identified across industry sector, mechanisms of injury, sex, and timely treatment and referral. Additional challenges exist in the context of secondary gains (e.g. financial) and the potential for symptom exaggeration. Emerging evidence from studies outside the United States (US) demonstrate the benefits of proactive assessment and treatment at the time of injury. These benefits can be further augmented by early referral to multidisciplinary treatment teams led by Physical Medicine and Rehabilitation (PM&R) physicians. Discussion Opportunities for ongoing research and development of strategies to improve treatment, management, and more timely return to work for patients with occupational mTBI are discussed. Conclusion It is concluded that challenges persist in treatment and management of patients with work-related mTBI as they present unique challenges not seen in those with non-work related mTBIs. The unique position of PM&R and the skills of physiatrists render them poised to lead multidisciplinary treatment teams for these patients and contribute to the development of a new guideline for return to work, with an emphasis on functional recovery.

© Andreae ME; Grafton LM; Hong JS; Vidt ME.  American Journal of Physical Medicine & Rehabilitation.  2022 Dec 14.

Purpose The purpose of this study was to investigate return to work (RTW) rates following a single uncomplicated mild Traumatic Brain Injury (mTBI) in the post-acute stage in the context of active litigation. More specifically, we sought to determine what psychological and/or cognitive factors predict a RTW after mTBI. Methods Archival data were obtained from a random sample of litigating patients (n = 125; 54% female; mean age: 42.96 (SD = 12.74) who were referred to a private practice for a neuropsychological examination regarding their disability status following a single uncomplicated mTBI. A hierarchical regression analysis was used to assess the predictive value of emotional symptoms and cognition with respect to RTW status. Results Approximately 50% of the sample did not RTW. Attentional deficits (rs = -0.248) and depressive symptoms (rs = 0.248) were significantly associated with RTW. A hierarchical regression analysis found that depressive symptoms (p < .05) were associated with RTW outcomes. Conclusions These findings suggest that individuals with increased depressive symptoms are more likely to demonstrate poor RTW outcomes in the post-acute stages of mTBI. These results are of interest to clinicians as they underscore the importance of screening and early intervention for depressive symptoms following a single uncomplicated mTBI in the post-acute stages in litigating samples.

© Sekely A; Makani A; Dhillon S; Zakzanis KK.  Applied Neuropsychology. Adult. 1-8, 2023 Jan 30.

Purpose Fear avoidance is associated with symptom persistence after mild traumatic brain injury (mTBI). In this study, we investigated whether fear avoidance was associated with other outcomes such as return to work-related activity (RTW). Methods We analyzed associations between fear avoidance and RTW 6–9 months after mTBI, in two merged prospective mTBI cohorts. Adult participants aged 16 or over (n=175), presenting to outpatient services in New Zealand within 3 months of their injury, who were engaged in work-related activity at the time of injury, were included. Participants completed the Fear Avoidance Behavior after Traumatic Brain Injury (FAB-TBI) questionnaire at enrollment and 6 months later. Associations between FAB-TBI scores and RTW outcome were analyzed using multivariate approaches. Results Overall, 53% of participants had RTW by 6–9 months after mTBI. While early fear avoidance was weakly associated with RTW, persistent high fear avoidance between study assessments or increasing avoidance with time were associated with greater odds of still being off work 6–9 months after injury. Conclusion Pervasive and increasing avoidance of symptom triggers after mTBI were associated with lower rates of RTW 6–9 months after mTBI. Further research is needed to better understand transition points along the recovery trajectory where fear avoidance behaviors fade or increase after mTBI.

© Snell DL; Faulkner JW; Williman JA; Silverberg ND; Theadom A; Surgenor LJ; Hackney J; Siegert RJ. Brain Injury. Feb2023.

Décembre 2022

Purpose While a vast amount of research focuses on unmodifiable and individual factors that may impact return to work (RTW) for patients with traumatic brain injury (TBI), less knowledge exists of the relationship between specific workplace factors and work retention. Objective: Identify types of accommodation in the workplace that influence the RTW process for employees with TBI and the challenges associated with them. Methods A multiple case study consisting of 38 cases and 109 interviews of employees with TBI and their managers conducted between 2017 and 2020 at two time points. Results Accommodation of both the organizational and psychosocial work environment influences RTW for employees with TBI. Social support and supportive management may have positive and negative effects. RTW is often not a linear process. Over time, maintaining and developing customized accommodation in the work organization is challenging. Conclusions Uncertainty about accommodation in RTW for employees with TBI is closely linked to lack of knowledge in the workplace of how to handle complex and nonlinear RTW processes. Work-oriented rehabilitation should to a greater extent provide managers with relevant information and support to develop the person-environment fit over time.

