Impact of return-to-work pathway on vocational outcomes following severe acquired brain injury: A secondary analysis of the VIP1.0 trial
Thomas M Gates, Philippa McRae, Maysaa Daher, Grahame K SimpsonBackground
Most research into vocational re-integration following severe acquired brain injury (ABI) has focused on returning to pre-injury employment. While there is significant demand for new employment post-ABI, much less is known about this return-to-work (RTW) pathway.
Objective
To compare and contrast the clinical profiles and outcomes achieved through vocational rehabilitation (VR) following severe ABI according to RTW pathway.
Methods
Secondary data analysis of the Vocational Intervention Program efficacy trial (VIP1.0). Participants with severe ABI undertaking a VR program were re-classified into two RTW pathway groups: return to pre-injury employment (Fast-Track; FT) or obtaining new employment (New-Track; NT). Competitive employment status (Yes/No) and clinician ratings of disability and participation were collected pre- and post-intervention and at 3-month follow-up.
Results
47 (46%) participants undertook a FT pathway and 55 (54%) a NT pathway. Compared to FT, NT participants were less educated, more likely to be single, further post-injury, already attempted to RTW unsuccessfully post-injury, and less likely to complete the VR intervention. For both pathways, employment rates improved from pre- to post-intervention and remained stable at follow-up. While FT was associated with high RTW success (post-intervention: 89%; follow-up: 88%), a significant minority of NT participants also achieved competitive employment (post-intervention: 34%; follow-up: 45%). FT participants were also rated as demonstrating greater improvements in work-related participation from pre- to post-intervention than NT.
Conclusions
Despite its challenges, VR interventions targeting new employment can lead to beneficial RTW outcomes for many individuals unable to return to their previous employer following severe ABI.