Five-year follow-up of persons with brain injury entering the French vocational and social rehabilitation programme UEROS: Return-to-work, life satisfaction, psychosocial and community integration

The Australian Traumatic Brain Injury Initiative: Systematic Review and Consensus Process to Determine the Predictive Value of Demographic, Injury Event, and Social Characteristics on Outcomes for People With Moderate-Severe Traumatic Brain Injury

The objective of the Australian Traumatic Brain Injury (AUS-TBI) Initiative is to develop a data dictionary to inform data collection and facilitate prediction of outcomes of people who experience moderate-severe TBI in Australia. The aim of this systematic review was to summarize the evidence of the association between demographic, injury event, and social characteristics with outcomes, in people with moderate-severe TBI, to identify potentially predictive indicators. Standardized searches were implemented across bibliographic databases to March 31, 2022. English-language reports, excluding case series, which evaluated the association between demographic, injury event, and social characteristics, and any clinical outcome in at least 10 patients with moderate-severe TBI were included. Abstracts and full text records were independently screened by at least two reviewers in Covidence. A pre-defined algorithm was used to assign a judgement of predictive value to each observed association. The review findings were discussed with an expert panel to determine the feasibility of incorporation of routine measurement into standard care. The search strategy retrieved 16,685 records; 867 full-length records were screened, and 111 studies included. Twenty-two predictors of 32 different outcomes were identified; 7 were classified as high-level (age, sex, ethnicity, employment, insurance, education, and living situation at the time of injury). After discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous predictors capable of enabling early identification of those at risk for poor outcomes and improved personalization of care through inclusion in routine data collection.

Trauma-Responsive Vocational Rehabilitation Services

Research on the effectiveness of Vocational Rehabilitation (VR) Programs has revealed that VR services are less effective for trauma-affected and Black consumers. For instance, consumers with trauma exposure disengage from services earlier than their non-traumatized counterparts, and Black consumers benefit less from each phase of VR services compared to others. One midwestern state's VR program sought to address these disparities by offering trauma-informed and trauma-responsive services that emphasize cultural responsiveness, racial equity, and strengths-based practices. To begin this work, the state's VR program collaborated with an applied research unit in a public university to establish two work groups: a communications group and a training group. The purpose of the communications group was to build a robust referral network within the VR Division and with other community-based agencies and providers, particularly for low-income, Black consumers. The purpose of the training group was to develop and deliver a training program to support VR professionals in providing trauma-informed and trauma-responsive services. Results from an evaluation of the training indicated that each training module generated for staff both reminders and new insights into ways to effectively work with consumers. Staff expressed that they wanted opportunities to further explore and apply the training content and needed additional, ongoing support to implement what they were learning. In response to staff needs, the state's VR program is continuing to invest in this community-university partnership by establishing communities of practice for staff and evaluating the effectiveness of the training program.

Experiences of individuals with acquired brain injury and their families interacting with community services: a systematic scoping review

PURPOSE

This scoping review aims to (1) synthesise the research findings on the experiences of individuals with acquired brain injuries, and their families, when interacting with, or accessing, community-based services and (2) identify where gaps in service provision may exist and their cause.

METHODS

A systematic search strategy was employed across multiple databases to identify all studies relating to the experiences of individuals with acquired brain injuries and their families when interacting with, or accessing, community-based services. Inclusion was assessed by at least two reviewers at each stage and data extraction was completed by one researcher and validity checked by another. A narrative synthesis was employed.

RESULTS

A total of 101 papers met the inclusion criteria with the narrative synthesis identifying three main themes of (1) unmet needs, (2) types of access, and (3) barriers to access.

CONCLUSIONS

The results identify that those with acquired brain injuries, and their families, experience significant difficulties interacting with community-based services and often do not receive appropriate access. Many barriers to access were identified including a lack of knowledge of the long-term effects of acquired brain injury amongst professionals working in health and social care services.Implications for rehabilitationBrain injury is a leading cause of disability worldwide with a range of physical, cognitive, emotional, and behavioural difficulties.It is important that service users and families are given appropriate information about the long-term difficulties associated with ABI so they are better informed about the types of support they may need upon discharge from hospital.Rehabilitation professionals need to ensure they have good level of knowledge of the difficulties associated with ABI to ensure appropriate access to services for individuals and their families.Understanding more about unmet needs allows community rehabilitation services to be tailored and person-centred.