© Spjelkavik O; Enehaug H; Klethagen P; Howe EI; Fure SCR; Terjesen HCA; Lovstad M; Andelic N. Work. 2022 Nov 25.

Purpose Acquired brain injury (ABI) is a complex injury which impacts engagement with worker roles. Return to work (RTW) rates for individuals with brain injury are low and those who do RTW often report job instability. Vocational rehabilitation (VR) can improve RTW rates and job stability; however, service provision is varied, and no gold standard has been identified.  Methods A systematic scoping review of the literature was completed to explore research activity in VR for individuals with ABI to address the following three questions: what models have been identified to underpin VR in ABI? What clinical processes have been identified to guide provision of VR in ABI? What components of VR have been described and/or recommended in the ABI literature? Results The number of included articles was 57. From these articles, 16 models, nine process steps, eight components, and four service delivery components were identified that were utilised in provision of ABI VR. Implications for practice are discussed. Conclusions Key processes and components of ABI VR have been identified across a range of models and apply to clients at all phases post-injury. Findings may be used to inform service provision across a range of time points and support clinicians in their delivery of VR to adults with brain injury. Implications for Rehabilitation: People with acquired brain injury (ABI), even severe injury, can be successful with return to work (RTW) when provided appropriate supports.A wide range of models, interventions, and service components have been identified in the literature which can be used to guide clinical and policy development in ABI vocational rehabilitation. Vocational rehabilitation for individuals with brain injury involves a complex interaction of factors, and consideration should be paid to not only the person and their abilities but also job demands and the environment (physical, social, cultural). Vocational rehabilitation services should be accessible and timed to maximise chances of a successful RTW, provided by a coordinated interdisciplinary team and should involve active stakeholder engagement.

© Murray A; Watter K; McLennan V; Vogler J; Nielsen M; Jeffery S; Ehlers S; Kennedy A. Disability & Rehabilitation. 44(24):7641-7654, 2022 Dec.

Septembre 2022

Purpose Injuries can have a long-lasting effect on ability to return to work, but there is little research on which outcomes are most important to patients. This study aims to identify and prioritise return-to-work outcomes important to patients for evaluating vocational rehabilitation interventions. Methods Nominal group technique focus group with trauma patients. Results Focus group participants (n = 6) included mostly traumatic brain injuries, a range of occupation types, ages and both genders. Participants identified and prioritised their eight most important outcomes which were: sense of purpose and life satisfaction, understanding the impact of injury, assessment of readiness to return to work, using SMART (specific, measurable, achievable, relevant and time-bound) goals, facilitated reintegration to work, assessing capacity to return to work, collaboration between key stakeholders and improved employer and employee knowledge. Many of these were measures of the process of, rather than change outcomes of vocational rehabilitation. Conclusions The range of outcomes identified by trauma patients highlights the complex process of return to work and the need for vocational rehabilitation evaluations to incorporate a broader range of outcomes. Measures of the process of vocational rehabilitation are also important to trauma patients and should be included in such evaluations.

© Bridger K, Kellezi B, Kendrick D, Kettlewell J, Holmes J, Timmons S, Andrews I, Fallon S, Radford K. British Journal of Occupational Therapy, Sep2022; 85(9): 704-711.

Purpose Persons with traumatic brain injuries (TBIs) who return to work often struggle with managing environmental distractions due to residual cognitive impairments. Previous literature has established that environmental distractions impact persons with TBI, yet, the extent to which distractions impact workplace performance is unknown. Methods This qualitative descriptive study using phenomenology methods, explored the experiences of seven individuals with TBIs and how they perceived workplace distractions to impact their productivity. Data was collected using semi-structured interviews with seven participants who were diagnosed with mild, moderate, and severe TBIs. Interviews were transcribed and analyzed using thematic analysis. Results Main findings centered around what environmental distractions impacted work performance, the farther-reaching consequences of distractibility, strong emotional feelings and worry about perceived work performance associated with distractibility, mitigating distractibility through "gaming the attentional system", and utilizing music as a distraction masker to enhance task performance. Conclusion In light of this study's findings, researchers, and clinicians are encouraged to consider the wider impact of distractions on persons with TBI. The real-life accounts documented in this study will assist researchers and clinicians to account for the impact of environmental distractions in rehabilitation and support employment for persons with TBI.

