Who among patients with acquired brain injury returned to work after occupational rehabilitation? The rapid-return-to-work-cohort-study

Abstract

Background: Acquired brain injury (ABI) is known to be severely disabling. On average, 40% of employees return to work (RTW) within two years after injury. There is, however, limited research on what might contribute to successful RTW.

Aim: To examine factors that might impact the time-to first RTW for patients with ABI, participating in a RTW-program.

Methods: The study was designed as a cohort study of patients on sick leave due to mild or moderate ABI (n = 137). The mean age of the patients was 51 years, and 58% were men. The most common diagnoses were stroke (75%) and traumatic brain injury (12%). Data were collected through questionnaires, and combined with register data on sickness absence. Survival analyses were used to analyse the effect of different variables on time to first RTW (full or partial), at one- and two-year follow-up.

Results: Generally, women (HR = 0.447; CI: 0.239–0.283) had higher RTW-rates than men, and patients with non-comorbid impairments returned to work earlier than patients with multiple impairments. Although not statistically significant, receiving individual consultations and participating in group-sessions were generally associated with a delayed RTW at both follow-up-times. The only service-related factor significantly associated with delayed RTW was meetings with the social insurance office (HR = 0.522; CI: 0.282–0.965), and only at one-year follow-up.

Conclusions: Women and patients with non-comorbid impairments returned to work earlier than men and patients with multiple impairments. There seems to be an association between intense and long-lasting participation in the RTW program and prolonged time-to first-RTW, even after controlling for level of cognitive impairments and comorbidity.

Implications for Rehabilitation

• Acquired brain injury (ABI) is known to be severely disabling, and persons with ABI often experience difficulties in regard to returning to work.

• This study provides information on prognostic factors that might contribute to return to work (RTW) for patients with acquired brain injury, both at the individual level, but also in regard to service and timing characteristics.

• Knowledge about such factors provide rehabilitation professionals with information about effective service components that might help patients with ABI to RTW, and thus makes it possible to adapt and adjust the services to the patient’s situation.

• Furthermore, having more knowledge on factors that contribute to RTW gives clinics the opportunity to select patients that might benefit the most from these services, thereby making them more effective.

Keywords:

• Acquired brain injury
• traumatic brain injury
• stroke
• rapid-RTW-studies
• occupational rehabilitation
• workplace disability prevention and integration
• disability management

Acknowledgements

We would like to thank the patients and the RTW-team at Sykehuset Innlandet, Hamar, Norway. Our special thanks go to the managers for the RTW-service; Eija Sareneva, Iver Fallet, and Inga Rønningen.

Disclosure statement

The authors report no declaration of interest.

Additional information

Funding

This work was funded by The Norwegian Directorate of Health and South-Eastern Norway Regional Health Authority.