Vocational Rehabilitation in Mild Traumatic Brain Injury: Supporting Return to Work and Daily Life Functioning

Frederik Lehman Dornonville de la Cour; Morten Arendt Rasmussen; Eva Meldal Foged; Line Svenning Jensen; Trine Schow

doi:10.3389/fneur.2019.00103

Vocational Rehabilitation in Mild Traumatic Brain Injury: Supporting Return to Work and Daily Life Functioning

Front Neurol. 2019 Feb 21:10:103. doi: 10.3389/fneur.2019.00103. eCollection 2019.

Authors

Frederik Lehman Dornonville de la Cour^{1

2}, Morten Arendt Rasmussen³, Eva Meldal Foged¹, Line Svenning Jensen¹, Trine Schow¹

Affiliations

¹ Research and Development, Brain Injury Center BOMI, Roskilde, Denmark.
² Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
³ Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.

Abstract

Persisting post-concussive symptoms are challenging to treat and may delay return-to-work (RTW). The aims of this study were to describe a multidisciplinary and holistic vocational rehabilitation (VR) program for individuals with mild traumatic brain injury (mTBI) and to explore course and predictors of employment outcome during VR. The VR program was described using the Standard Operating Procedures (SOPs) framework. Further, a retrospective, cohort study on individuals with mTBI receiving VR was conducted based on clinical records (n = 32; 22% males; mean age 43.2 years; 1.2 years since injury on average). The primary outcome was difference in hours at work per week from pre- to post-VR, and the secondary outcome was change in a three-level RTW-status. Time since injury, age, sex, and loss of consciousness were investigated as predictors of the outcomes. The VR intervention is individually tailored and targets patients' individual needs. Thus, it may combine a variety of methods based on a biopsychosocial theoretical model. During VR, hours at work, 17.0 ± 2.2, p < 0.001, and RTW-status, OR = 14.0, p < 0.001, improved significantly with 97% having returned to work after VR. Shorter length of time since injury and male sex were identified as predictors of a greater gain of working hours. Time since injury was the strongest predictor; double the time was associated with a reduction in effect by 4.2 ± 1.4 h after adjusting for working hours at start of VR. In sum, these results suggest that individuals facing persistent problems following mTBI may still improve employment outcomes and RTW after receiving this multidisciplinary and holistic VR intervention, even years after injury. While results are preliminary and subject to bias due to the lack of a control group, this study warrants further research into employment outcomes and VR following mTBI, including who may benefit the most from treatment.

Keywords: concussion; employment; mild traumatic brain injury; multidisciplinary rehabilitation; post-concussive syndrome; return to work; standard operating procedure (SOP); vocational rehabilitation.