Return to work following acquired brain injury: the views of patients and employers

<b>Purpose:</b> To investigate which factors are experienced as facilitators of or barriers to return to work (RTW), or as solutions to RTW-problems, by patients with acquired brain injury (ABI) and by employers. <b>Design:</b> Qualitative study. <b>Method:</b> Ten patients with ABI and seven employers participated in semi-structured interviews. Patients and employers were unrelated. Transcripts were open coded. Factors perceived to be facilitators, barriers, or solutions to RTW-problems were grouped on a thematic basis. <b>Results:</b> Both patients and employers distinguished patient-related and work-related facilitators. When questioned about barriers, both patients and employers emphasized the importance of work-related factors such as sensory overload at the workplace and condition-related factors such as fatigue. Patients regarded poor guidance and support as barriers, but employers did not. Employers and patients suggested that solutions to RTW-problems were work-related, if necessary backed up by professional supervision. Patients also mentioned the need for understanding and acceptance of the limitations resulting from ABI. <b>Conclusions:</b> Both patients and employers mentioned work-related and patient-related facilitators, work-related and condition-related barriers, and work-related solutions to RTW-problems. Patients mentioned lack of guidance and support as barriers, and stressed the need for understanding and acceptance of the limitations resulting from ABI in any RTW-solution.Implications for rehabilitation•Patients and employers are important stakeholders in the return to work (RTW) process of a patient with acquired brain injury (ABI)•Professionals in rehabilitation practice, occupational and insurance physicians need to help patients and employers to realize RTW•Professionals have to be aware of the perspectives of patients and employers regarding RTW, such as:^Little understanding of limitations resulting from ABI^Work-related aspects hindering RTW, such as sensory overload and high work pressure^Condition-related barriers to RTW such as (invisible) cognitive limitations and fatigue^Need for professional assistance during the RTW process •Patients and employers are important stakeholders in the return to work (RTW) process of a patient with acquired brain injury (ABI) •Professionals in rehabilitation practice, occupational and insurance physicians need to help patients and employers to realize RTW •Professionals have to be aware of the perspectives of patients and employers regarding RTW, such as: ^Little understanding of limitations resulting from ABI ^Work-related aspects hindering RTW, such as sensory overload and high work pressure ^Condition-related barriers to RTW such as (invisible) cognitive limitations and fatigue ^Need for professional assistance during the RTW process

<b>研究目的：</b> 探究获得性脑损伤（acquired brain injury, ABI）患者与雇主眼中，哪些因素可作为重返工作岗位（return to work, RTW）的促进因素、阻碍因素，或是解决重返工作岗位相关问题的可行方案。
<b>研究设计：</b> 质性研究。
<b>研究方法：</b> 招募10名获得性脑损伤患者与7名雇主参与半结构化访谈，二者互不关联。对访谈转录文本进行开放式编码，并按主题对被感知为促进重返工作岗位、阻碍重返工作岗位或可解决重返工作岗位问题的各类因素进行归类分组。
<b>研究结果：</b> 患者与雇主均区分出了与患者自身相关及与工作相关的两类促进因素。在谈及阻碍因素时，双方均强调了工作相关因素（如工作场所的感官过载）与病情相关因素（如疲劳）的重要性。患者将缺乏指导与支持视为重返工作岗位的阻碍因素，但雇主并未持此观点。双方均提出，重返工作岗位问题的解决方案应与工作场景相关，必要时可辅以专业督导。患者还提及需要对获得性脑损伤导致的功能受限给予理解与接纳。
<b>研究结论：</b> 患者与雇主均提及了与患者自身相关、与工作相关的促进因素，与工作相关、与病情相关的阻碍因素，以及可解决重返工作岗位问题的工作相关方案。患者将缺乏指导与支持视为阻碍因素，并强调在所有重返工作岗位的解决方案中，都需要对获得性脑损伤导致的功能受限给予理解与接纳。
康复实践启示：
• 患者与雇主均为获得性脑损伤患者重返工作岗位过程中的重要利益相关方
• 康复临床从业者、职业医师与保险医师需协助患者与雇主推进重返工作岗位进程
• 从业者需充分了解患者与雇主对于重返工作岗位的视角，包括：
^ 对获得性脑损伤导致的功能受限缺乏认知
^ 阻碍重返工作岗位的工作相关因素，如感官过载与高工作负荷
^ 与病情相关的重返工作岗位阻碍因素，如（隐匿性的）认知功能受限与疲劳
^ 重返工作岗位过程中对专业协助的需求
• 患者与雇主均为获得性脑损伤患者重返工作岗位过程中的重要利益相关方
• 康复临床从业者、职业医师与保险医师需协助患者与雇主推进重返工作岗位进程
• 从业者需充分了解患者与雇主对于重返工作岗位的视角，包括：
^ 对获得性脑损伤导致的功能受限缺乏认知
^ 阻碍重返工作岗位的工作相关因素，如感官过载与高工作负荷
^ 与病情相关的重返工作岗位阻碍因素，如（隐匿性的）认知功能受限与疲劳
^ 重返工作岗位过程中对专业协助的需求