“Acquired brain injury and return to work”: the feasibility of a training program for insurance physicians

Purpose: To study the feasibility (limited efficacy, acceptability, and implementation) of a training program for insurance physicians. Methods: Limited efficacy was evaluated over time (T0–T2) by conducting knowledge question tests using realistic case scenarios, analyzed by non-parametric Friedman and Wilcoxon signed-rank tests. Acceptability was evaluated by asking participants to agree or disagree with statements; for example, the knowledge was “relevant,” “useful,” or “appropriate.” Answers were analyzed using descriptive statistics. Open-ended questions were used to ask participants what, in their opinion, were the facilitators of and barriers to implementing the knowledge taught. Their answers were coded and categorized. Results: Fifty-one IPs participated in the study. Concerning limited efficacy: the median values of the knowledge scores increased significantly over time and between time points from 16 (T0) to 21 (T1) and 32 (T2), p < 0.00. Concerning acceptability: 46 of 47 respondents perceived the training program to be “relevant,” “useful,” and “appropriate”; 44 respondents intended to use it in practice. Concerning implementation: participants reported “training” and “utility” as examples of facilitators and “lack of time,” for example, as a barrier. Conclusion and implications: The feasibility (limited efficacy, acceptability, implementation) of the training program is demonstrated; the training program can be applied in practice.Implications for rehabilitation The “acquired brain injury and return to work” training programme can be applied in postgraduate teaching and continuing medical education for insurance physicians. Interactive teaching methods including realistic case scenarios with a link to practice are recommended to provide insurance physicians the opportunity to learn to apply and discuss new knowledge and effectively improve insurance physicians’ knowledge. Implementation of a training programme for insurance physicians can be facilitated if a brief summary of the imparted knowledge is available. Barriers, such as “other occupational healthcare and paramedical professionals being unfamiliar with the imparted knowledge” need to be addressed when implementing the “acquired brain injury and return to work” training programme

Erworbene Hirnschädigung und Teilhabe am Arbeitsleben: Eine interdisziplinäre Leitlinie aus den Niederlanden - Prozess und Inhalt

This article discusses the Dutch interdisciplinary guideline 'Acquired brain injury and work participation'. Its development follows the methodology of evidence-based medicine and supports all professionals involved in the vocational re-integration of workers with traumatic (e.g., traffic accident) and non-traumatic (e.g., stroke) acquired brain injury

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

To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI). 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. 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. 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 Rehabilitation We 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 wor

Effective return-to-work interventions after acquired brain injury: A systematic review

To gather knowledge about effective return-to-work (RTW) interventions for patients with acquired brain injury (ABI). A database search was performed in PubMed, EMBASE, PsycINFO, CINAHL and the Cochrane Library using keywords and Medical Subject Headings. Studies were included if they met inclusion criteria: adult patients with non-progressive ABI, working pre-injury and an intervention principally designed to improve RTW as an outcome. The methodological quality of included studies was determined and evidence was assessed qualitatively. Twelve studies were included, of which five were randomized controlled trials and seven were cohort studies. Nine studies had sufficient methodological quality. There is strong evidence that work-directed interventions in combination with education/coaching are effective regarding RTW and there are indicative findings for the effectiveness of work-directed interventions in combination with skills training and education/coaching. Reported components of the most effective interventions were tailored approach, early intervention, involvement of patient and employer, work or workplace accommodations, work practice and training of social and work-related skills, including coping and emotional support. Effective RTW interventions for patients with ABI are a combination of work-directed interventions, coaching/education and/or skills training. These interventions have the potential to facilitate sustained RTW for patients with AB

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

<div><p></p><p><i>Purpose</i>: To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI). <i>Method</i>: 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. <i>Results</i>: Twenty-seven studies were included. There is <i>strong</i> evidence that a high education level is <i>positively</i> associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are <i>negatively</i> associated, and <i>a clear tendency</i> has been deduced from the studies that conscious state in the Emergency Department is <i>not</i> associated with RTW. <i>A</i>fter non-traumatic ABI, there is <i>strong</i> evidence that independence in activities of daily living is <i>positively</i> associated with RTW and aetiology of stroke is <i>not. Conclusions</i>: This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are <i>not</i> associated with RTW. In addition, it provides further evidence that <i>personal factors</i> after <i>traumatic</i> ABI and <i>activity-related factors</i> after <i>non-traumatic</i> ABI are strongly associated with RTW.</p><p></p><p>Implications for Rehabilitation</p><p></p><p>We found <i>strong</i> evidence for a significant association between RTW and <i>personal factors (education level, unemployment)</i> after <i>traumatic</i> ABI, and <i>activities of daily living (ADL)</i> after <i>non-traumatic</i> ABI.</p><p></p><p></p><p>We advise to focus on <i>work-related activities</i> during the RTW process besides <i>ADL-training</i> and pay attention to and support patients <i>at risk</i> for not returning to work.</p><p></p><p></p><p></p></div

Return-to-work in patients with acquired brain injury and psychiatric disorders as a comorbidity: A systematic review

To explore the association between psychiatric disorders as a comorbidity and return-to-work (RTW) in individuals with acquired brain injury (ABI). A systematic review was performed. The search strategy (2002-2012) contained terms related to ABI, psychiatric comorbidity and keywords adapted to the outcome measure RTW. Selection and review were performed by two authors independently. In the case of uncertainty, a third author was consulted to reach consensus on inclusion or exclusion. The methodological quality of included studies was determined and evidence was classified. Seven studies were included. Strong evidence was found for a negative association between psychiatric disorders as a comorbidity (like depression, anxiety and post-traumatic stress disorder) and RTW of patients with ABI. Patients with a previous history of psychiatric disorders were at considerably higher risk for a new episode and lower RTW rates following ABI. Psychiatric disorders as a comorbidity after ABI are strong negatively associated with RTW. The heightened frequency of psychiatric disorders as a comorbidity after ABI and more important their amenability to treatment implicates that more attention should be paid to diagnosing and treating psychiatric disorders as a comorbidity in patients with ABI in order to further improve re-integration in wor

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

Purpose: 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. Design: Qualitative study. Method: 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. Results: 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. Conclusions: 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-solutio

Designing a new working method to support physicians’ (dis)ability prognosis evaluation

Introduction: Physicians performing disability assessments have to evaluate the prognosis of the (dis)abilities for work. This is a very complex task challenged by limited knowledge and skills of evidence-based medicine (EBM), time constraints, high quality demands and conflicting interests. Material and Methods: A new working method was developed to support physicians’ (dis)ability prognosis evaluation. The Intervention Mapping framework was used to identify content items, design features and considerations on implementation and evaluation of this working method. Results and Conclusions: The new working method consists of a stepwise EBM-approach to support physicians to gather available evidence, to review and weigh important prognostic aspects and to integrate these aspects into a transparent, tailored assessment. This working method is supported by a software tool, containing a database with links to evidence and other resources in order to facilitate searching, appraising and applying evidence-based information. An additional training program will further support the use of this working method. Physicians attending the training program will learn to apply the stepwise EBM-approach with support of the software tool and evaluate the prognosis of (dis)abilities in case scenarios based on daily practice. In a next phase limited efficacy, acceptability and practicality testing of the new working method is planned in a pilot study