Facilitators of and barriers to return to work after mild traumatic brain injury: A thematic analysis

ABSTRACT

Individuals with mild traumatic brain injury (mTBI) may experience protracted symptoms affecting their ability to work. Several actors may facilitate or act as a barrier to a successful return to work (RTW). This qualitative study used semi-structured in-depth interviews with 22 adults with mTBI at 2–5 years post injury, targeting experiences of how different actors facilitated or acted as a barrier in the RTW process, and encompassed the mTBI trajectory from the acute phase to the post-acute phase. A thematic analysis with a hermeneutical phenomenological approach was used to analyse data. Three main themes emerged. (1) Worker–employer relationship: Workplace accommodations such as decreased working hours, modified working conditions, and support from co-workers were lacking. (2) The role of the general practitioner: The general practitioner was lacking treatment and referral opportunities and failed to provide the patient with relevant and individualized guidance. (3) Municipal case management: Participants perceived being met with distrust by social workers, follow-up assessments were too frequent, unnecessary, and did not target concussion, and rehabilitation was referred too late. Clinical practice guidelines to improve referral to relevant concussion rehabilitation in case of persistent symptoms are needed to inform clinicians, employers, and public institutions to facilitate a successful RTW.

KEYWORDS:

• Mild traumatic brain injury
• Concussion
• Rehabilitation
• Return to work

Acknowledgements

The authors wish to thank the Centre for Rehabilitation of Brain Injury, Copenhagen, Denmark, for assisting in recruiting participants for the study, and for administrative support. We would also like to thank the study participants for their time and participation. We are grateful for the assistance provided by Emilia Socha Refshammer and André Mathiassen. Author contributions: HJG participated in study design, interviews, data analysis and interpretation, and manuscript preparation. ND and PC participated in study design, interviews and manuscript preparation. HMR conceived the study, participated in study design, data analysis and interpretation, and manuscript preparation. All authors reviewed and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Research Foundation, Rigshospitalet [grant number E-22260-03, E-23473-01]; the Danish Health Foundation (Helsefonden) [grant number 16-B-0050]; and the Aase and Ejnar Danielsen Foundation [grant number 20-000054].