Three versus seven days to return-to-work after mild traumatic brain injury: a randomized parallel-group trial with neuropsychological assessment

ABSTRACT

Although most patients with a mild traumatic brain injury (mTBI) recover within days to weeks, some experience persistent physical, cognitive and emotional symptoms, often described as post-concussion syndrome (PCS). The optimal recovery time including return-to-work (RTW) after mTBI is unclear. In this single-centre parallel-group trial, patients assigned three days (3D-group) or seven days (7D-group) sick leave were compared with a comprehensive neuropsychological test battery including the Post-Concussion Symptom Scale (PCSS) within one week, after three and 12 months post-injury. The influence of the effective time until RTW on post-concussional symptoms and cognitive performance was analysed. The 3D-group rated significantly higher mean scores in some PCSS symptoms, tended to fulfil diagnosis criteria of PCS more often and showed better cognitive performance in several neuropsychological test scores than the 7D-group at all three time-points of follow-up. Overall, patients returned to work 11.35 d post-injury, thus distinctly above both recommended sick leaves. There was a trend for longer sick leave in patients randomized into the 3D-group. Further analyses revealed that the group with an absolute RTW within one week showed lower symptom severity in fatigue at 3 and 12 months, less PCS and faster performance in fine motor speed at 12 months than the group with an absolute RTW after one week. Our data underline the heterogeneity of mTBI and show that acute and sub-acute symptoms are not prognostic factors for neuropsychological outcome at one year. Later, ability to work seems to be prognostic for long-term occurrence of PCS.

KEYWORDS:

• Mild traumatic brain injury
• return-to-work
• post-concussion syndrome
• neuropsychological assessment
• temporary work disability

Acknowledgments

The authors thank Mrs Patzl and Mrs Filipin of the Clinical Trial Unit of the Cantonal Hospital St. Gallen for their important contribution in the collection of data. The authors also thank the clinical trial unit (CTU) commission, the Olga Mayenfisch Foundation, the Hans und Wilma Stutz Foundation and the Alfred und Bertha Zangger-Weber Foundation for their financial support.

The study was funded by three independent private foundations (Olga Mayenfisch, Wilma Stutz and Alfred und Bertha Zangger-Weber), the Commission of the Clinical Trials Unit of the Cantonal Hospital St. Gallen and the Department of Neurosurgery, Cantonal Hospital St. Gallen.

Disclosure statement

No competing financial interests exist. The authors report no conflict of interest.

Additional information

Funding

The authors also thank the clinical trial unit (CTU) commission, the Olga Mayenfisch Foundation, the Hans und Wilma Stutz Foundation and the Alfred und Bertha Zangger-Weber Foundation for their financial support. The study was funded by three independent private foundations (Olga Mayenfisch, Wilma Stutz and Alfred und Bertha Zangger-Weber), the Commission of the Clinical Trials Unit of the Cantonal Hospital St. Gallen and the Department of Neurosurgery, Cantonal Hospital St. Gallen.