03 Dec 2021

Return to work after a brain injury: a major review shows what predicts best outcomes

Returning to work is one of the main benchmarks of recovery and of overall well- being following a brain injury.

Therefore, a major review of 101 studies exploring relturn to work rates after a mild traumatic brain injury (mTBI) provides a valuable insight into what supports recovery and what are the main predictors of a delayed or non-return to work.

What do the studies tell us about likelihood of return to work after a brain injury?

Three of the four studies suggest most workers with MTBI do return to work. For example, one study showed 76% of participants (152 of 201) were fully back at work six months after their original injury. Another study, which included individuals making legal claims for their injury, found 72 per cent of people were back at work after 72 days. However, five per cent had not returned to work and were full time unemployed two years after their injury. A fourth study reported more pessimistic outcomes: more than half the individuals with brain injuries had not returned to work six to nine months after the original injury. Overall, considering all of the studies reviewed, it was found that after a mTBI, around 5 to 20 per cent of injured workers face persisting problems and unable to return to work one to two years after their original injury.

What predicts problems with returning to work?

The review of 101 studies found there were a number of factors which predicted a stronger possibility of return to work. These included: having more than 11 years of formal education, absence of nausea or vomiting on hospital admission, absence of additional extracranial injuries, absence of severe pain immediately after injury. Younger individuals (aged 20 to 29 years) were more likely to return to work and there was no significant difference between genders. One study found that after an mTBI, people whose jobs had greater independence and scope for decision-making did better in terms of return to work than those with less. Student, homemaker, professional/semi-professional, and management categories were defined as occupations offering more independence and opportunity for decision making compared with the clerical, sales and service, manual labour and trades occupations. This echoes another study which individuals holding professional and/or managerial positions are three times more likely to return to work
than those in the manual labour occupations.

What does this mean in terms of support and rehabilitation for people with brain injuries?

The review provides a really interesting and valuable insight into what might support a good recovery and what might be risk factors for long term, disabling difficulties. There is a mixture of physical and social aspects; we might expect, for example, the presence of nausea and vomiting to be linked to increased risk of poor outcome and equally we might expect, for example, for younger individuals to do a little better in terms of returning to work. What stands out is the links between educational achievement prior to injury, occupational scope for independent decision making and type of occupation. It seems that there are a number of factors that make a person in a lower skilled, less independent job with lower prior educational attainment less likely to return to work after a brain injury. We already know the importance of a holistic and comprehensive support and rehabilitation approach to support best outcomes for each individual. This review suggests there is perhaps a need for this support to be more precisely personalised to meet the distinct challenges in certain job types and for older individuals. This might encompass, for example, an early focus on what the specific difficulties are and what support there could be and if needed, support to find an adapted role or even a move to a different job in order to mitigate against the debilitating prospect of failing to return to work and loss of confidence and capacity to work.

References

Systematic Review of Return to Work After Mild Traumatic Brain Injury: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Carol Cancelliere et al. Archives of Physical Medicine and Rehabilitation 2014;95(3 Suppl 2):S201-9.

Walker WC, Marwitz JH, Kreutzer JS, Hart T, Novack TA. Occupational categories and return to work after traumatic brain injury: a multicenter study. Arch Phys Med Rehabil 2006;87:1576-82.

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