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Perini P, Caristi M, Mondin E, Matarrese MR, Cortese G, Giustini A, Cannella I, Pinzello A, Fogar P. Traumatic Brain Injury Caused by Work Accidents: How can Occupational and Vocational Recovery be Achieved? JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2020; 3:1000031. [PMID: 33884133 PMCID: PMC8008731 DOI: 10.2340/20030711-1000031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 11/16/2022]
Abstract
Issues connected with the reintegration of individuals affected by severe brain injury are numerous and complex. Extensive data indicate the effectiveness of treatments based on an holistic approach, which integrates medical interventions with social programmes and offers continuity, leading to the rapid achievement of independent living outcomes and return to work. In Italy, extensive resources are available for the clinical and rehabilitation management of individuals affected by traumatic brain injury in the acute and post-acute phase, but there are only a few organized services to support the reintegration phase. This paper describes a model created via a 2-year collaboration between the National Institute for Insurance against Accidents at Work (INAIL) in Rome and the National Federation of Traumatic Brain Injury Associations (FNATC). The combined effort of these organizations led to the development of an Italian Model of Vocational Rehabilitation (IMoVR), which was exportable to all 20 Italian Regions. Due to the experience gained by a few avant-garde teams, IMoVR was used to pioneer an approach characterized by structured phases and actions aimed at designing high-quality interventions, and at monitoring their long-term effectiveness. These teams comprised experts in different areas, including: forensic doctors, social workers, administrative managers of INAIL, neuropsychologists, psychotherapists, educators working in associations registered with FNATC, all of whom are members of a service network that had already activated small individual vocational projects. In total, the collaboration comprised 42 pro-fessionals working in 7 Italian cities: Ancona, Arezzo, Ferrara, Milano, Pordenone, Rimini and Vicenza.
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Affiliation(s)
- Paola Perini
- Istituto di Riabilitazione Madre della Divina Provvidenza Agazzi, Arezzo, Italy
- FNATC, Federazione Nazionale Traumi Cranici, Pordenone, Italy
- Associazione Casa e Lavoro APS, Ferrara, Italy
| | - Margherita Caristi
- INAIL Istituto Nazionale Assicurazione Infortuni sul lavoro, Direzione Centrale, Roma, Italy
| | - Elisabetta Mondin
- FNATC, Federazione Nazionale Traumi Cranici, Pordenone, Italy
- Sogno e Vita Cooperativa Sociale, Vicenza, Italy
| | - Maria Rosaria Matarrese
- INAIL Istituto Nazionale Assicurazione Infortuni sul lavoro, Direzione Centrale, Roma, Italy
| | - Giovanni Cortese
- INAIL Istituto Nazionale Assicurazione Infortuni sul lavoro, Direzione Centrale, Roma, Italy
| | - Alessandro Giustini
- Istituto di Riabilitazione Madre della Divina Provvidenza Agazzi, Arezzo, Italy
- Ospedale Di Riabilitazione San Pancrazio Arco di Trento, Arco, Italy
- FNATC, Federazione Nazionale Traumi Cranici, Pordenone, Italy
| | - Ilaria Cannella
- INAIL Istituto Nazionale Assicurazione Infortuni sul lavoro, Direzione Centrale, Roma, Italy
| | - Alessia Pinzello
- INAIL Istituto Nazionale Assicurazione Infortuni sul lavoro, Direzione Centrale, Roma, Italy
| | - Paolo Fogar
- FNATC, Federazione Nazionale Traumi Cranici, Pordenone, Italy
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Sargénius Landahl K, Sandqvist J, Bartfai A, Schult ML. Is a structured work task application for the assessment of work performance in a constructed environment, useful for patients with attention deficits? Disabil Rehabil 2019; 43:1699-1709. [PMID: 31642716 DOI: 10.1080/09638288.2019.1674391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of our study was to develop a Structured Work Task application for the Assessment of Work Performance for patients with attention deficits. MATERIAL AND METHODS We developed a computer-based registration task titled the Attention-demanding Registration Task. It had a structured administrative procedure with additional scoring regarding time and accuracy, also linked to the original scoring of the Assessment of Work Performance. We evaluated the Attention-demanding Registration Task for content validity. Furthermore, we investigated it concerning sensitivity and specificity in patients with attention deficits due to acquired brain injury (n = 65) against a comparison group of healthy people (n = 47). RESULTS Our investigation on content validity using the Assessment of Work Characteristics confirmed that the Attention-demanding Registration Task sets high demands on process skills, especially on energy, temporal organization, and adaptation. The Attention-demanding Registration Task showed high sensitivity and specificity in differing between patients with attention deficits and a healthy working group; nine out of ten participants were placed in the correct group. CONCLUSIONS To assess work performance, the use of a Structured Work Task application, the Attention-demanding Registration Task, linked with the Assessment of Work Performance, proved to be sensitive to attention deficits.Implications for rehabilitationA Structured Work Task application for the Assessment of Work Performance was developed for use in people with attention deficits and showing a high degree of sensitivity and specificity.Linking performance time and accuracy to the Assessment of Work Performance scoring and providing a guide for linking task performance to the Assessment of Work Performance skills in addition to the usual observations performed, may increase scoring accuracy.Reference data for a comparison group of healthy subjects are provided.The use of the Attention demanding Registration Task, while using the Assessment of Work Performance within clinical practice ensures a more accurate description of process skills in performance.
