Scaratti Chiara, Leonardi Matilde, Sattin Davide, Schiavolin Silvia, Willems Michelle, Raggi Alberto
a Neurology, Public Health and Disability Unit , Neurological Institute Carlo Besta IRCCS Foundation , Milan , Italy.
Disabil Rehabil. 2017 May;39(9):847-855. doi: 10.3109/09638288.2016.1162854. Epub 2016 Apr 10.
To address the content of work-related difficulties and explore which variables are associated to or determinants of these difficulties in persons that suffered from Traumatic Brain Injury (TBI).
Papers published between 1993 and February 2015 were included. Quality was judged as poor, acceptable, good or excellent. Determinants were extracted from longitudinal data, associated variables from cross-sectional data; variables were grouped by similarity. Evidence was judged as strong if the same results were reported by two or more good studies; limited if reported by one good and some acceptable studies.
Forty-two papers were selected (25,756 patients). Work-related difficulties were referred as unemployment, job instability or job cessation. Strong evidence of impact was found for: low educational level, pre-injury unemployment, Glasgow Coma Scale score and TBI severity, length of stay in acute and rehabilitation settings, lower Functional Independence Measure scores and presence of cognitive disturbances.
Evidence on the effect of rehabilitation interventions on TBI patients' work-related difficulties exists, but is poorly measured. Future studies should address the sustainability of holistic and tailored interventions targeting employees, employers and workplaces and aimed to reduce the gap between work duties and worker's abilities, using appropriate assessment instruments measuring difficulties in work activities. Implications for rehabilitation Traumatic Brain Injury (TBI) primarily affects young persons of working age causing a broad range of motor, sensory and cognitive impairments. A combination of variables related both to pre-morbid and to injury-related factors predict and are associated to work-related difficulties. While demographic and injury characteristics cannot be modified, some TBI outcomes (e.g. cognitive impairments or functional status) may be addressed by specific rehabilitative interventions: the knowledge of the specific work-related difficulties of TBI patients is of importance to tailor rehabilitation programs that maximize vocational outcomes. Rehabilitation researchers should give attention to vocational issues and use assessment instruments addressing the difficulties in work-related activities, in order to demonstrate the benefits of rehabilitative interventions on TBI patients' ability to work.
探讨与创伤性脑损伤（TBI）患者工作相关困难的内容，并探究哪些变量与这些困难相关或可作为其决定因素。
纳入1993年至2015年2月发表的论文。质量被判定为差、可接受、良好或优秀。从纵向数据中提取决定因素，从横断面数据中提取相关变量；变量按相似性分组。如果两项或更多良好研究报告了相同结果，则证据被判定为有力；如果由一项良好研究和一些可接受研究报告，则证据有限。
选取了42篇论文（25756名患者）。工作相关困难被定义为失业、工作不稳定或离职。发现以下因素有有力的影响证据：低教育水平、伤前失业、格拉斯哥昏迷量表评分和TBI严重程度、急性和康复环境中的住院时间、较低的功能独立性测量评分以及认知障碍的存在。
关于康复干预对TBI患者工作相关困难影响的证据存在，但衡量不足。未来研究应使用适当的评估工具来衡量工作活动中的困难，针对员工、雇主和工作场所开展全面且量身定制的干预措施，以减少工作职责与工人能力之间的差距，并探讨这些干预措施的可持续性。对康复的启示创伤性脑损伤（TBI）主要影响工作年龄的年轻人，会导致广泛的运动、感觉和认知障碍。与病前和损伤相关因素相关的变量组合可预测工作相关困难并与之相关。虽然人口统计学和损伤特征无法改变，但一些TBI结果（如认知障碍或功能状态）可通过特定的康复干预来解决：了解TBI患者特定的工作相关困难对于制定能使职业结果最大化的康复计划非常重要。康复研究人员应关注职业问题，并使用能够解决工作相关活动困难的评估工具，以证明康复干预对TBI患者工作能力的益处。
