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Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial - 12/10/21

Doi : 10.1016/j.rehab.2021.101538 
Silje C.R. Fure a, b, , Emilie Isager Howe a, c, Nada Andelic a, b, Cathrine Brunborg d, Unni Sveen a, e, Cecilie Røe a, b, c, Per-Ola Rike f, Alexander Olsen g, h, Øystein Spjelkavik i, Helene Ugelstad j, Juan Lu b, k, Jennie Ponsford l, Elizabeth W. Twamley m, n, Torgeir Hellstrøm a, Marianne Løvstad o, p
a Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway 
b Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway 
c Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway 
d Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway 
e Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway 
f Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway 
g Department of Psychology, Norwegian University of Technology and Science, Trondheim, Norway 
h Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway 
i Work Research Institute, Oslo Metropolitan University, Oslo, Norway 
j Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway 
k Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA 
l Monash Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia 
m Center of Excellence for Stress and Mental Health, Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA, USA 
n Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA 
o Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway 
p Department of Psychology, University of Oslo, Oslo, Norway 

Corresponding author at: Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0407 Oslo, Norway.Department of Physical Medicine and Rehabilitation, Oslo University HospitalOslo0407Norway

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Highlights

Returning to work is often challenging after a traumatic brain injury.
Some patients do not return to work for months after a mild traumatic brain injury.
Here, cognitive rehabilitation and supported employment was delivered together.
The intervention resulted in an accelerated return to work after injury.

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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.

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


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Vol 64 - N° 5

Article 101538- septembre 2021 Retour au numéro
Article précédent Article précédent
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