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Purpose: The aim of this study is to investigate person-related, injury-related, activity-related and rehabilitation-related risk markers for not return to work among patients with acquired brain injury (ABI).

Methods: Retrospective data from the Quality register, WebRehab Sweden, on an ABI cohort of 2008 patients, was divided into two groups: those who had returned to work (n = 690) and those who had not returned to work (n = 1318) within a year of the injury.

Results: Risk ratio analyses showed that several factors were risk markers for not returning to work: personal factors, including being a woman, being born outside of Sweden, having a low education level, and not having children in the household; injury-related factors, including long hospital stay (over 2 months), aphasia, low motor function, low cognitive function, high pain/discomfort, and high anxiety/depression; activity-related factors, including low function in self-care, inability to perform usual activities, and not having a driver's license; and rehabilitation-related factors, including being dissatisfied with the rehabilitation process and the attentiveness of the staff having limited influence over the rehabilitation plan, or not having a rehabilitation plan at all. Conclusion Several factors in different aspects of life were risk markers for not returning to work among patients with ABI. This suggests that rehabilitation and interventions need to address not only direct injury-related issues, but also person-related, activity-related, and rehabilitation-related factors in order to increase the patient's opportunities to return to work.

BACKGROUND: Research shows that variety of factors are related to risks of not returning to work among people with acquired brain injury (ABI). In Sweden, 40% of those with ABI in working age return to work within two years after the injury, which in line with international findings. However, since countries may differ in work rehabilitation, social security systems, culture and laws, different factors may influence the possibilities of returning to work across countries.

AIMS: The aim of this study was to investigate person, injury, activity and rehabilitation related risk markers for not return to work among persons with ABI in Sweden.

METHODS: Retrospective data of an ABI cohort of 2008 people from the WebRehab Sweden quality register were used.

RESULTS: Analyses showed that the risk ratio for not returning to work was larger for people that, among the Personal factors, were woman, born outside of Sweden, had low education level, and not having children in the household; among the injury related factors, had long (> 2 months) hospital stay, aphasia, low motor function, low cognitive function, high pain/discomfort, and high anxiety/depression; among the activity related factors, had low function in self-care, inability to perform usual activities, and had their driver´s license suspended; and finally among the rehabilitation related factors, were satisfied with treatment and having influence over their rehabilitation plan.

DISCUSSION / CONCLUSION: Several factors in different areas were risk markers for not returning to work among people with ABI. This suggest that work rehabilitation and interventions, in addition to direct injury related issues, need to address personal related, activity related and rehabilitation related factors in order to increase the patient´s possibility to return to work. Influences of general and country specific factors on returning to work among people with ABI will be discussed.

PURPOSE: This study investigated changes in quality of life (QoL) in relation to return to work among patients with acquired brain injury (ABI).

METHOD: The sample consisted of 1487 patients with ABI (63% men) aged 18-66 years (mean age 52) from the WebRehab Sweden national quality register database. Only patients who worked at least 50% at admission to hospital and were on full sick leave at discharge from hospital were included. QoL was measured by the EuroQol EQ-5D questionnaire.

RESULTS: Patients who returned to work perceived a larger improvement in QoL from discharge to follow-up one year after injury compared to patients who had not returned to work. This difference remained after adjustment for other factors associated with improved QoL, such as having a university education, increased Extended Glasgow Outcome Scale scores and getting one's driving licence reinstated.

CONCLUSION: Return to work is an important factor for change in QoL among patients with ABI, even after adjusting for other factors related to QoL. This is consistent with the hypothesis that having employment is meaningful, increases self-esteem and fosters participation in society. Thus, helping patients with ABI return to work has a positive influence on QoL.

Introduction and aim:

Return to work (RTW) after acquired brain injury (ABI) is a demanding process for the client and need support. This study’s aim was to understand the support person’s perception of supporting clients with ABI to a successful RTW.

Method:

Nine persons who acted as support persons in the vocational rehabilitation (VR) process were chosen by clients with ABI participating in a previous study. Three of the support persons had a formal mandate to support the client by the employer and six of them were characterized as providing informal support. All the support persons had different kind of work. Semi structured interviews were conducted and analyzed by latent content analysis.

