Posts Tagged return to work

[Abstract] Rehabilitation Trajectories and Outcomes in Individuals With Mild Traumatic Brain Injury and Psychiatric Histories. – A TRACK-TBI Pilot Study


Objective: To determine differences in rehabilitation trajectories and return to work(RTW) and social outcomes in individuals with mild traumatic brain injury (mTBI) with and without significant psychiatric histories at index hospitalization.

Setting: Three level 1 trauma centers participating in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) consortium.

Participants: A total of 305 individuals with index mTBI enrolled in the TRACK-TBI pilot project.

Design: Secondary analysis of data from the TRACK-TBI pilot study.

Main Measures: Chart review and patient/family interview at emergency department (ED) admission, ED clinical data, ED discharge plan, functional interview data at 3- and 6-month outcomes, Trail Making Tests, the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index, the California Verbal Learning Test, Second Edition, and the Craig Handicap Assessment and Reporting Technique.

Results: Controlling for neurological history and CT lesion at ED admission, participants with and without psychiatric histories did not differ in terms of treatment, return to work, or reported social function. Individuals with psychiatric histories demonstrated lower processing speed and reported reduced satisfaction with occupational function at outcome.

Conclusions: Individuals with mTBI and psychiatric histories may require specialized rehabilitation planning to address increased risk for cognitive difficulties and occupational dissatisfaction at outcome. CT lesion may independently influence outcomes.

via Rehabilitation Trajectories and Outcomes in Individuals With… : The Journal of Head Trauma Rehabilitation

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[Abstract] Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity – Occupational and Environmental Medicine.


Objectives To determine whether the Disabilities of the Arm, Shoulder, and Hand (DASH) tool added to the predictive ability of established prognostic factors, including patient demographic and clinical outcomes, to predict return to work (RTW) in injured workers with musculoskeletal (MSK) disorders of the upper extremity.

Methods A retrospective cohort study using a population-based database from the Workers’ Compensation Board of Alberta (WCB-Alberta) that focused on claimants with upper extremity injuries was used. Besides the DASH, potential predictors included demographic, occupational, clinical and health usage variables. Outcome was receipt of compensation benefits after 3 months. To identify RTW predictors, a purposeful logistic modelling strategy was used. A series of receiver operating curve analyses were performed to determine which model provided the best discriminative ability.

Results The sample included 3036 claimants with upper extremity injuries. The final model for predicting RTW included the total DASH score in addition to other established predictors. The area under the curve for this model was 0.77, which is interpreted as fair discrimination. This model was statistically significantly different than the model of established predictors alone (p<0.001). When comparing the DASH total score versus DASH item 23, a non-significant difference was obtained between the models (p=0.34).

Conclusions The DASH tool together with other established predictors significantly helped predict RTW after 3 months in participants with upper extremity MSK disorders. An appealing result for clinicians and busy researchers is that DASH item 23 has equal predictive ability to the total DASH score.

Source: Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity — Armijo-Olivo et al. — Occupational and Environmental Medicine

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[WEB SITE] TBI Research Review: Return to Work After Traumatic Brain Injury –

  • How Big of a Problem is Post-TBI Failure to RTW?
  • What Do We Know from Current Research About RTW After TBI?
  • What Can We Conclude From Current Research?
  • What are the Implications of Current Research?

How Often Does TBI Happen?

Returning to work, school or being a homemaker is a major problem for many people with traumatic brain injury (TBI). (This TBI Research Review does not distinguish between those who did not work at the time of injury and those who did, although important differences characterize these two groups.) The failure to return to productive roles comes at great economic and personal costs to people with TBI, to their families and to society. The costs are great because the number of people with TBI is huge, estimated at more than five million individuals in the U.S.1

TBI is often an injury of youth, as incidence rates peak between ages 16 and 255, leading to many years of living with disability. This adds to the tremendous cost, which Thurman6 estimates at $56 billion yearly in the United States. Much of this is due to lost economic productivity. Failure to return to work (RTW) after TBI is the focus of this issue of TBI Research Review.

How Big of a Problem is Post-TBI Failure to RTW

Whiteneck and colleagues7, analyzing data from the Colorado TBI registry, which includes all people hospitalized with TBI in that state, found that about 50 percent of those who were severely injured failed to RTW at one-year post injury. Twenty percent of those with so-called mild injuries were unemployed. Other studies vary in their estimates. This variation is due to differing definitions of “successful” RTW, how long after injury the outcomes are studied and the severity of injury.

Despite study differences, all evidence points to many people with TBI being unable to return to the vocational roles they had established before injury. This has strong implications at the personal level, where research shows lower subjective well-being8in people who fail to RTW after TBI compared to those who succeed in RTW. Research also shows many people feel they have strong unmet needs in connection with working9. At the societal level, lost wages and increased dependence on governmental and other financial support contributes to the huge yearly cost of TBI. Further, employers face the cost of lowered productivity due to unfilled positions and the cost of hiring and training replacement staff.

What Do We Know from Current Research About RTW After TBI?

A few studies are available that evaluate the effectiveness of efforts to maximize RTW; however, there are many more studies that document the factors associated with, but not necessarily promoting, RTW. The results of systematic reviews and other substantive reviews of this literature on RTW10-13 are summarized in this TBI Research Review. Then we review policy implications for researchers, clinicians and policy makers.

Prognostic Studies

Most reports of research on post-TBI vocational outcomes seek to identify the personal (and, occasionally, the environmental) characteristics that hinder RTW. These research results are potentially useful in pinpointing who needs the most help, but the results seldom demonstrate the specific nature of the needs.

Visit site —> TBI Research Review: Return to Work After Traumatic Brain Injury

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[ARTICLE] Predictors of return to work with upper limb disorders


Background: Return to work (RTW) is a key goal in the proper management of upper limb disorders (ULDs). ULDs stem from diverse medical aetiologies and numerous variables can affect RTW. The abundance of factors, their complex interactions and the diversity of human behaviour make it difficult to pinpoint those at risk of not returning to work (NRTW) and to intervene effectively.

Aims: To weigh various clinical, functional and occupational parameters that influence RTW in ULD sufferers and to identify significant predictors.

Methods: A retrospective analysis of workers with ULD referred to an occupational health clinic and further examined by an occupational therapist. Functional assessment included objective and subject ive [Disability of the Arm, Shoulder and Hand (DASH) score] parameters. Quantification of work requirements was based on definitions from the Dictionary of Occupational Titles web site. RTW status was confirmed by a follow-up telephone questionnaire.

Results: Among the 52 subjects, the RTW rate was 42%. The DASH score for the RTW group was 27 compared with 56 in the NRTW group (P < 0.001). In multivariate analyses, only the DASH score was found to be a significant independent predictor of RTW (P < 0.05).

Conclusions: Physicians and rehabilitation staff should regard a high DASH score as a warning sign when assessing RTW prospects in ULD cases. It may be advisable to focus on workers with a large discrepancy between high DASH scores and low objective disability and to concentrate efforts appropriately.

via Predictors of return to work with upper limb disorders.

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[REVIEW] Community Reintegration | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF



While the majority of stroke survivors return to live in the community, re-integration may be an enormous challenge. The ability to return to an acceptable lifestyle, participating in both social and domestic activities is important for perceived quality of life. The present review examines issues arising following discharge from hospital care or rehabilitation into the community. These include social support, impact of caregiving on informal carers, family functioning, provision of information and education, leisure activities, driving, sexuality and return to work.

Get Full Text PDF

via Community Reintegration | EBRSR – Evidence-Based Review of Stroke Rehabilitation.

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