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Randomized Controlled Trial
. 2021 Sep;64(5):101538.
doi: 10.1016/j.rehab.2021.101538. Epub 2021 Jul 22.

Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial

Silje C R Fure  1 , Emilie Isager Howe  2 , Nada Andelic  3 , Cathrine Brunborg  4 , Unni Sveen  5 , Cecilie Røe  6 , Per-Ola Rike  7 , Alexander Olsen  8 , Øystein Spjelkavik  9 , Helene Ugelstad  10 , Juan Lu  11 , Jennie Ponsford  12 , Elizabeth W Twamley  13 , Torgeir Hellstrøm  14 , Marianne Løvstad  15
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Free article
Randomized Controlled Trial

Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial

Silje C R Fure et al. Ann Phys Rehabil Med. 2021 Sep.
Free article

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.

Keywords: Cognitive rehabilitation; Concussion; Mild-to-moderate traumatic brain injury; Return to work; Vocational rehabilitation; Work stability.

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