Work-related difficulties in patients with traumatic brain injury: a systematic review on predictors and associated factors

<p><b>Purpose</b>: To address the content of work-related difficulties and explore which variables are associated to or determinants of these difficulties in persons that suffered from Traumatic Brain Injury (TBI). <b>Method</b>: Papers published between 1993 and February 2015 were included. Quality was judged as poor, acceptable, good or excellent. Determinants were extracted from longitudinal data, associated variables from cross-sectional data; variables were grouped by similarity. Evidence was judged as strong if the same results were reported by two or more good studies; limited if reported by one good and some acceptable studies. <b>Results</b>: Forty-two papers were selected (25,756 patients). Work-related difficulties were referred as unemployment, job instability or job cessation. Strong evidence of impact was found for: low educational level, pre-injury unemployment, Glasgow Coma Scale score and TBI severity, length of stay in acute and rehabilitation settings, lower Functional Independence Measure scores and presence of cognitive disturbances. <b>Discussion</b>: Evidence on the effect of rehabilitation interventions on TBI patients’ work-related difficulties exists, but is poorly measured. Future studies should address the sustainability of holistic and tailored interventions targeting employees, employers and workplaces and aimed to reduce the gap between work duties and worker’s abilities, using appropriate assessment instruments measuring difficulties in work activities.Implications for rehabilitation</p><p>Traumatic Brain Injury (TBI) primarily affects young persons of working age causing a broad range of motor, sensory and cognitive impairments. A combination of variables related both to pre-morbid and to injury-related factors predict and are associated to work-related difficulties.</p><p>While demographic and injury characteristics cannot be modified, some TBI outcomes (e.g. cognitive impairments or functional status) may be addressed by specific rehabilitative interventions: the knowledge of the specific work-related difficulties of TBI patients is of importance to tailor rehabilitation programs that maximize vocational outcomes.</p><p>Rehabilitation researchers should give attention to vocational issues and use assessment instruments addressing the difficulties in work-related activities, in order to demonstrate the benefits of rehabilitative interventions on TBI patients’ ability to work.</p><p></p> <p>Traumatic Brain Injury (TBI) primarily affects young persons of working age causing a broad range of motor, sensory and cognitive impairments. A combination of variables related both to pre-morbid and to injury-related factors predict and are associated to work-related difficulties.</p> <p>While demographic and injury characteristics cannot be modified, some TBI outcomes (e.g. cognitive impairments or functional status) may be addressed by specific rehabilitative interventions: the knowledge of the specific work-related difficulties of TBI patients is of importance to tailor rehabilitation programs that maximize vocational outcomes.</p> <p>Rehabilitation researchers should give attention to vocational issues and use assessment instruments addressing the difficulties in work-related activities, in order to demonstrate the benefits of rehabilitative interventions on TBI patients’ ability to work.</p

Mediation between agreeableness (IV), disability (MedV) and social support (DV).

<p>Note: ***p < .001 The numerical values are zero order correlations. Path c' represents the beta weight for the independent-to-dependent variable relationship adjusted for the inclusion of the mediating variable.</p

Demographic, socio-economic and clinical characteristics of the sample.

<p>Demographic, socio-economic and clinical characteristics of the sample.</p

Mediation between extraversion (IV), disability (MedV) and social support (DV).

<p>Note: ***p < .001 The numerical values are zero order correlations. Path c' represents the beta weight for the independent-to-dependent relationship adjusted for the inclusion of the mediating variable</p

Item characteristics resulting from the final Rasch model: infit statistics, item location, and item thresholds.

<p>Item characteristics resulting from the final Rasch model: infit statistics, item location, and item thresholds.</p

Assignment of raw scores, persons’ abilities and transformed scores on a 0–100 scale of the PARADISE 24 metric.

<p>Assignment of raw scores, persons’ abilities and transformed scores on a 0–100 scale of the PARADISE 24 metric.</p

Demographic characteristics of the sample.

<p>* HDRS: Hamilton Depression Rating Scale; CRS: Clinical Rating of Severity; MIDAS: Migraine Disability Assessment; EDSS: Expanded Disability Status Scale; Hoehn & Yahr: Hoehn & Yahr Score; NIHSS: National Institutes of Health Stroke Scale; CGI: Clinical Global Impression (CGI); MMSE: Mini Mental State Examination; ADS: Alcohol Dependence Scale.</p><p>** In substance dependency, 44 persons had alcohol dependence as their main diagnosis. The data reported here refer to the 34 of those from whom the ADS data were available. Mean is not reported because of the low N. For all other substance dependency conditions, the intention was to collect data with the ‘Severity of Dependence Scale’. There were, however, a larger number missing data and the results are, therefore, not reported.</p><p>Demographic characteristics of the sample.</p

Distribution of persons’ abilities, items’ difficulties (bullets) and items’ thresholds (circles) on the latent scale.

<p>Legend: The upper part of the figure displays the distribution of personal abilities, while items’ locations and thresholds are displayed on the lines below. The items are presented according to their location in increasing order.</p

Additional file 1 of The impact of primary headaches on disability outcomes: a literature review and meta-analysis to inform future iterations of the Global Burden of Disease study

Supplementary Material 1

Hierarchical regression models to predict quality of life.

<p>Hierarchical regression models to predict quality of life.</p