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Consultez les résultats de notre veille scientifique d'août 2022!

Incapacité et retour au travail

Returning to work in critical care after a break in clinical practice can be a daunting process. This article describes development and evolution of the Critical Care, Resuscitation, Airway Skills: Helping you return to work (CRASH) course, including the supporting literature. CRASH is the first bi-national course assisting return to work (RTW) for critical care practitioners. It evolved as a collaborative effort across Australia and New Zealand, involving anaesthetists, emergency physicians and intensivists. The course is based around tailored sessions practising skills and clinical decision-making using simulation and case discussions, incorporating practical tips on returning to work. Participants receive resources to assist RTW including questionnaires and checklists developed by the faculty, which have been used to aid RTW in more than 30 hospitals in Australia and New Zealand. Attendance is open to all critical care practitioners who are registered with the relevant medical board and returning to work, who have taken leave from work for any reason. Since 2014, 197 participants have attended CRASH in-person or virtually, one of the largest RTW groups described in the literature. The aim of this article is to outline the literature around inactivity and RTW, and describe the development and adaptation of the CRASH course.

© Allen KJ; Wright JC; Lee EM; Vickerman BJ; Barnett SG. Anaesthesia & Intensive Care. 2022 Aug 18.

Purpose For persons on disability benefits who are facing multiple problems, active labour market policies seem less successful. Besides health problems, these people perceive personal, social, and environmental problems. Since very little is known about these "non-medical" problems our aim was to explore the prevalence of clients experiencing multiple problems, the types and number of perceived problems, combinations of perceived problems, and associated characteristics in a group of work disability benefit recipients. Methods We performed a cross-sectional study, using self-reported data on perceived problems and socio-demographics, and register data from the Dutch Social Security Institute on diagnosed diseases and employment status. A convenient group of labour experts recruited eligible clients on work disability benefit. Results Of the 207 persons on work disability benefit, 87% perceived having multiple problems. Most reported problems were related to physical (76%) or mental (76%) health. Health problems most frequently occurred together with a mismatch in education, financial problems, or care for family members. Clients with lower education experienced significantly more problems than clients with an intermediate or high educational level. Conclusions Clients with multiple problems face severe and intertwined problems in different domains of life, and need tailored multi-actor work disability management. Implications for rehabilitation: Clients with multiple problems face severe and intertwined problems in different domains of life; therefore, interventions tailored to deal with needs related to specific problems might be more effective than traditional programs. Interventions should match experienced barriers, and involve multi-actor work disability management with all the challenges of mutual cooperation. For persons with multiple problems a focus on pure medical barriers is too narrow, because personal, social, and environmental factors might also obstruct participation in work.

©   Brongers KA; Hoekstra T; Roelofs PDDM; Brouwer S.  Disability & Rehabilitation. 44(16):4303-4310, 2022 Aug.

Purpose Safety climate (SC) is a robust leading indicator of occupational safety outcomes. There is, however, limited research on SC among workers who have returned to work with a work-related permanent impairment. This study examined three propositions: (1) a two-level model of SC (group-level and organization-level SC) will provide the best fit to the data; (2) antecedent factors such as safety training, job demands, supervisor and coworker support, and decision latitude will predict SC; and (3) previously reported associations between SC and outcomes such as reinjury, work-family conflict, job performance, and job security will be observed. Methods A representative cross-sectional survey gathered information about experiences during the first year of work reintegration. About one year after claim closure, 599 interviews with workers were conducted (53.8% response rate). Confirmatory factor analyses were conducted to test the factor structure of the SC construct. Further, researchers used correlation analyses to examine the criterion-related validity. Results Consistent with general worker populations, our findings suggest the following: (1) the two-factor structure of SC outperformed the single-factor structure in our population of workers with a permanent impairment; (2) correlations demonstrate that workplace safety training, decision latitude, supervisor support, coworker support, and job demand  could predict SC; and (3) SC may positively impact reinjury risk, work-family conflict, and may increase job performance and job security. Conclusions Our study validated a two-factor SC scale among workers with a history of disabling workplace injury or permanent impairment who have returned to work. Practical applications of this scale will equip organizations with the necessary data to improve working conditions for this population.

