Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Ann Phys Rehabil Med. 2021 Sep;64(5):101538. doi: 10.1016/j.rehab.2021.101538. Epub 2021 Jul 22.
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.
This study aimed to examine the effect of a combined cognitive and vocational intervention on work-related outcomes after mild-to-moderate TBI.
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.
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).
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.
重返工作岗位通常是创伤性脑损伤（TBI）后的主要康复目标。然而，关于重返工作岗位（RTW）和稳定工作维持的治疗选择的证据基础仍然很少。
本研究旨在探讨认知和职业联合干预对轻度至中度 TBI 后与工作相关结果的影响。
在这项研究中，我们将 6 个月的认知补偿训练和支持性就业（CCT-SE）联合治疗与 6 个月的常规治疗（TAU）进行了随机对照试验比较，以检验对 RTW 时间、工作百分比、每周工作小时数和工作稳定性的影响。合格患者为轻度至中度 TBI 患者，在受伤时至少有 50%的工作时间，年龄在 18 至 60 岁之间，由于脑震荡后症状（通过 Rivermead 脑震荡后症状问卷评估），受伤后 8 至 12 周病假时间至少为 50%。两种治疗均在奥斯陆大学医院的门诊 TBI 部门进行，在纳入后 3、6 和 12 个月进行随访。
我们纳入了 116 名患者，其中 60 名随机分配到 CCT-SE 组，56 名分配到 TAU 组。两组在 12 个月随访时的特征无差异。总体而言，较高比例的患者在 12 个月时已重返工作岗位（CCT-SE 组为 90%；TAU 组为 84%，P=0.40），除 3 人外，所有患者在 RTW 后均稳定就业。然而，CCT-SE 组的参与者在 3 个月时返回稳定就业的比例明显高于 TAU 组（81%比 60%，P=0.02）。
这些结果表明，CCT-SE 干预可能有助于那些在受伤后 8 至 12 周仍处于病假状态的轻度至中度 TBI 患者更早地重返稳定就业。然而，在得出结论之前，还需要进行复制和成本效益分析。
