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Employment interventions for return-to-work in working-age adults following traumatic brain injury

Additional Info

  • Authors: Carolyn Graham, Michael West, Jessica Bourdon, Katherine J. Inge
  • Published date: 2016-09-01
  • Coordinating group(s): Education
  • Type of document: Review, Plain language summary
  • Title: Employment interventions for return-to-work in working-age adults following traumatic brain injury
  • Library Image: Library Image
  • See the full review: https://onlinelibrary.wiley.com/doi/10.4073/csr.2016.6
  • Records available in: English, Spanish
  • English:

    PLAIN LANGUAGE SUMMARY

    Interventions for adults with traumatic brain injury may improve employment status

    Programs for adults who have suffered traumatic brain injury may improve employment status. All programs lead to employment, although no single program was more effective than the other programs.

    What is this review about?

    The unemployment rate in the USA for people who have suffered traumatic brain injury (TBI) was around 60% for 2001-10, compared to a national average of around 7%.

    Post-acute rehabilitation services – such as residential community reintegration programs, comprehensive day treatment programs, and community re-entry programs - focus on helping individuals adjust to ongoing impairments and to re-enter their communities, workplaces, and education. This review assesses the most effective type of intervention for returning individuals with TBI to work.

    What is the aim of this review?

    This Campbell systematic review examines the effectiveness of vocational rehabilitation interventions to help adults with traumatic brain injury get competitive employment. Three randomized controlled trials are included: two of military populations in the USA and one of the civilian population in China (Hong Kong).

    What studies are included?

    Studies are included which assess interventions focused on assisting helping working-aged adults with TBI return to competitive employment, including self-employment. Participants must have been between 18 and 65 years of age, experienced a non-penetrating TBI, been engaged in either full-time or part-time employment at time of injury, and been unemployed or on medical leave at time of receipt of the intervention.The studies must have competitive employment as an outcome.

    Three randomized controlled trials (RCT) are included in the analysis, two studying US military personnel and one of civilians in China (Hong Kong). All three studies compared alternative programmes. One compared an intensive in-hospital program versus an at-home program. The second study compared the CogSMART program plus supported employment with supported employment alone. And in the third study the control group received psycho-educational training with the treatment group receiving the same content via a virtual reality-based training platform.

    How effective are the programmes?

    None of the programs were better at improving employment outcomes than the comparator program to which it was compared. The intensive in-hospital program was no better than the at-home alternative, CogSMART added no value to supported employment alone, and virtual reality-based training was no better than psycho-educational training. Comparison of employment before and after the interventions showed the interventions in the United States improved employment status. The intervention in China did not improve employment status.

    None of the studies reported secondary employment outcomes: hours worked and wages earned.

    It was not possible to conduct analysis of the relative effectiveness of different types of programme because of the small number of included studies.

    What are the implications of this review for policy makers and decision makers?

    These three studies have limited implications for practice and policy. No intervention was found to be more effective than any other. In two of the studies the populations were limited to military subjects, who present with significantly different challenges such as posttraumatic stress disorder.

    The comparator interventions of at-home training and supported employment appear promising.

    What are the research implications of this review?

    There is a need for more RCTs on return-to-work interventions for adults with TBI, preferably separating competitive employment from school attendance. Military interventions should be conducted with civilian samples in order to determine their effectiveness in the civilian population, including on populations outside the United States. A broader range of employment outcomes should be studied, with regular follow up at standard intervals (e.g., six months, 12 months, 18 months, etc.).

    How up-to-date is this review?

    The search was completed in 2015.

  • Spanish:

    Click on 'Download PDF' on the right to view the plain language summary in Spanish.

Select language:

PLAIN LANGUAGE SUMMARY

Interventions for adults with traumatic brain injury may improve employment status

Programs for adults who have suffered traumatic brain injury may improve employment status. All programs lead to employment, although no single program was more effective than the other programs.

What is this review about?

The unemployment rate in the USA for people who have suffered traumatic brain injury (TBI) was around 60% for 2001-10, compared to a national average of around 7%.

Post-acute rehabilitation services – such as residential community reintegration programs, comprehensive day treatment programs, and community re-entry programs - focus on helping individuals adjust to ongoing impairments and to re-enter their communities, workplaces, and education. This review assesses the most effective type of intervention for returning individuals with TBI to work.

What is the aim of this review?

This Campbell systematic review examines the effectiveness of vocational rehabilitation interventions to help adults with traumatic brain injury get competitive employment. Three randomized controlled trials are included: two of military populations in the USA and one of the civilian population in China (Hong Kong).

What studies are included?

Studies are included which assess interventions focused on assisting helping working-aged adults with TBI return to competitive employment, including self-employment. Participants must have been between 18 and 65 years of age, experienced a non-penetrating TBI, been engaged in either full-time or part-time employment at time of injury, and been unemployed or on medical leave at time of receipt of the intervention.The studies must have competitive employment as an outcome.

Three randomized controlled trials (RCT) are included in the analysis, two studying US military personnel and one of civilians in China (Hong Kong). All three studies compared alternative programmes. One compared an intensive in-hospital program versus an at-home program. The second study compared the CogSMART program plus supported employment with supported employment alone. And in the third study the control group received psycho-educational training with the treatment group receiving the same content via a virtual reality-based training platform.

How effective are the programmes?

None of the programs were better at improving employment outcomes than the comparator program to which it was compared. The intensive in-hospital program was no better than the at-home alternative, CogSMART added no value to supported employment alone, and virtual reality-based training was no better than psycho-educational training. Comparison of employment before and after the interventions showed the interventions in the United States improved employment status. The intervention in China did not improve employment status.

None of the studies reported secondary employment outcomes: hours worked and wages earned.

It was not possible to conduct analysis of the relative effectiveness of different types of programme because of the small number of included studies.

What are the implications of this review for policy makers and decision makers?

These three studies have limited implications for practice and policy. No intervention was found to be more effective than any other. In two of the studies the populations were limited to military subjects, who present with significantly different challenges such as posttraumatic stress disorder.

The comparator interventions of at-home training and supported employment appear promising.

What are the research implications of this review?

There is a need for more RCTs on return-to-work interventions for adults with TBI, preferably separating competitive employment from school attendance. Military interventions should be conducted with civilian samples in order to determine their effectiveness in the civilian population, including on populations outside the United States. A broader range of employment outcomes should be studied, with regular follow up at standard intervals (e.g., six months, 12 months, 18 months, etc.).

How up-to-date is this review?

The search was completed in 2015.

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See the full review

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