©   Huang YH; Sears JM; He Y; Courtney TK; Rega E; Kelly A.  Work.  2022 Aug 16.

Purpose The return-to-work (RTW) process for people with multimorbidity and psychosocial difficulties can be complicated. This study explores the organisational prerequisites for coordinating these patients' RTW processes from the perspective of coordinators in different clinical areas in Sweden. Methods Six focus group interviews were conducted with 24 coordinators working in primary healthcare (PHC), psychiatric and orthopaedic clinics. The data were analysed thematically, inspired by organisation theory. Results Coordinators described varying approaches to people with multimorbidity and psychosocial difficulties, with more hesitancy among PHC coordinators, who were perceived by other coordinators as hindering patient flows between clinical areas. Most organisational barriers to RTW were identified in the healthcare sector. These were long waiting times, physicians drawing up inadequate RTW plans, coordinators being involved late in the sickness absence process, and lack of rehabilitation programmes for people with multimorbidity. The barriers in relation to organisations such as Social Insurance Agency and Employment Services were caused by regulations and differing perspectives, priorities, and procedures. Conclusion Our findings indicate what is needed to improve the RTW process for patients with complex circumstances: better working conditions, steering, and guidelines; shorter waiting times; and a willingness among coordinators from different clinical areas to collaborate around patients. Implications for rehabilitation: RTW coordinators need sufficient physical and psychosocial working conditions as well as clear leadership. In order to avoid inequalities in access to RTW support, better systems are needed to identify patients who would benefit from rehabilitation and RTW coordination. There is a need for multilevel collaboration between clinical areas so that patients with multiple healthcare contacts and prolonged sickness absence can obtain support during the RTW process.
©   Svard V; Jannas S.  Disability & Rehabilitation. 1-10, 2022 Aug 25.

Purpose Much of the existing research on disability and disability-related workplace accommodations presume that disabilities are visible and commonly accepted. Yet, many disabilities are invisible and contested, or perceived as fake, low-severity/minor, and/or illegitimate. The purpose of this research is to investigate the effect of identity management strategies that individuals with contested disabilities might use when requesting accommodations in a workplace setting. Methods We used two electronic experiments to investigate the effect of identity management strategies on perceived fairness of accommodations and attributions about individuals requesting accommodations. Studies 1 and 2 used online surveys to collect data from 117 and 184 working adults, respectively. Results Study 1 indicates that four invisible disabilities (chronic fatigue syndrome, attention deficit/hyperactivity disorder, generalized anxiety disorder, and chronic migraine) are viewed as significantly less legitimate than the visible disability paraplegia. In study 2, any form of disclosure of a contested disability (vs. no disclosure) resulted in higher perceived fairness and more positive attributions about the person requesting accommodations. There were minimal differences between the different identity management strategies tested. Conclusion Workplaces should work to create spaces in which employees can disclose contested disabilities to managers and coworkers without fear of enhanced stigmatization.

© Godard R; Hebl M; Nittrouer C. Journal of Vocational Rehabilitation. Aug 2022, p1-10.