© Pinnow DA, Causey-Upton R, Meulenbroek P. Scientific Reports. 9/23/2022, Vol. 12 Issue 1, p1-9.

Purpose Research has found that Hispanics with traumatic brain injury (TBI) have reduced functional outcomes compared to non-Hispanic Whites, including lower probabilities of post-injury employment. However, previous studies were cross-sectional, combined racial/ethnic minority groups, and did not examine the factors that predict return to work of Hispanics longitudinally. Objective: To determine the demographic and injury-related predictors of employment probability trajectories during the first 10 years after TBI. Methods 1,346 Hispanics in the TBI Model Systems Database was included. Hierarchical linear modeling was used to examine baseline predictors of employment probability trajectories across this time period. Results Employment probability demonstrated a quadratic movement over time, with an initial increase followed by a plateau or slight decrease. Hispanics with TBI had higher employment probability trajectories if they had been younger at the time of injury, spent less time in posttraumatic amnesia, had greater years of education, had been employed at the time of injury, had higher annual earnings at the time of injury, and had experienced a non-violent mechanism of injury. Conclusion Culturally adapted treatment programs with a focus on early intervention incorporating vocational rehabilitation and employment programs for Hispanics with TBI who present with these risk factors are needed.

© Arango-Lasprilla JC; Watson JD; Rodriguez M; Ramos-Usuga D; Mascialino G; Perrin PB, NeuroRehabilitation, 2022 Sep 23.

Août 2022

Purpose To explore work outcomes, vocational services, barriers and facilitators for returning to work in individuals with acquired brain injury (ABI) in Queensland, Australia and to identify areas for improvement. Methods Ten semi-structured interviews were conducted with individuals with ABI (stroke, traumatic brain injury, tumour). Interviews were analysed using a realist thematic analysis approach. Results Participants either returned to the same work, different work, did not maintain work or did not have any work since their injury. Use of vocational services depended on participants' needs and insurance. Facilitators for return to work (RTW) were a supportive workplace and family, vocational rehabilitation that met the individual's needs, insurance coverage and self-motivation. Workplaces that were not understanding of brain injury, employment service providers who were unable to find work for participants, and physical and cognitive deficits were barriers to RTW. Workplaces, employment service providers and individuals require more information about the deficits associated with brain injury. Conclusions The use and effectiveness of vocational services were variable across participants and depended on insurance coverage and needs. Barriers and facilitators for RTW were affected by both the environment and the individual. Implications for vocational rehabilitation were identified. Implications for Rehabilitation: A supportive workplace and family, and access to appropriate vocational rehabilitation are important environmental facilitators for RTW in individuals with ABI.Workplaces with a poor understanding of ABI and employment service providers unable to find work for individuals with ABI are environmental barriers to RTW.Workplaces, employment service providers and individuals with ABI require more information about the physical and cognitive deficits associated with ABI.Employment service providers need more training to develop comprehensive strategies to help individuals with ABI find new employment.

© Brakenridge CL; Leow CKL; Kendall M; Turner B; Valiant D; Quinn R; Johnston V. Disability & Rehabilitation. 44(16):4332-4342, 2022 Aug.

Juillet 2022

Purpose To document the development and clinician evaluation of a psychoeducational and support tool: the return to work after traumatic brain injury app (RTW after TBI app). Methods Co-design of the app involved the collaboration of traumatic brain injury (TBI) /vocational rehabilitation (VR) expert researchers and lived experience co-designers (individuals with TBI who had previously returned to work; n = 4). Twelve TBI/VR clinician reviewers then evaluated the app. Content analysis of TBI/VR clinician reviewers’ interviews revealed four themes: content, usability (functional ease of use), utility (applicability to RTW after TBI) and suggestions for improvements. Results All clinicians reported that they would use the RTW after TBI app in their clinical practice. Although several aspects were reported to potentially limit the app’s appropriateness for some TBI clients, many feasible improvements were suggested to address limitations. These improvements aim to increase the utility of the app with a wider range of clients and extend its use to other settings. Conclusion Future research should evaluate, in a clinical trial, the efficacy of the RTW after TBI app in supporting individuals with TBI and their vocational providers and optimizing RTW success.