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Affiliation(s)
- Kristina Sargénius Landahl
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jan Sandqvist
- The Rehabilitation Medicine University Clinic, Danderyd Hospital, Stockholm, Sweden.,Department of Social Welfare Studies, Faculty of Health Sciences, Linkoping University, Norrkoping, Sweden
| | - Aniko Bartfai
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Marie-Louise Schult
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Radford K, Sutton C, Sach T, Holmes J, Watkins C, Forshaw D, Jones T, Hoffman K, O'Connor R, Tyerman R, Merchán-Baeza JA, Morris R, McManus E, Drummond A, Walker M, Duley L, Shakespeare D, Hammond A, Phillips J. Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT. Health Technol Assess 2019; 22:1-124. [PMID: 29863459 DOI: 10.3310/hta22330] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI. OBJECTIVE To assess the feasibility of a definitive, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, specialist VR plus usual care (UC) compared with UC alone on work retention 12 months post TBI. DESIGN A multicentre, feasibility, parallel-group RCT with a feasibility economic evaluation and an embedded mixed-methods process evaluation. Randomisation was by remote computer-generated allocation. SETTING Three NHS major trauma centres (MTCs) in England. PARTICIPANTS Adults with TBI admitted for > 48 hours and working or studying prior to injury. INTERVENTIONS Early specialist TBI VR delivered by occupational therapists (OTs) in the community using a case co-ordination model. MAIN OUTCOME MEASURES Self-reported RTW 12 months post randomisation, mood, functional ability, participation, work self-efficacy, quality of life and work ability. Feasibility outcomes included recruitment and retention rates. Follow-up was by postal questionnaires in two centres and face to face in one centre. Those collecting data were blind to treatment allocation. RESULTS Out of 102 target participants, 78 were recruited (39 randomised to each arm), representing 39% of those eligible and 5% of those screened. Approximately 2.2 patients were recruited per site per month. Of those, 56% had mild injuries, 18% had moderate injuries and 26% had severe injuries. A total of 32 out of 45 nominated carers were recruited. A total of 52 out of 78 (67%) TBI participants responded at 12 months (UC, n = 23; intervention, n = 29), completing 90% of the work questions; 21 out of 23 (91%) UC respondents and 20 out of 29 (69%) intervention participants returned to work at 12 months. Two participants disengaged from the intervention. Face-to-face follow-up was no more effective than postal follow-up. RTW was most strongly related to social participation and work self-efficacy. It is feasible to assess the cost-effectiveness of VR. Intervention was delivered as intended and valued by participants. Factors likely to affect a definitive trial include deploying experienced OTs, no clear TBI definition or TBI registers, and repatriation of more severe TBI from MTCs, affecting recruitment of those most likely to benefit/least likely to drop out. LIMITATIONS Target recruitment was not reached, but mechanisms to achieve this in future studies were identified. Retention was lower than expected, particularly in UC, potentially biasing estimates of the 12-month RTW rate. CONCLUSIONS This study met most feasibility objectives. The intervention was delivered with high fidelity. When objectives were not met, strategies to ensure feasibility of a full trial were identified. Future work should test two-stage recruitment and include resources to recruit from 'spokes'. A broader measure covering work ability, self-efficacy and participation may be a more sensitive outcome. TRIAL REGISTRATION Current Controlled Trials ISRCTN38581822. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Radford
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Chris Sutton
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jain Holmes
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Caroline Watkins
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Denise Forshaw
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Trevor Jones
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Karen Hoffman
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Rory O'Connor
- Academic Department of Rehabilitation Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Ruth Tyerman
- Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | | | - Richard Morris
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma McManus
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Avril Drummond
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Marion Walker
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lelia Duley
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Alison Hammond
- Health Sciences Research Centre, University of Salford, Salford, UK
| | - Julie Phillips