Trouble musculosquelettique

Purpose Spinal surgeries to treat chronic low back pain (CLBP) have variable success rates, and despite the significant personal and socioeconomic implications, we lack consensus for prognostic factors. This systematic review and meta-analysis evaluated the evidence for preoperative predictors of return to work (RTW) after spinal surgery for CLBP. Methods We searched electronic databases and references (January 1984 to March 2021), screened 2,622 unique citations, and included 8 reports (5 low and 3 high risk-of-bias) which involved adults with >=3 months duration of CLBP with/without leg pain undergoing first elective lumbar surgery with RTW assessed >=3 months later. Results Narrative synthesis and meta-analysis where possible found that individuals less likely to RTW were older (odds ratio [OR] = .58; 95% confidence interval [CI]: 0.46-0.72), not working before surgery, had longer sick leave (OR = .95; 95% CI: 0.93-0.97), higher physical workload, legal representation (OR = .61; 95% CI: 0.53-0.71), psychiatric comorbidities and depression (moderate quality-of-evidence, QoE), and longer CLBP duration and opioid use (low QoE), independent of potential confounders. Low quality and small number of studies limit our confidence in other associations. In conclusion, RTW after spinal surgery for CLBP likely depends on sociodemographic and affective psychological factors, and potentially also on symptom duration and opioid use. Conclusion This systematic review and meta-analysis synthesizes and evaluates existing evidence for preoperative predictors of return to work after spinal surgery for chronic low back pain. Demonstrated associations between return to work and sociodemographic, health-related, and psychological factors can inform clinical decision-making and guide further research.

©   Halicka M; Duarte R; Catherall S; Maden M; Coetsee M; Wilby M; Brown C. Journal of Pain. 23(8):1318-1342, 2022 Aug.

Purpose Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant individual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status; evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally; and identify factors potentially modifiable with intervention (e.g., psychological distress and pain). Methods Prospective cohort study of 2019 adult participants, recruited within 28 days of a non-catastrophic RTI, predominantly of mild-to-moderate severity, in New South Wales, Australia. Biopsychosocial, injury, and compensation data were collected via telephone interview within one-month of injury (baseline). Work status was self-reported at baseline, 6-, 12-, and 24-months. Analyses were restricted to participants who reported paid work pre-injury (N = 1533). Type-3 global p-values were used to evaluate explanatory factors for returning to 'any' or 'full duties' paid work across factor subcategories. Modified Poisson regression modelling was used to evaluate factors associated with RTW with adjustment for potential covariates. Results Only ~ 30% of people with RTI returned to full work duties within one-month post-injury, but the majority (76.7%) resumed full duties by 6-months. A significant portion of participants were working with modified duties (~ 10%) or not working at all (~ 10%) at 6-, 12-, and 24-months. Female sex, low education, low income, physically demanding occupations, pre-injury comorbidities, and high injury severity were negatively associated with RTW. Claiming injury compensation in the fault-based scheme operating at the time, and early identified post-injury pain and psychological distress, were key factors negatively associated with RTW up until two years post-injury. Conclusions Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW.

© Papic C; Kifley A; Craig A; Grant G; Collie A; Pozzato I; Gabbe B; Derrett S; Rebbeck T; Jagnoor J; Cameron ID.  BMC Public Health. 22(1):1498, 2022 08 05.

Purpose Occupational accidents may lead laborers to lose their working capacities, affecting their physical and mental health. Occupational rehabilitation helps improve the ability of patients with occupational accidents and suggests appropriate jobs to avoid second injuries. This study aimed to identify whether any of the functional capacity evaluation (FCE) strength subtests predicted successful return to work. Methods Data were collected of 84 patients receiving government-subsidized occupational rehabilitation between September 2016 and December 2018. A structured questionnaire was employed for pre- and post-training assessment, including basic information, information of the occupational accident, status of the laborer at the opening of the injury case, physical requirement for the job, and physical capacity. Eight subtests of strength were included in the physical capacity evaluation, i.e., carrying, lifting to several levels, power grip, and lateral pinch, to explore the association between the strength tests and return to work. Results The unadjusted model showed that for every additional kilogram in bilateral carrying strength before work hardening training, the odds of successful return to work increased (crude odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.01-1.24, p = 0.027). After adjustment for basic demographic information and pre-accident physical functional elements of work, the odds of successful return to work increased (adjusted OR = 1.27, 95% CI = 1.04-1.54, p = 0.02) for every additional kilogram in the pre-training bilateral carrying strength. There were no statistically significant differences observed in the other seven subtests. Conclusion Through thorough evaluation and work hardening training provided in the occupational rehabilitation, patients' physical capacity can be understood and improved. However, a full evaluation of functional capacities is prolonged and time-consuming. This study provides evidence that pre-work-hardening bilateral carrying strength may be a promising predictor of return to work and we recommend to consider it as a prioritized test to assist in determining appropriate advice regarding return to work.

