Scoping review of return-to-work interventions for persons with traumatic brain injury

PURPOSE

The study approach sought to understand which vocational rehabilitation (VR) strategies are available for individuals seeking return to work (RTW) following traumatic brain injury (TBI). Secondly, the review aimed to identify how these RTW interventions and outcomes are evaluated.

MATERIALS AND METHODS

Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, the scoping review began by identifying relevant English language articles via PubMed, CINAHL, PsycINFO, and Embase databases for peer-reviewed journal articles published from January 2013 to September 2021. The review focused on identifying studies with a sample population of people with moderate to severe TBI.

RESULTS

A total of 23 studies met the search criteria. For each included study, the following data were extracted: (a) country of origin, (b) sample size, (c) civilian or military sample population, (d) age, (e) participant gender, (f) RTW definition, (g) intervention approach, and (h) RTW outcome. The results were synthesized by placement into one of four categories as a function of the study's underlying methodological approach.

CONCLUSIONS

The development of effective RTW approaches has largely been neglected in the rehabilitation literature for persons with TBI in civilian and military populations. Effective strategies do exist to help guide efforts to return this population to productive activity, including work.Implications for RehabilitationLack of productive engagement in work and school among persons with traumatic brain injury (TBI) presents a chronic challenge in rehabilitation systems internationally.Rehabilitation professionals should utilize multidisciplinary and integrated return-to-work (RTW) interventions given the varied areas of function that can result from TBI.Rehabilitation professionals should apply RTW interventions that promote on-site training and workplace integration.Given the idiosyncratic nature of TBI, RTW interventions should be tailored to meet the specific needs of the person seeking support.

Revising the Pragmatics Profile of Everyday Communication Skills for traumatic brain injury: An international Delphi study

BACKGROUND

Assessment tools that assess pragmatic skills in adults with a mild-severe traumatic brain injury (TBI) are hard to access, not person-centred and have a high risk of clinician bias. The Pragmatics Profile is an informant report tool that was originally designed to assess pragmatic skills in people with a developmental disability.

AIMS

The aim of this study was to seek consensus from a panel of experts and create a version of the Pragmatics Profile for the TBI population.

METHODS AND PROCEDURES

A three-round modified Delphi methodology panel of 13 experts were invited to comment anonymously on the suitability of each question from the Pragmatics Profile modified for those with TBI until ≥ 80% agreement was reached.

OUTCOMES AND RESULTS

The Pragmatics Profile (TBI) included 66 questions that achieved consensus after three rounds of the Delphi panel. Qualitative analysis illuminated themes relating to adults with TBI and the need to include contextual factors.

CONCLUSIONS AND IMPLICATIONS

The outcome of this project was a revised version of the Pragmatics Profile which is suitable for adults with a mild-severe TBI, informed by experts and freely available online. Future research exploring the tool's utility and acceptability is the next step in its evaluation.

WHAT THIS PAPER ADDS

What is already known on this subject Assessment of the everyday functional use of language is challenging but vital. This is particularly true for those who have traumatic brain injury (TBI) where the communication outcomes can be highly variable and may include difficulties with conversational turn-taking, topic maintenance and reading social cues. There are limited tools available to clinicians and those tend to be rating scales or checklists which have a high risk of clinician bias. Available tools have a limited ability to capture the individual's personal social communication goals. What this paper adds to existing knowledge This study created an online Pragmatics Profile (PP) for TBI based on experts' opinions. This paper details the themes that emerged during the process of revising the PP for those with TBI. What are the potential or actual clinical implications of this work? The PP-TBI adds to the toolkit for speech and language therapists working with people with TBI. It meets recent recommendations in the literature to create an interview-based tool. The versatility of an online tool combined with revised input from a panel of experts increases the likelihood that clinicians will utilise this tool. Given the long-term use of the original PP by clinicians for almost 30 years and a focus on personalised care, the format and approach are also likely to be acceptable to clinicians.

The Vicissitudes of Life: Some Effects of Injuries on Career Development

The purpose of this paper is to examine four case studies on the effects of injuries on adult career development. The four cases are taken from published judgements in the New South Wales and Australian Capital Territory Supreme Courts. Each case is analysed in terms of the person's background, the key issues and the demonstrable impact on educational and vocational development. As expected, these selected cases highlight the catastrophic effects of injuries on expected career development. This was viewed as a function of the person's background and the type of accident and the associated injuries. Sometimes there is evidence of a return to work but it is qualitatively and quantitatively different from what might be expected had the accident not occurred.

Analysis of the Earning Capacity Assessment Form-2: Some Australian data

The Earning Capacity Assessment Form-2 assesses the factors that inhibit and facilitate an individual’s vocational rehabilitation following an acquired disability (e.g. accident, misadventure). The purpose of this paper is to provide a psychometric analysis of the form. Data on Australian accident victims (N = 87) from a medico-legal vocational assessment practice were used as a basis for evaluation. In order to resolve scoring issues, the responses were converted to dichotomous categories and analysed using the Rasch method. It was concluded that there are weaknesses in the rationale of the Earning Capacity Assessment Form-2 but that some components may be worthwhile where economic loss is a consideration. A revised categorisation is proposed.

A Report on the Return-to-Work Rates Following Compensatable Accident or Injury

This study examined return-to-work in a sample of 468 compensatable injury cases. These included amputees, brain damage, hearing loss, mental disorders, musculoskeletal problems, nervous system, paraplegia, sight loss and miscellaneous conditions. Around 35% returned to work. It was substantially higher for work-related injuries compared to motor vehicle accidents or general insurance claims. Those who underwent surgery or were admitted to hospital had higher return-to-work rates than those never attending hospital. Psychiatric adjustment factors were a major influence on low rates of return-to-work. Other social and demographic factors were considered (gender, age, city vs. rural location, whether a spinal injury was involved, family status, years of schooling, qualifications, job status at time of accident, occupation). Eight out of 17 possible factors were more statistically significantly related than the remainder to whether someone was working but the substantive limitations of even relevant pre- or post-accident indicators are outlined.