Silje C R Fure1, Emilie Isager Howe2, Nada Andelic3, Cathrine Brunborg4, Unni Sveen5, Cecilie Røe6, Per-Ola Rike7, Alexander Olsen8, Øystein Spjelkavik9, Helene Ugelstad10, Juan Lu11, Jennie Ponsford12, Elizabeth W Twamley13, Torgeir Hellstrøm14, Marianne Løvstad15. 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. Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway.
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.
RCT Entities:
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.
Authors: Emilie Isager Howe; Nada Andelic; Silje C R Fure; Cecilie Røe; Helene L Søberg; Torgeir Hellstrøm; Øystein Spjelkavik; Heidi Enehaug; Juan Lu; Helene Ugelstad; Marianne Løvstad; Eline Aas Journal: BMC Health Serv Res Date: 2022-02-12 Impact factor: 2.655