Early intervention vocational rehabilitation for return to work following traumatic injury: A randomized controlled trial

Abstract

Background: Returning to work (RTW) is an important goal for individuals sustaining traumatic injury (Multi-Trauma Orthopaedic [MTO], traumatic brain injury [TBI], and spinal cord injury [SCI]). Vocational rehabilitation is often unavailable or delayed, and controlled evaluation limited.

Objectives: This study evaluated the impact of providing an Early Intervention Vocational Rehabilitation Service (EIVRS) following traumatic injury on employment outcomes, mental health and quality of life 1- and 2-years post-injury.

Methods: A randomised parallel 2-group design was used to compare the EIVRS group with a control group receiving usual rehabilitation. Outcomes included hours worked and time to return to first job (primary outcomes), anxiety, depression and quality of life 1- and 2-years post-injury. Participants were adults aged 16-70, employed pre-injury. Eighty-eight EIVRS treatment and 82 controls were recruited; mean 47 days post-injury, 75% male, mean age 38 years. Dedicated EIVRS therapists provided activities associated with fostering hope for RTW, thinking about and preparing for returning to work, building RTW goals into rehabilitation, identifying an employer liaison, and peer support.

Results: There were no significant group differences in employment outcomes at 1-year follow-up, but EIVRS participants reported lower anxiety. Median quartile regressions revealed that at 2-year follow-up, the EIVRS group worked more hours (38, 24; 40) and took significantly less time from injury to RTW (166, 87; 280) than controls (29, 23; 36 and 238, 144; 325). Quartile regressions by diagnosis showed a significant main effect of group (P = 0.02) but no interaction between group and diagnosis (P = 0.60). Trends for shorter time to RTW were strongest in the MTO and TBI groups at 2 years. At 2 years there were no group differences in anxiety, depression or quality of life.

Conclusions: Offering EIVRS may reduce time to RTW and increase hours worked 2 years after traumatic injury.

Trial registration: #ACTRN12619000521123.

Keywords: Multi-trauma orthopaedic injury; Outcomes; Return to work; Spinal cord injury; Traumatic brain injury; Vocational rehabilitation.