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Meulenbroek P, Turkstra LS. Job stability in skilled work and communication ability after moderate-severe traumatic brain injury. Disabil Rehabil 2015; 38:452-61. [PMID: 25958999 PMCID: PMC5308217 DOI: 10.3109/09638288.2015.1044621] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Communication deficits may play a critical role in maintaining employment after traumatic brain injury (TBI), but links between specific communication deficits and employment outcomes have not been determined. This study identified communication measures that distinguished stably employed versus unstably employed adults with TBI. METHODS Participants were 31 adults with moderate-severe TBI who were employed full-time for at least 12 consecutive months before injury in skilled jobs and had attempted return to skilled jobs after injury. Sixteen had achieved stable employment (SE) post-injury, defined as full-time employment for ≥12 consecutive months; and 15 had unstable employment (UE). Participants completed a battery of communication tests identified in a prior qualitative study of communication skills required for skilled work. RESULTS Measures of spoken language comprehension, verbal reasoning, social inference, reading and politeness in spoken discourse significantly discriminated between SE and UE groups. Two nested models were completed and compared. The first model excluded discourse data because of missing data for two UE and one SE participant. This model revealed that measures of verbal reasoning speed (β = -0.18, p = 0.05) and social inference (β = 0.19, p = 0.05) were predictive independent of the overall model. The second model included discourse politeness data and was a better overall predictor of group membership (Likelihood ratio test, Model 1: 3.824, Model 2: 2.865). CONCLUSION Communication measures were positively associated with SE in skilled jobs after TBI. Clinicians should include assessment of communication for adults attempting return to work after TBI, paying specific attention to social inference and speed of verbal reasoning skills. IMPLICATIONS FOR REHABILITATION Traumatic brain injury (TBI) often results in communication impairments associated with the cognitive skills underlying interpersonal skills. Communication impairment after TBI has been anecdotally associated with job instability. This research associate communication functioning with work stability after TBI in skilled jobs. These findings indicate that communication impairment should be assessed in persons with TBI returning to skilled employment after injury.
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Affiliation(s)
- Peter Meulenbroek
- Northwestern University, Department of Physical Medicine and Rehablitation, Feinberg School of Medicine, Chicago, IL, USA
- The Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Lyn S. Turkstra
- University of Wisconsin – Madison, Department of Communication Sciences and Disorders, Madison, WI, USA
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Forslund MV, Arango-Lasprilla JC, Roe C, Perrin PB, Sigurdardottir S, Andelic N. Multi-level modelling of employment probability trajectories and employment stability at 1, 2 and 5 years after traumatic brain injury. Brain Inj 2014; 28:980-6. [PMID: 24655118 DOI: 10.3109/02699052.2014.888770] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVES To examine trajectories of employment probability and stability over the first 5 years after traumatic brain injury (TBI) by using multi-level modelling and multinomial logistic regressions. RESEARCH DESIGN A longitudinal cohort study. METHODS AND PROCEDURES One hundred and five individuals with moderate-to-severe TBI who had been admitted to the Trauma Referral Centre for the Southeast region of Norway were followed up at 1, 2 and 5 years after the injury. MAIN OUTCOMES AND RESULTS Employment status was dichotomized into employed and unemployed, while employment stability was categorized into stably employed, unstably employed and unemployed at 1, 2 and 5 years after injury. Being single, unemployment prior to injury, blue collar occupation, lower Glasgow Coma Scale (GCS) score at hospital admission and greater length of post-traumatic amnesia (PTA) were significantly associated with being unemployed at 1, 2 and 5 years post-injury. Further, younger patients, those with a lower GCS, greater length of PTA and greater length of hospital stay were negatively associated with employment stability. CONCLUSIONS It could be wise to target patient population with these demographic and injury characteristics for more extensive follow-ups and vocational rehabilitation to help improve employment outcomes following injury.
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Affiliation(s)
- Marit V Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital , Oslo , Norway
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