© Libeson L; Ross P; Downing M; Ponsford J. Neuropsychological Rehabilitation. Jul2022, p1-19.

Purpose Appropriate supports and accommodations are necessary to ensure full concussion recovery and return-to-work (RTW). This research investigated barriers and facilitators to concussion recovery and RTW, and resource gaps reported by adults with concussion ('workers') and workplace and healthcare professionals ('workplaces'). Methods Semi-structured interviews and focus groups were conducted with workers ( n = 31) and workplaces ( n = 16) across British Columbia. Data were analyzed using inductive content analysis. Results Facilitators to workers' concussion recovery and RTW included treatment, social support, and workplace and lifestyle modifications. To address barriers, both groups recommended: (a) widespread concussion and RTW education and training (b) standardized concussion recovery guidelines; (c) changing attitudes toward concussion; (d) mental health supports; and (e) increasing awareness that every concussion is unique. Conclusion Findings can inform best practice for concussion recovery and RTW among professionals in workplaces, healthcare, occupational health and safety, and workers' compensation boards.

© Karmali S; Beaton MD; Babul S, International journal of environmental research and public health, 2022 Jul 05; Vol. 19 (13)

Purpose Return-to-work is often the most important objective of working-age patients with acquired brain injury, but is often difficult to achieve. There is a lack of evidence for effective treatment. This study aimed to assess the benefit of a multidisciplinary neurorehabilitation in a daytime hospital on return-to-work after an acquired brain injury. Methods Design: Retrospective case-control study. Patients: Acquired brain injury patients between 18 and 65 years of age. Data collection & analysis: Two periods, before (n = 82 patients) and after (n = 89 patients) the implementation of a daytime hospital in our neuro-rehabilitation unit were compared. Patients followed in the daytime hospital received intensive, interdisciplinary, coordinated, individual and group-level physical, cognitive, and vocational rehabilitation. During the control period, patients received outpatient neurorehabilitation with less intensive treatment without interdisciplinary coordination. The main outcome was the proportion of patients returning to > 50% of their premorbid work activity. Results Fifty-five percent of patients were able to resume more than 50% of their premorbid work level in the daytime hospital period vs 41% in the control period (p = 0.076). Conclusion Intensive and coordinated outpatient neurorehabilitation may facilitate return-to-work after an acquired brain injury.

© Moreno Legast G; Durand A; Aboulafia Brakha T; Schnider A; Guggisberg A, Journal of rehabilitation medicine, 2022 Jul 21

Purpose Mild traumatic brain injury (mTBI) may impair the ability to work. Strategies to facilitate return to work are understudied. Objective: To assess employment and economic outcomes for employed, working-age adults with mTBI in the 12 months after injury and the association between return to work and employer assistance. Methods Using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a cohort study of patients with mTBI presenting to emergency departments of 11 level I US trauma centers was performed. Patients with mTBI enrolled in the TRACK-TBI cohort study from February 26, 2014, to May 4, 2016, were followed up at 2 weeks and 3, 6, and 12 months after injury. Work status and income decline of participants were documented in the first year after injury. Associations between work status, injury characteristics, and offer of employer assistance and associations between follow-up care and employer assistance were investigated. Results were adjusted for unobserved outcomes using inverse probability weighting. Data were extracted July 12, 2020; analyses were completed March 24, 2021. Analyses included 435 participants aged 18 to 64 years who were working before the injury, had a Glasgow Coma Scale score of 13 to 15, and completed all postinjury follow-up surveys. Primary outcomes were work status (working or not working) at each study follow-up milestone. Employer assistance included sick leave, reduced hours, modified schedule, transfer to different tasks, assistive technology, and coaching offered during the first 3 months after injury.  Results Of 435 participants (147 [34%] female; 320 [74%] White; mean[SD] age 37.3 [12.9] years), 258 (59%) reported not working at 2 weeks after injury and 74 (17%) reported not working at 12 months after injury. More than one-fifth (92 [21%]) experienced a decline in annual income. Work status at 12 months was significantly associated with postconcussion symptoms experienced at 3 months after injury (73% of patients with 3 or more symptoms reported working at 12 months after injury vs 89% of patients with 2 or fewer symptoms; P < .001) but not with other injury characteristics. Participants offered employer assistance in the first 3 months after injury were more likely to report working after injury than those not offered such assistance (at 6 months: 88% vs 78%; P = .02; at 12 months: 86% vs 72%; P = .005). Conclusions In this cohort study, mTBI was associated with substantial employment and economic consequences for some patients. Clinicians should systematically follow up with patients with mTBI and coordinate with employers to promote successful return to work.