©   Yang CL; Yin YR; Chu CM; Tang PL. BMC Public Health. 22(1):1472, 2022 08 02.

Cancer

Purpose Continuing employment or returning to work (RTW) as a cancer survivor can be meaningful and financially necessary, yet challenging. However, there is a lack of qualitative research on RTW experiences and financial wellbeing of people with advanced colorectal cancer (CRC-A). This study aimed to fill this gap. Methods Adults treated for CRC-A were recruited 0.5-2 years post-surgery (or post-diagnosis of CRC-A for palliative chemotherapy participants).Semi-structured telephone interviews, exploring RTW and finances, were subjected to framework analysis. Demographic, clinical, and quality of life data (FACT-C, Distress Thermometer, COST measure) were collected to characterise the sample and inform the framework analysis. Results Analysis of 38 interviews revealed five overarching themes: work as a struggle, work as my identity, work as my saviour, work as a financial necessity, and employer and colleague response. Many survivors with CRC-A desired to, and had the capacity to, continue work or RTW, yet faced unique challenges from compounded stigma of both cancer and toileting issues. Inability to RTW negatively impacted financial and psychosocial wellbeing. Workplace support was an important facilitator of RTW. Conclusion For survivors with CRC-A, continuing or RTW is fraught with challenges, including physical functioning challenges, financial anxiety, and unsupportive workplace environments. Survivors require psychosocial, financial, and employer support to manage these difficulties. This paper recommends a multiprong approach, including education programmes (facilitated through workers' union groups, human resource institutions, and/or large consumer CRC groups) and policies, to support workers and for employers to understand the unique challenges of employees with CRC-A.

© Lim CYS; Laidsaar-Powell RC; Young JM; Steffens D; Koczwara B; Zhang Y; advanced-CRC survivorship authorship group; Butow P. Supportive Care in Cancer.  2022 Aug 16.

Purpose Fatigue after breast cancer treatment affects one in four women. Feeling tired affects womens daily activities, coping with the disease and quality of life. After active treatment, women want to return to their working lives, where fatigue is a barrier. Despite the fact of fatigue being such a common consequence of the treatment, it seems to be often overlooked. Methods This article is a substudy of the research focused on the complex experience of women with breast cancer. In this substudy, we focus on breast cancer patients perceptions of fatigue and its impact on daily life. A qualitative methodology was used to collect the data. The interviews were structured into two consecutive parts. The first, narrative part was followed by a semi-structured interview. The research population was recruited to meet the conditions of maximum variation sample (different regions of the country, age categories, education, stage of the disease, and treatment modality). Fifty-three interviews were collected and transcribed verbatim. The data from which the categories were created were analysed using NVivo10 software and were open coded. The codes were then grouped into themes for thematic analysis. Results Most women experienced fatigue as a consequence of the disease. Fatigue often forced them to change their lifestyle. The women perceived great limitations when returning to work. They did not feel ready to return to work and often postponed it or considered changing their working hours or a type of job. Conclusion Fatigue seems to be an underestimated consequence of the treatment in breast cancer patients. It often leads to a forced change in womens lifestyle, which has a negative impact on their mental health. Methods to monitor fatigue and early interventions are needed to improve womens quality of life after the treatment.

©   Cernikova KA; Kluzova Kracmarova L; Pesoutova M; Tavel P. Klinicka Onkologie. 35(4):290-296, 2022 Summer.

