Predictors of return to work after moderate-to-severe traumatic brain injury: a systematic review of current literature and recommendations for future research

To identify factors associated with employment between six months and five years after traumatic brain injury (TBI). Using a predefined search algorithm, four electronic databases were searched for literature published between 2014 and the first half of April 2021 containing predictors of employment outcome. Data were selected in accordance with the PRISMA flow and the whole process was conducted by two reviewers who had to attain a consensus. The study results were discussed with an expert panel, in order to provide guidance for future research on this topic. This review found clear evidence for employment status at time of injury, occupation at time of injury, Glasgow Coma Scale, length of stay, disability level and primary payer to be predictors of return to work after TBI. More literature investigating in depth the functioning and environmental factors is required for further improvement of predictions, rehabilitation and policy.Implications for rehabilitationThis study identifies predictors of return to work in TBI patients, which can be used to identify patients with high risk early in the recovery process.Current literature shows difficulties with general functioning are a barrier for return to work, but gives no indication about effective therapeutic interventions.More knowledge about modifiable factors is desirable to improve rehabilitation and, thereby, employment outcomes after TBI. This study identifies predictors of return to work in TBI patients, which can be used to identify patients with high risk early in the recovery process. Current literature shows difficulties with general functioning are a barrier for return to work, but gives no indication about effective therapeutic interventions. More knowledge about modifiable factors is desirable to improve rehabilitation and, thereby, employment outcomes after TBI.

本研究旨在明确创伤性脑损伤（traumatic brain injury, TBI）后6个月至5年内与就业状况相关的影响因素。研究采用预设检索算法，对2014年至2021年4月上旬发表的相关文献进行检索，检索范围覆盖4个电子数据库，目标文献需包含就业结局的预测因子。文献筛选严格遵循PRISMA流程图法，且全程由两名评审人员独立完成并达成共识。研究结果已与专家小组开展研讨，以期为该领域的后续研究提供参考指引。本综述明确证实，受伤时的就业状态、受伤时的职业、格拉斯哥昏迷量表（Glasgow Coma Scale）评分、住院时长、残疾程度及主要支付方，均为TBI后重返工作岗位的预测因子。未来需开展更多针对功能与环境因素的深入研究，以进一步优化预测模型、康复干预及相关政策制定。康复启示：本研究明确了TBI患者重返工作岗位的预测因子，可用于在康复早期识别高风险人群。现有研究表明，总体功能障碍是重返工作岗位的阻碍，但尚未明确有效的治疗干预手段。亟需更多关于可干预因素的研究，以改善康复效果，进而提升TBI患者的就业结局。本研究明确了TBI患者重返工作岗位的预测因子，可用于在康复早期识别高风险人群。现有研究表明，总体功能障碍是重返工作岗位的阻碍，但尚未明确有效的治疗干预手段。亟需更多关于可干预因素的研究，以改善康复效果，进而提升TBI患者的就业结局。