© Gaudette E; Seabury SA; Temkin N; Barber J; DiGiorgio AM; Markowitz AJ; Manley GT; TRACK-TBI Investigators. JAMA Network Open. 5(6):e2219444, 2022 Jun 01.

Juin 2022

Purpose Return to work (RTW) might be delayed in patients with complicated mild traumatic brain injury (MTBI), i.e., MTBI patients with associated traumatic intracranial lesions. However, the effect of different types of lesions on RTW has not studied before. We investigated whether traumatic intracranial lesions detected by CT and MRI are associated with return to work and post-concussion symptoms in patients with MTBI. Methods We prospectively followed up 113 adult patients with MTBI that underwent a brain MRI within 3-17 days after injury. Return to work was assessed with one-day accuracy up to one year after injury. Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and Glasgow Outcome Scale Extended (GOS-E) were conducted one month after injury. A Kaplan-Meier log-rank analysis was performed to analyze the differences in RTW. Results Full RTW-% one year after injury was 98%. There were 38 patients with complicated MTBI, who had delayed median RTW compared to uncomplicated MTBI group (17 vs. 6 days), and more post-concussion symptoms (median RPQ 12.0 vs. 6.5). Further, RTW was more delayed in patients with multiple types of traumatic intracranial lesions visible in MRI (31 days, n = 19) and when lesions were detected in the primary CT (31 days, n = 24). There were no significant differences in GOS-E. Conclusions The imaging results that were most clearly associated with delayed RTW were positive primary CT and multiple types of lesions in MRI. RTW-% of patients with MTBI was excellent and a single intracranial lesion does not seem to be a predictive factor of disability to work.

© Huovinen A; Marinkovic I; Isokuortti H; Korvenoja A; Maki K; Nybo T; Raj R; Melkas S. Acta Neurochirurgica. 2022 May 31.

Purpose MTBI Practice Guidelines recommend screening for psychological symptoms. Optimal timing of screening is not established. In this 10-year matched cohort study of workers' compensation cases, early mental health intervention, defined as treatment within three months of injury, was associated with lower health care costs and shorter durations of disability. Objective: To examine the impact of timing of mental health interventions in workers' compensation claims for mild traumatic brain injury (MTBI). Methods A 10-year matched retrospective cohort study of MTBI claims. Cases who started treatment within 3 months of the date of injury were hard matched to cases who started treatment more than 3 months after the date of injury. Outcomes were incremental cost difference and loss of earnings benefit duration 1 year after first intervention. Results Seventeen percent (17%) of patients received mental health interventions. The early mental health intervention group had lower mean costs (incremental difference$1580 [95% CI: $5718 to $2085]) and shorter durations of disability (off loss of earnings) (59.2% versus 46.6%, NS). Sensitivity and stratified analyses demonstrated the same trend. Conclusions Early mental health interventions for MTBI patients may lead to reduced health care costs and shorter durations of disability.

© Nanwa N; Wong V; Thompson AMS. Journal of Occupational & Environmental Medicine. Jun2022, p458-464.