Purpose While many studies investigated changes in working status in cancer survivors, most studies have been performed in survivors of breast cancer and few studies evaluated factors associated with changes in the working status of cancer survivors comprehensively. We aimed to evaluate the changes in the working status of cancer survivors after diagnosis and socio-demographic, clinical, work-related and psychological factors associated with it. Methods We conducted a cross-sectional survey of adult patients with cancer who were working at the time of diagnosis. A trained interviewer inquired about participants' current working status, including leave of absence, discontinuing, continuing, and changing work. Sociodemographic, clinical, work-related and psychological factors were measured. Multinomial logistic regression was used to identify factors associated with changes in the working status. Results Among the 730 patients, 29%, 18% and 6% were currently on a discontinued working, leave of absence and had changed jobs, respectively. Patients who discontinued working after cancer diagnosis were more likely to be female, have ≥ $3,000 of monthly family income, not be the principal wage earners for their families and be blue-collar workers. In clinical characteristics, advanced-stage cancer and experienced cancer recurrence was associated with leave of absence and discontinued working. In work-related and psychological factors, stress due to insufficient job control (relative risk ratio [RRR] = 2.26), interpersonal conflict (RRR = 1.86), job insecurity (RRR = 2.63), organizational system (RRR = 3.49), and lack of reward (RRR = 11.76), and less meaning to work were more likely to discontinue working after a cancer diagnosis. Conclusion Occupational health care professionals and other stakeholders need to openly communicate with patients with cancer about potential barriers during the return-to-work trajectory.

© Kang D; Bae KR; Kim HY; Ahn Y; Kim N; Shim Y; Sohn TS; Lee WY; Baek JH; Kweon SS; Cho J. BMC Cancer. Vol. 22 Issue 1, p1-9.

Purpose Breast cancer-related lymphedema (BCRL), a side effect of cancer treatment, may negatively impact the ability to perform work. Factors such as delayed diagnosis, late-stage disease, and a high percentage of service occupations may challenge work choices for Latinas after BCRL diagnosis. Methods Our multiple case study explored work experiences and quality of life (QOL) for Hispanic/Latina survivors. Participants completed demographic and short form-36 (SF-36) surveys. Semi-structured interviews focused on how work environment, self-management, and QOL were influenced by BCRL. Thematic analysis of cases used In Vivo and descriptive coding and constant cross-case comparative methods. Results Analysis illustrated how Hispanic/Latina survivors perceive the influence of BCRL on work experience as requiring adaptation and personal resilience. Participants identified BCRL knowledge gap challenges and described coping with physical, psychosocial, and work activity changes. They described creative work adaptations and discussed BCRL's impact on both positive and negative interpersonal perceptions. Strong support from family, friends, and colleagues contributed to improved QOL and continued work activities. Conclusion Future research should incorporate coping strategies and creative management of BCRL to optimize work activities across the lifespan. These strategies can provide guidance for the creation of survivorship care plans, education of healthcare professionals (HCPs), and lifelong occupational support.

© Anderson EA; Anbari AB; Sun Y; Armer JM, Hispanic health care international : the official journal of the National Association of Hispanic Nurses, 2022 Aug 10, pp. 15404153221116755

Accident vasculaire cérébral (AVC)

Purpose Sustaining a stroke frequently leads to difficulties in returning to work, leisure, and social participation. These outcomes are important for occupational therapy practitioners to address. Objective: To determine the current evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve social participation, work, and leisure among adults poststroke. Methods Data sources: MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study selection and data collection:  Primary inclusion criteria were peer-reviewed journal articles published between January 1, 2009, and December 31, 2019, within the scope of occupational therapy that evaluated an intervention to address work, leisure, or social participation poststroke (levels of evidence ranged from Level 1b to Level 2b). Reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Forty-seven articles met the inclusion criteria. Forty-four articles related to social participation were categorized as follows: occupation-based approaches, metacognitive strategy training, education and training approaches, impairment-based approaches, and enriched environment approaches. Three articles related to work and 3 articles related to leisure were not further categorized (2 articles were each included in two categories). Seventeen Level 1b and 30 Level 2b articles were included. The strength of evidence to support occupational therapy interventions for social participation, work, and leisure outcomes is predominantly low. Conclusions Occupational therapy interventions may improve work, leisure, and social participation outcomes poststroke, with the strongest evidence existing for client education, upper extremity training, and cognitive training for improving social participation. What This Article Adds: Occupational therapy practitioners may use the available literature along with clinical reasoning to improve work, leisure, and social participation outcomes among clients poststroke. Additional research is required to build stronger evidence to support clinical decision making in stroke rehabilitation in these areas.

