Predictors of Return To Work After Moderate-To-Severe Traumatic Brain Injury: A Systematic Review of Current Literature and Recommendations for Future Research

Abstract

Objective(s) To identify factors associated with employment between six months and five years after moderate-to-severe traumatic brain injury (TBI). Data Sources Pubmed, Web Of Science, PsychINFO and EconLit were searched for research articles published between 2014 and the first half of April 2021 in English, French, German or Dutch containing predictors of employment outcome. In addition, backward as well as forward citation tracking was performed. Study Selection Study selection was in accordance with the PRISMA flow and the whole process was conducted by two reviewers who had to attain a consensus. Studies were required to: (1) be original quantitative research articles, (2) concern civilian working-age adults with moderate-to-severe TBI and (3) assess employment outcome or employment stability (for wage only). Nineteen studies met inclusion criteria and were included in the review. Data Extraction Evidence was collected from regression coefficients, correlations or other analysis types appropriate for prognostic modelling. Quality appraisal was performed by two independent researchers in accordance with the guidelines of the National Institute of for Health and Clinical Excellence (NICE) for prognostic studies. Data Synthesis Evidence was found for being employed and white-collar occupations as pre-injury facilitators of return to work. Low Glasgow Coma Scale, long time to follow commands and prolonged hospital stays can be considered acute barriers. High levels of disability and weak memory performance were identified as functional barriers. Insurance status and year of injury were found as possible environmental facilitators. Conclusions While there was a reasonable amount of evidence about pre-injury and injury variables, literature on modifiable factors related to functioning and the patient's environment remains scarce. Future studies should focus on this domain to increase predictive accuracy as well as enable targeted advancements in the fields of rehabilitation and policymaking in order to improve the vocational prognosis of patients with TBI. Author(s) Disclosures No conflict of interest to declare. To identify factors associated with employment between six months and five years after moderate-to-severe traumatic brain injury (TBI). Pubmed, Web Of Science, PsychINFO and EconLit were searched for research articles published between 2014 and the first half of April 2021 in English, French, German or Dutch containing predictors of employment outcome. In addition, backward as well as forward citation tracking was performed. Study selection was in accordance with the PRISMA flow and the whole process was conducted by two reviewers who had to attain a consensus. Studies were required to: (1) be original quantitative research articles, (2) concern civilian working-age adults with moderate-to-severe TBI and (3) assess employment outcome or employment stability (for wage only). Nineteen studies met inclusion criteria and were included in the review. Evidence was collected from regression coefficients, correlations or other analysis types appropriate for prognostic modelling. Quality appraisal was performed by two independent researchers in accordance with the guidelines of the National Institute of for Health and Clinical Excellence (NICE) for prognostic studies. Evidence was found for being employed and white-collar occupations as pre-injury facilitators of return to work. Low Glasgow Coma Scale, long time to follow commands and prolonged hospital stays can be considered acute barriers. High levels of disability and weak memory performance were identified as functional barriers. Insurance status and year of injury were found as possible environmental facilitators. While there was a reasonable amount of evidence about pre-injury and injury variables, literature on modifiable factors related to functioning and the patient's environment remains scarce. Future studies should focus on this domain to increase predictive accuracy as well as enable targeted advancements in the fields of rehabilitation and policymaking in order to improve the vocational prognosis of patients with TBI.