Mars 2022

Purpose Sociodemographic and injury-related predictors for return to work (RTW) after mild-to-moderate traumatic brain injury (TBI) have been extensively explored. However, there is a knowledge gap regarding work-related predictors of RTW. The main aim of this study was to explore work-related predictors of work participation 6 and 12 months after mild-to-moderate TBI. Methods Data were collected at baseline 8 to 12 weeks after injury, and 3, 6, and 12 months after baseline, at a specialized TBI rehabilitation outpatient clinic at Oslo University Hospital, Oslo, Norway. Eligible patients had suffered a mild-to-moderate TBI 8 to 12 weeks previously, were employed 50% or more at time of injury, were between 18 and 60 years of age, and sick listed 50% or more at time of inclusion due to symptoms of TBI (based on the Rivermead Post-Concussion Symptoms Questionnaire). In total, 116 patients were included in a randomized controlled trial, of whom 113 were included in the 1-year analysis. Patients were originally included in a randomized controlled trial. There were no between-group differences in RTW after 1 year. Thus, the participants were evaluated as one cohort in this study. The primary outcome measure was work participation 1 year after study inclusion. Work-related predictors were chosen on the basis of previous research and expert opinion and entered into a multivariable linear regression model. The model controlled for sociodemographic and injury-related factors. Results The best-fitting model explained 25% of variation in work participation at 1 year. Significant predictors were predictability, quantitative demands and rewards (recognition) at the workplace, private or public employment, symptom burden at baseline, and sex. Conclusion In this study, several work-related predictors outperformed some of the established sociodemographic and injury-related predictors of RTW after TBI, thus stressing the need for further focus and research on amendable predictors of RTW after mild-to-moderate TBI.

© Fure SCR, Howe EI, Andelic N, Brunborg C, Olsen A, Rike PO, Spjelkavik Ø, Enehaug H, Røe C, Løvstad M, The Journal of head trauma rehabilitation, 2022 Mar 15

Février 2022

Purpose Post-traumatic headache (PTH) is a common symptom following mild traumatic brain injury (mTBI). Patients at risk to develop acute PTH (aPTH) and further persistent PTH (pPTH) need to be recognized. Methods This is a one-year follow-up of 127 patients with mTBI, aged 18 to 68, referred to outpatient clinic in the Helsinki University Hospital. Symptoms were assessed at the emergency department (ED), with structured interview at outpatient clinic visit and with Rivermead post-concussion symptom questionnaire at one, three, and 12 months after injury. Psychiatric disorders were assessed with Structured Clinical Interview for DSM-IV Axis I disorders at 3-4 months and return to work (RTW) from patient records. Results At one month, 77/127 patients (61%) had aPTH. According to multiple logistic regression analysis, risk factors for aPTH were headache at the emergency department (ED) (OR 5.43), other pain (OR 3.19), insomnia (OR 3.23), and vertigo (OR 5.98). At three months, 17 patients (22% of aPTH patients) had developed pPTH, and at one year, 4 patients (24% of pPTH patients) still presented with pPTH. Risk factors for pPTH at three months were older age (OR 1.06) and current insomnia (OR 12.3). The frequency of psychiatric disorders did not differ between the groups. pPTH patients performed worse on their RTW. Conclusions Risk factors for aPTH were insomnia, headache at ED, other pain, and vertigo and for pPTH, insomnia and older age. RTW rate was lower among pPTH patients.

© Kraemer Y; Mäki K; Marinkovic I; Nybo T; Isokuortti H; Huovinen A; Korvenoja A; Melkas S; Harno H, The journal of headache and pain, 2022 Feb 19; Vol. 23 (1), pp. 27

Purpose Fatigue is a common sequela of traumatic brain injury (TBI) and adversely impacts on the ability to return to work. To the authors' knowledge, no prior studies have investigated how people manage TBI-related fatigue at work. This qualitative descriptive study explored how people managed fatigue attributed to TBI when returning to and maintaining paid work. Methods Eight employed adults, who sustained a recent TBI and experienced TBI-related fatigue, participated in a semi-structured interview. Transcripts were analysed using a general inductive approach. Results Participants learned through trial and error to recognise 'change points' - fatigue symptom awareness that prompted fatigue management. At each change point, participants selected the most effective strategy from a continuum of options to minimise the impact on productivity at work. Conclusion This continuum may provide useful guidance to other people returning to and maintaining paid work while managing post-TBI fatigue symptoms.