©   Proffitt R; Boone A; Hunter EG; Schaffer O; Strickland M; Wood L; Wolf TJ. American Journal of Occupational Therapy. 76(5), 2022 Sep 01.

Purpose Facilitating return-to-work (RTW) for working-age stroke survivors is a key component of stroke rehabilitation, however, research investigating the long-term outcomes of working-age stroke survivors is lacking. Objective: To investigate the factors that influence long-term RTW for patients enrolled on a community-based early supported discharge (ESD) rehabilitation program in Singapore about five years post stroke. Methods Sixty-nine patients, aged between 18 and 60 years and were employed at the time of their hospitalization, were enrolled into the ESD program between 2012 and 2014. A prospective cohort design was adopted to examine the relationships between the factors- demographic, functional, personal, psychosocial factors and work related- and RTW at five-year follow-up. Details of RTW were collected through questionnaires via telephone follow-up. Results Sixty percent of the participants (n = 49) were selected for Cox and logistic regression analyses of RTW at five-year follow-up. The results indicated that having social problems is a negative predictor of RTW (OR 0.02; 95% CI 0.00-0.22) while being the breadwinner is a positive predictor of RTW (OR 13.79; 95% CI 2.46-77.52). The same factors were also significant in the time to RTW event at five-year follow-up, with a hazard ratio of 0.09 and 4.07, respectively. Conclusions Early identification of the characteristics of stroke patients enrolled into an ESD program who have the potential to RTW would make interventions more targeted, increasing the likelihood of RTW.

© Teo SH; Fong KNK; Chen Z; Chung RCK. Work. 2022 Aug 18.

Purpose Rates of stroke in people of working age are increasing. Returning to work (RTW) after stroke is a key rehabilitation aspiration for younger stroke survivors. A pilot community-based Stay at Work Initiative (SAWI) was developed and delivered from March 2017 to December 2019. SAWI used a co-ordination based approach, covering rehabilitation and vocational recovery to support RTW in younger stroke survivors. The aim of the study was to conduct a feasibility evaluation of SAWI. Methods A mixed methods approach was taken considering quantitative and qualitative data. Quantitative data included employment, mood, anxiety and fatigue outcomes at time of engagement with the service and at 6-months post-stroke. Qualitative data was collected on a sub-sample of SAWI clients who volunteered to participate in a semi-structured interview. Results Overall, there were 93 referrals to SAWI, with 42 clients completing an initial service meeting. Average working hours pre-stroke were high (mean 46.9, SD 22.0, range 5–100 hours/week). By 6 months post stroke, 71% n = 29 of 41) of SAWI clients were working. For those with 6-month questionnaire information (n = 19), there was a significant reduction in cognitive fatigue, overall fatigue levels, and perceived impact of stroke on employment (medium effect sizes of r = 0.36, 0.34 and 0.40 respectively). No significant difference was seen on measures of mood or anxiety from pre- to post-intervention. Qualitative interviews with six SAWI participants highlighted the importance of personalised support that addresses individual needs during the RTW journey. A significant number of eligible participants referred to SAWI can engage with the service. Conclusion RTW is able to be assessed as are potential predictor variables. Seventy one percent of participants had RTW at 6 months post-stroke. Mood, self-efficacy, adjustment, and fatigue likely impact RTW. Qualitative interviews identified that SAWI’s personalised support, tailored to individual need, was valued.
© Turner A; De Wet TJ; McMurray J; Wrobel A; Smith H; Clissold B; Mohebbi M; Kneebone I. Journal of Vocational Rehabilitation. Aug 2022, p1-14.

Traumatisme crânien cérébral léger (TCCL)

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.