Towards developing a guideline for vocational evaluation following traumatic brain injury: the qualitative synthesis of clients’ perspectives

Abstract

Purpose: This paper is a qualitative synthesis of clients’ perspectives of the elements significant to return to work following traumatic brain injury (TBI). This is part of a larger review, completed to provide the evidence base for a vocational evaluation guideline. Methods: Processes outlined in the Cochrane Handbook of Systematic Review guided the full review including: developing review questions, search strategies and selection criteria; quality appraisal; data extraction, analysis and synthesis; drawing conclusions. Four data bases (i.e. Medline, Embase, PsychInfo, Cochrane) were searched for relevant qualitative studies. Evidence tables were used to extract data from studies and thematic analysis employed to analyze the qualitative data. Results: Analysis of clients’ perspectives on return to work resulted in four key themes including the following: 1) meaning of work; 2) process of return to work and reconciling new identities; 3) opportunities to try versus risks of failure; 4) significance of supports. Themes are discussed in relation to vocational evaluation and findings from other syntheses. Conclusions: Vocation evaluation should include the assessment of: the meaning clients ascribe to work following a TBI and their post-injury goals; clients’ self-perceptions of work competency, work readiness and anticipated challenges with return to work; and the available supports.

Implications for Rehabilitation

• Incorporating clients’ perspectives within vocational evaluation facilitates their partnership in the process.

• Vocational evaluators should assess clients’ post-injury work goals, interests and motivations, as the meaning of work can change following traumatic brain injury (TBI).

• Vocational evaluators should assess the opportunities for experimentation with work activities, to facilitate clients’ development of self-awareness and new self-identities.

• Vocational evaluators should identify instrumental and emotional supports available to clients, to mediate challenges that may arise during return to work.

Keywords::

• employment
• rehabilitation
• return to work
• traumatic brain injury
• vocational

Acknowledgements

The authors would like to thank Ms. Tanya Glencross-Eimantas B.Sc.OT, MSc. OT Reg (Ont.) and Ms. Lynn Rutlege MscOT, Ph D (student) in the Graduate Department of Rehabilitation Science, University of Toronto, for their assistance with the quality appraisal of the studies in this review.

Declaration of interest: This review is part of the first author’s doctoral research and was supported by funding from the following sources: Doctoral Fellowship from the Social Science and Humanities Research Council of Canada; Doctoral Fellowship from the Ontario Neurotrauma Foundation; Finkler Graduate Student Fellowship from the Kunin-Lunenfeld Applied Research Unit at Baycrest, the S. Leonard Syme Doctoral Training Fellowship in Work & Health from the Institute of Work & Health, and a Continuing Education and Professional Development Award from the Faculty of Medicine, University of Toronto.