© Lillas S; Hay-Smith J; Levack W, International journal of rehabilitation research, 2022 Mar 01; Vol. 45 (1), pp. 93-97

Septembre 2021

Purpose Individuals with mild traumatic brain injury (mTBI) may experience protracted symptoms affecting their ability to work. Several actors may facilitate or act as a barrier to a successful return to work (RTW). Methods This qualitative study used semi-structured in-depth interviews with 22 adults with mTBI at 2-5 years post injury, targeting experiences of how different actors facilitated or acted as a barrier in the RTW process, and encompassed the mTBI trajectory from the acute phase to the post-acute phase. A thematic analysis with a hermeneutical phenomenological approach was used to analyse data. Results Three main themes emerged. (1) Worker-employer relationship: Workplace accommodations such as decreased working hours, modified working conditions, and support from co-workers were lacking. (2) The role of the general practitioner: The general practitioner was lacking treatment and referral opportunities and failed to provide the patient with relevant and individualized guidance. (3) Municipal case management: Participants perceived being met with distrust by social workers, follow-up assessments were too frequent, unnecessary, and did not target concussion, and rehabilitation was referred too late. Conclusion Clinical practice guidelines to improve referral to relevant concussion rehabilitation in case of persistent symptoms are needed to inform clinicians, employers, and public institutions to facilitate a successful RTW.

© Graff HJ, Deleu NW, Christiansen P, Rytter HM, Neuropsychological rehabilitation, 2021 Oct; Vol. 31 (9), pp. 1349-1373

Purpose To understand the experience of employers of individuals with traumatic brain injury (TBI) who have received comprehensive vocational rehabilitation (VR), the factors involved in supporting an individual with TBI to return to work (RTW), and the support needs of employers. Methods 12 employers completed semi-structured interviews, which were recorded, transcribed, and analysed thematically. Results Five main themes were identified: challenges and impact on employer, managing employee post-injury changes, looking after employee wellbeing, managing conflicting emotions, and utilizing sources of support. Although employers received support with operational challenges, findings suggest they were not prepared for the emotional journey. While they struggled to support employees through the difficult process of realizing they could no longer perform at their pre-injury level, employers strove to find appropriate roles and ensure wellbeing for their injured employees. Despite employers' endeavours, they felt this process was demoralizing for some employees. Conclusions Advising employers on operational as well as emotional support needs of both employees and employers is an ongoing challenge for VR providers. Although unsupportive employers were not well-represented in this sample, the study highlights the challenges faced and strategies used by employers who have a strong personal investment in the successful RTW of their employees.

© Libeson L, Ross P, Downing M, Ponsford J, Neuropsychological rehabilitation, 2021 Aug 30, pp. 1-23

Purpose Individuals with traumatic brain injury (TBI) often present injury-related cognitive and behavioural sequelae hindering a successful professional outcome, even many years after injury. The aim of this study was to investigate cognitive and behavioural factors predicting vocational outcome in the post-acute stages (≥one year) of TBI. Methods A systematic review of empirical research about vocational outcome of individuals with TBI was conducted. Studies published in PubMed and PsycINFO from 1 January 1998 to 31 May 2019 were screened. Only studies using the same injury severity criteria (the Glasgow Coma Scale score and/or the duration of post-traumatic amnesia) were selected. Results We found that (1) self-reported symptoms, (2) Functional Independence Measure and Mayo-Portland Adaptability Inventory Scores, (3) alcohol abuse and mood disorders, and (4) Differentiated Outcome Scale Cognitive Scores in individuals with TBI were highly predictive of the vocational outcome. Conclusion This systematic review emphasized the link between cognitive and behavioural functioning and vocational rehabilitation in individuals with TBI. However, scientific literature lacks cognitive and behavioural models predicting vocational outcome of these individuals, including academic or vocational training. Such models would allow clinicians to improve vocational guidance of these individuals.Implications for rehabilitationCognitive and behavioural assessment is highly important even many years after traumatic brain injury, especially in a social and professional rehabilitation context.Clinicians should integrate objective measures of cognition and behaviour in post-acute phases of traumatic brain injury.Identifying vocational outcome related cognitive and behavioural patterns of functioning would allow clinicians to improve vocational guidance of adults with traumatic brain injury.