Findings:

The analysis elicited three themes describing the support person’s perception in the assistance for the client to successfully RTW: (i) Commitment, (ii) Adaptation and (iii) Cooperation. Within each of the theme multiple mechanisms were identified, reflecting the complexity that the VR process had for the client. The mechanisms were about strategic issues, reflection and decision making. The support persons experienced that their role was extra valuable for the client in contexts where adaptation and cooperation was required. Commitment built on social relations is linked to sustainability of the support.

Conclusion:

Support persons play a multi-dimensional role which is important for client with ABI to successfully RTW.

Background: Acquired brain injury (ABI) is often a lifelong disability that entails a marked change in a person’s life. It involves biopsychosocial levels and return to work (RTW) is one of the main goals for the person. Several of those suffering an ABI are of working age. The society and the individuals are both winners if the person could get back to work and sustain working.

Objective: The aim of this study was to increase knowledge about the opportunities and barriers for successful RTW among individuals with ABI.

Methods: Adults who have ABI and had participated in work rehabilitation were interviewed in regard to their experiences of the process. The informants (five females, five males) had participated in work rehabilitation, had successfully RTW and had worked at least 50% in at least a year after the injury. The interviews were transcribed, structured and analysed by latent content analysis with a hermeneutic approach.

Results: Three main themes that influenced RTW after ABI were identified: (i) individually adapted rehabilitation process, (ii) motivation for RTW and (iii) cognitive abilities and inabilities. The results indicate that an individually adapted vocational rehabilitation (VR) process was an important issue. The individuals with ABI actively involved in their own rehabilitation process also required continuous support from the society, the specialists, their employers and colleagues; this support has to be designed for each individual. A moderate level of motivation for RTW was necessary for the best result to RTW, in other words it was important to achieve a balance between too high and too low motivation. Finally, a comprehensive knowledge about the cognitive abilities and inabilities of the individual after ABI helped the individuals and their employers to find compensatory strategies to handle their work tasks. One implication of the findings was the necessity of a good support system and a good VR that functions well and lasts for a longer period. When there are obstacles in the VR process, it is important to have strategies and awareness of how to proceed further.

Conclusions: Consequently, the support built for a person individually, with a balanced motivation, knowledge about the cognitive abilities and awareness of how to proceed further in the process will help to build a successful and sustainable RTW.

The aim is to explore the perception of being a support person for clients with acquired brain injury undergoing vocational rehabilitation. Nine support persons, identified by clients with brain injury, were interviewed. Interviews were analyzed using qualitative content analysis, resulting in three themes for assisting the client: (i) commitment; (ii) adaptation; and (iii) cooperation. Within each theme, multiple dimensions were identified, reflecting the complexity of vocational rehabilitation following acquired brain injury. Commitment built on social relations is linked to sustainability of support. The included support persons' role was especially valuable in contexts where adaptation and cooperation were required.

Research aim

The aim of this study was to increase our knowledge about the opportunities and barriers for successfully return to work (RTW) among individuals with acquired brain injury (ABI).

Methodology

Adults who have ABI were interviewed in regard to their experiences of the work rehabilitation process. The informants (5 females, 5 males) had participated in a work rehabilitation, had successfully RTW and had worked at least 50 % in at least a year after the injury. The interviews were transcribed, structured and analyzed by latent content analysis with a hermeneutic approach.

Findings and conclusions

Three main themes that influenced RTW after ABI were identified: (i) individually adapted rehabilitation process, (ii) motivation for RTW and (iii) cognitive abilities and inabilities.

The findings indicated that an individually adapted vocational rehabilitation (VR) process was important because the individuals with ABI involved actively in their own rehabilitation process and they required continuous support from the society, the specialists, their employers and colleagues. A moderate level of motivation for RTW was necessary to achieve the best result for RTW and it was important to achieve a balance between too high and too low motivation. Finally, a comprehensive knowledge about the cognitive abilities and inabilities of the individual after ABI helped the individuals and their employers to find compensatory strategies to handle their work tasks.

One implication of the findings was the necessity of a good support system and a good VR that functions well and lasts for a longer period. When there are obstacles in the VR process, it is important to have strategies and awareness of how to proceed further.

Consequently the support built for a person individually, with a balanced motivation, a high knowledge about the cognitive abilities and awareness of how to proceed further in the process will help to build a successful and sustainable RTW.