Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury

Purpose: To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI). Method: A systematic literature search was conducted in PubMed (2008–2014), applying terms for ABI and RTW. In addition, studies published after 2003 of a previous review on the same topic were added. The methodological quality of the included studies was assessed and evidence was classified. Results: Twenty-seven studies were included. There is strong evidence that a high education level is positively associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are negatively associated, and a clear tendency has been deduced from the studies that conscious state in the Emergency Department is not associated with RTW. After non-traumatic ABI, there is strong evidence that independence in activities of daily living is positively associated with RTW and aetiology of stroke is not. Conclusions: This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are not associated with RTW. In addition, it provides further evidence that personal factors after traumatic ABI and activity-related factors after non-traumatic ABI are strongly associated with RTW.Implications for RehabilitationWe found strong evidence for a significant association between RTW and personal factors (education level, unemployment) after traumatic ABI, and activities of daily living (ADL) after non-traumatic ABI.We advise to focus on work-related activities during the RTW process besides ADL-training and pay attention to and support patients at risk for not returning to work.

目的：旨在探究并确定脑损伤（ABI）后重返工作（RTW）的预后因素。方法：在PubMed数据库（2008-2014年）中进行了系统文献检索，应用了ABI和RTW的相关术语。此外，还将之前关于同一主题的综述中2003年后发表的研究纳入。对所纳入研究的方法论质量进行了评估，并对证据进行了分类。结果：纳入了27项研究。强有力的证据表明，高教育水平与创伤性ABI后的RTW呈正相关；低教育水平、失业和康复期间住院时间与RTW呈负相关，且从研究中推导出急诊室中的意识状态与RTW无明确关联。在非创伤性ABI后，有强有力的证据表明日常生活活动（ADL）的独立性与RTW呈正相关，而中风病因与RTW无关。结论：本研究证实了早期发现，无论是创伤性还是非创伤性ABI，急诊室中的损伤相关因素与RTW无关联。此外，它还提供了进一步证据，表明创伤性ABI后的个人因素（教育水平、失业）和非创伤性ABI后的活动相关因素与RTW有强烈关联。对康复的影响：我们发现，创伤性ABI后的RTW与个人因素（教育水平、失业）以及非创伤性ABI后的日常生活活动（ADL）之间存在显著关联。我们建议在RTW过程中除了ADL训练外，还应关注与工作相关活动，并关注和支持那些有未重返工作风险的患者。