© Manoli R, Delecroix H, Daveluy W, Moroni C, Disability and rehabilitation, 2021 Sep; Vol. 43 (18), pp. 2531-2540

Août 2021

Purpose Individuals with mild traumatic brain injury (mTBI) may experience protracted symptoms affecting their ability to work. Several actors may facilitate or act as a barrier to a successful return to work (RTW). Methods This qualitative study used semi-structured in-depth interviews with 22 adults with mTBI at 2-5 years post injury, targeting experiences of how different actors facilitated or acted as a barrier in the RTW process, and encompassed the mTBI trajectory from the acute phase to the post-acute phase. A thematic analysis with a hermeneutical phenomenological approach was used to analyse data. Results Three main themes emerged. (1) Worker-employer relationship: Workplace accommodations such as decreased working hours, modified working conditions, and support from co-workers were lacking. (2) The role of the general practitioner: The general practitioner was lacking treatment and referral opportunities and failed to provide the patient with relevant and individualized guidance. (3) Municipal case management: Participants perceived being met with distrust by social workers, follow-up assessments were too frequent, unnecessary, and did not target concussion, and rehabilitation was referred too late. Conclusion Clinical practice guidelines to improve referral to relevant concussion rehabilitation in case of persistent symptoms are needed to inform clinicians, employers, and public institutions to facilitate a successful RTW.

© Graff HJ, Deleu NW, Christiansen P, Rytter HM, Neuropsychological rehabilitation, 2021 Oct; Vol. 31 (9), pp. 1349-1373

Purpose To understand the experience of employers of individuals with traumatic brain injury (TBI) who have received comprehensive vocational rehabilitation (VR), the factors involved in supporting an individual with TBI to return to work (RTW), and the support needs of employers. Methods 12 employers completed semi-structured interviews, which were recorded, transcribed, and analysed thematically. Results Five main themes were identified: challenges and impact on employer, managing employee post-injury changes, looking after employee wellbeing, managing conflicting emotions, and utilizing sources of support. Although employers received support with operational challenges, findings suggest they were not prepared for the emotional journey. While they struggled to support employees through the difficult process of realizing they could no longer perform at their pre-injury level, employers strove to find appropriate roles and ensure wellbeing for their injured employees. Despite employers' endeavours, they felt this process was demoralizing for some employees. Conclusions Advising employers on operational as well as emotional support needs of both employees and employers is an ongoing challenge for VR providers. Although unsupportive employers were not well-represented in this sample, the study highlights the challenges faced and strategies used by employers who have a strong personal investment in the successful RTW of their employees.

© Libeson L, Ross P, Downing M, Ponsford J, Neuropsychological rehabilitation, 2021 Aug 30, pp. 1-23

Purpose Individuals with traumatic brain injury (TBI) often present injury-related cognitive and behavioural sequelae hindering a successful professional outcome, even many years after injury. The aim of this study was to investigate cognitive and behavioural factors predicting vocational outcome in the post-acute stages (≥one year) of TBI. Methods A systematic review of empirical research about vocational outcome of individuals with TBI was conducted. Studies published in PubMed and PsycINFO from 1 January 1998 to 31 May 2019 were screened. Only studies using the same injury severity criteria (the Glasgow Coma Scale score and/or the duration of post-traumatic amnesia) were selected. Results We found that (1) self-reported symptoms, (2) Functional Independence Measure and Mayo-Portland Adaptability Inventory Scores, (3) alcohol abuse and mood disorders, and (4) Differentiated Outcome Scale Cognitive Scores in individuals with TBI were highly predictive of the vocational outcome. Conclusion This systematic review emphasized the link between cognitive and behavioural functioning and vocational rehabilitation in individuals with TBI. However, scientific literature lacks cognitive and behavioural models predicting vocational outcome of these individuals, including academic or vocational training. Such models would allow clinicians to improve vocational guidance of these individuals.Implications for rehabilitationCognitive and behavioural assessment is highly important even many years after traumatic brain injury, especially in a social and professional rehabilitation context.Clinicians should integrate objective measures of cognition and behaviour in post-acute phases of traumatic brain injury.Identifying vocational outcome related cognitive and behavioural patterns of functioning would allow clinicians to improve vocational guidance of adults with traumatic brain injury.

© Manoli R, Delecroix H, Daveluy W, Moroni C, Disability and rehabilitation, 2021 Sep; Vol. 43 (18), pp. 2531-2540

Juin 2021

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.

© 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

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.

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