Effectiveness of Combining Compensatory Cognitive Training and Vocational Intervention vs. Treatment as Usual on Return to Work Following Mild-to-Moderate Traumatic Brain Injury: Interim Analysis at 3 and 6 Month Follow-Up.

Emilie Isager Howe,Cathrine Brunborg,Nada Andelic,Cecilie Røe,Tonje Haug Nordenmark,Helene L Søberg,Kjersti Sagstad,Silje C R Fure,Torgeir Hellstrøm,Heidi Enehaug,Marianne Løvstad,Elizabeth Twamley,Juan Lu

doi:10.3389/fneur.2020.561400

Abstract

Aims: Knowledge regarding the most effective return to work (RTW) approaches after traumatic brain injury (TBI) is lacking. This trial aimed to compare the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on RTW and work stability after TBI.Methods: We performed a parallel-group randomized controlled trial (RCT) at a TBI outpatient clinic at Oslo University Hospital (OUH), Norway. Patients with a history of mild-to-moderate TBI (n = 116) aged 18–60 were randomized (1:1) by an independent investigator to receive group-based compensatory cognitive training (CCT) and supported employment (SE) (n = 60) or TAU consisting of individualized multidisciplinary treatment (n = 56). Participants were enrolled 2–3 months post-injury. The nature of the intervention prevented blinding of patients and therapists, however, outcome assessors were blinded to group allocation. The primary outcome measure was RTW at 3 and 6 months following study inclusion. Secondary outcomes were work percentage, stability, and productivity. The present study provides results from an interim analysis from the first two planned follow ups, while subsequent publications will present results up to 12 months following study inclusion.Results: Mixed effects models showed no between-group differences in the RTW proportion, work percentage, and hours worked between CCT-SE and TAU from baseline to 6 months. A significantly higher proportion of participants in CCT-SE had returned to work at 3 months when adjusting for baseline differences. The majority of participants who were employed at 3 and 6 months were stably employed. There was a statistically significant within-group improvement on RTW proportion, hours worked and work percentage in both groups.Conclusion: The results revealed no difference between CCT-SE and TAU on work-related outcomes from baseline to 6 months. However, there was a higher RTW proportion in the CCT-SE group compared to TAU at 3 months. Future publications will assess the effectiveness of CCT-SE vs. TAU up to 12 months.Clinical Trial Registration: US National Institutes of Health ClinicalTrials.gov, identifier #NCT03092713.

Highlights

Failure to return to work (RTW) and decreased work stability following traumatic brain injury (TBI) constitutes a major personal and societal burden [1]
As previous cognitive interventions have proven effective in reducing post-concussive complaints in the TBI population [31, 32, 35] and supported employment (SE) has been successfully applied in the Norwegian context to participants with mental illness [36], we developed a combined cognitive and vocational intervention to be tested in people with mild-to-moderate TBI who were still on sick leave 2 months post-injury due to persisting symptoms [37]
All patients referred to the clinic between July 2017 and April 2019 were eligible according to the following criteria: [1] diagnosed with mildto-moderate TBI as assessed by a Glasgow Coma Scale [38] (GCS) score of 10–15, loss of consciousness (LOC)

Summary

Introduction

Failure to return to work (RTW) and decreased work stability following traumatic brain injury (TBI) constitutes a major personal and societal burden [1]. A substantial proportion of those who sustain a TBI are of working age [2], and the lifetime work loss costs of TBI in the US have been estimated to almost $70 billion [3], while costs due to productivity loss and early retirement have been estimated to approximately e19 billion annually in Europe [4]. To resume and maintain employment while experiencing post-injury difficulties is challenging for many individuals with TBI [6]. Most patients with mild TBI (mTBI) resume work within weeks to months after their injury [8]. Between 5 and 30% of individuals who sustain a mild or moderate TBI are unable to RTW within 6–12 months [8, 9]. Studies have shown that individuals who resume employment may continue to experience symptoms affecting work stability and productivity [10,11,12,13]

Methods

Results

Discussion

Conclusion