Predictors of return to work after moderate-to-severe traumatic brain injury: a systematic review of current literature and recommendations for future research

Abstract

Purpose: To identify factors associated with employment between six months and five years after traumatic brain injury (TBI).

Methods: Using a predefined search algorithm, four electronic databases were searched for literature published between 2014 and the first half of April 2021 containing predictors of employment outcome. Data were selected in accordance with the PRISMA flow and the whole process was conducted by two reviewers who had to attain a consensus. The study results were discussed with an expert panel, in order to provide guidance for future research on this topic.

Results: This review found clear evidence for employment status at time of injury, occupation at time of injury, Glasgow Coma Scale, length of stay, disability level and primary payer to be predictors of return to work after TBI.

Conclusions: More literature investigating in depth the functioning and environmental factors is required for further improvement of predictions, rehabilitation and policy.Implications for rehabilitationThis study identifies predictors of return to work in TBI patients, which can be used to identify patients with high risk early in the recovery process.Current literature shows difficulties with general functioning are a barrier for return to work, but gives no indication about effective therapeutic interventions.More knowledge about modifiable factors is desirable to improve rehabilitation and, thereby, employment outcomes after TBI.

Keywords: Brain injury; employment; neurotrauma; return to work; review.