Vocational rehabilitation following traumatic brain injury: a quantitative synthesis of outcome studies

Abstract

This study is a quantitative synthesis of research relating to Traumatic Brain Injury (TBI) and employment outcomes. Using broad inclusion criteria, 26 studies were selected for review. The study comprised a combined sample of 3688 participants aged 16 years and above who had sustained a TBI as an adult. Aggregate results across selected studies indicated that individuals with TBI returned to competitive employment and other productive activities earlier with vocational intervention than without intervention. The current synthesis also demonstrated that the use of a narrow definition of return-to-work (i.e., full-time competitive work only) produced more apparent unemployment than an inclusive definition (i.e., any competitive work or productive activity). Although this finding is not surprising, full-time employed persons seemed more likely to remain 'employed' over time compared to those who were in any type of employment or productive activity. These findings have important implications regarding the timeliness of vocational interventions and highlight the need for competitive employment (full-time) preparation to ensure optimal long-term outcomes following TBI. The definition of employment and the nature of pre-injury employment is crucial to any interpretation of return-to-work in TBI. The current study also highlights the importance of measuring employment outcomes using multiple points over time, rather than single data points or first return-to-work.