Factors associated with employment stability following traumatic brain injury, in a sample who have received comprehensive vocational rehabilitation

PURPOSE

To quantify employment stability of individuals with traumatic brain injury (TBI) who received comprehensive vocational rehabilitation (VR) using different measures to identify difficulties experienced and factors associated with employment stability.

MATERIALS AND METHODS

72 individuals with predominantly moderate-severe TBI were interviewed. Neuropsychological assessment scores were collected. Three employment stability measures were used: number of post-injury employers, duration with employer and average weekly hours. Descriptive and predictive analyses were performed.

RESULTS

90.2% remained employed at time of interview (Mean = 4.83 years post-injury). However, participants worked significantly fewer hours, 63.9% had changed roles or employers at least once and only 51% achieved their pre-injury level of responsibility. 61% reported a high level of employer support. Self-reported difficulties included physical sequelae, memory problems and fatigue. Post-injury testing found impaired memory (34.4%) and processing speed (49.2%). After accounting for time since injury, demographic and employment variables (older age, male gender, higher pre-injury skill-level, higher level of employer support), higher level of injury-related difficulties and lower level of cognitive function significantly predicted employment stability.

CONCLUSION

Injury-related difficulties impact employment long-term, necessitating ongoing work modifications. Individualised VR is important, not only to facilitate return to work but to support long-term employment stability after TBI.Implications for rehabilitationBeing male was associated with working more hours, and having faster processing speed, lower levels of fatigue and ongoing physical sequelae were associated with a longer duration with the same employer.Initial return to work is often the first step on a long journey as injury-related difficulties can continue to impact work in the-long term and require lasting modifications to duties and working hours.VR should include ongoing follow-up to facilitate work modifications and support both the employer and the employee in adjusting to these.VR should be individualised to support the impact of the unique cognitive and physical limitations experienced by each individual with TBI, based on the needs and employment demands of each workplace.

Vocational rehabilitation and return to work: integrative review

Analysis of population growth trends and aging-which is associated with occurrence of chronic diseases, in addition to (work-related or not) diseases and accidents in general-points to an increasing need to implement rehabilitation services worldwide. Rehabilitation comprises three aspects: medical, vocational and social. The aim of the present study was to describe the state of the art in vocational rehabilitation approaches in several countries, as well as vocational rehabilitation-based return-to-work strategies for individuals with restrictions due to diseases and accidents in general developed in the past 30 years. We performed an integrative review of studies located in databases Virtual Health Library-Regional Library of Medicine (VHL-BIREME), PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Web of Science, Sociological Abstracts, Education Resources Information Center (ERIC) and SCOPUS. A total of 1,109 studies were initially retrieved, of which 12 were considered eligible on methodological assessment and included for review. The selected studies analyzed new approaches and the implementation of existing programs, new programs/projects, and educational measures for workers on sick leave. Most programs had multidisciplinary nature and included complementary educational approaches, early intervention, and possibility of workplace adjustments. The studies on new projects consisted in job retention and return-to-work programs for unemployed or temporary workers. The number of studies which describe occupational rehabilitation programs is small and evaluating their efficacy is difficult. Scientific research on this subject is still scarce vis-à-vis the current demands.

The factor structure of the Quality of Life Inventory (QOLI) following traumatic brain injury

Quality of life is a key indicator of outcome following traumatic brain injury (TBI). Research has reported several different factor structures for the Quality of Life Inventory (QOLI, Frisch, 1994). We compared the fit of existing factor models and examined the clinical utility of the QOLI's factors in a sample of Australian adults with TBI. Archival data from 901 participants were provided by the Neurotrauma Register of Tasmania. Participants were aged 16-80 years and 63% were male. Approximately 69% had mild TBI (PTA < 24 h), approximately 24% had moderate TBI (PTA >1 day, <7 days) and 7% had severe TBI. Both cross sectional and longitudinal analyses were utilized, as participants provided data at one or more of seven time-points, up to 3 years following injury. The results showed the data best fitted a three-factor model, comprising Self-functioning and activity, Self-actualization and Family and environment factors, and a second order Overall QOL factor. Differences in the trajectory of recovery were noted between the QOLI factor scores over time and in relation to demographic and injury variables. In conclusion, the three-factor structure of the QOLI provided useful clinical information about the recovery of patients' subjective quality of life following TBI.