Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial

Silje C R Fure; Emilie Isager Howe; Nada Andelic; Cathrine Brunborg; Unni Sveen; Cecilie Røe; Per-Ola Rike; Alexander Olsen; Øystein Spjelkavik; Helene Ugelstad; Juan Lu; Jennie Ponsford; Elizabeth W Twamley; Torgeir Hellstrøm; Marianne Løvstad

doi:10.1016/j.rehab.2021.101538

Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial

Ann Phys Rehabil Med. 2021 Sep;64(5):101538. doi: 10.1016/j.rehab.2021.101538. Epub 2021 Jul 22.

Authors

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway. Electronic address: siljfu@ous-hf.no.
² Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
⁴ Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
⁵ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
⁶ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁷ Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway.
⁸ Department of Psychology, Norwegian University of Technology and Science, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁹ Work Research Institute, Oslo Metropolitan University, Oslo, Norway.
¹⁰ Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway.
¹¹ Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway; Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA.
¹² Monash Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
¹³ Center of Excellence for Stress and Mental Health, Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
¹⁴ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
¹⁵ Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway; Department of Psychology, University of Oslo, Oslo, Norway.

PMID: 33957293
DOI: 10.1016/j.rehab.2021.101538

Abstract

Background: Returning to work is often a primary rehabilitation goal after traumatic brain injury (TBI). However, the evidence base for treatment options regarding return to work (RTW) and stable work maintenance remains scarce.

Objective: This study aimed to examine the effect of a combined cognitive and vocational intervention on work-related outcomes after mild-to-moderate TBI.

Methods: In this study, we compared 6 months of a combined compensatory cognitive training and supported employment (CCT-SE) intervention with 6 months of treatment as usual (TAU) in a randomised controlled trial to examine the effect on time to RTW, work percentage, hours worked per week and work stability. Eligible patients were those with mild-to-moderate TBI who were employed ≥50% at the time of injury, 18 to 60 years old and sick-listed ≥50% at 8 to 12 weeks after injury due to post-concussion symptoms, assessed by the Rivermead Post Concussion Symptoms Questionnaire. Both treatments were provided at the outpatient TBI department at Oslo University Hospital, and follow-ups were conducted at 3, 6 and 12 months after inclusion.

Results: We included 116 individuals, 60 randomised to CCT-SE and 56 to TAU. The groups did not differ in characteristics at the 12-month follow-up. Overall, a high proportion had returned to work at 12 months (CCT-SE, 90%; TAU, 84%, P=0.40), and all except 3 were stably employed after the RTW. However, a significantly higher proportion of participants in the CCT-SE than TAU group had returned to stable employment at 3 months (81% vs. 60%, P=0.02).

Conclusion: These results suggest that the CCT-SE intervention might help patients with mild-to-moderate TBI who are still sick-listed 8 to 12 weeks after injury in an earlier return to stable employment. However, the results should be replicated and a cost-benefit analysis performed before concluding.

Keywords: Cognitive rehabilitation; Concussion; Mild-to-moderate traumatic brain injury; Return to work; Vocational rehabilitation; Work stability.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Adult
Brain Injuries, Traumatic*
Cognition
Humans
Middle Aged
Quality of Life*
Rehabilitation, Vocational
Return to Work
Young Adult