To identify factors associated with employment between six months and five years after
moderate-to-severe traumatic brain injury (TBI).
Pubmed, Web Of Science, PsychINFO and EconLit were searched for research articles
published between 2014 and the first half of April 2021 in English, French, German
or Dutch containing predictors of employment outcome. In addition, backward as well
as forward citation tracking was performed.
Study selection was in accordance with the PRISMA flow and the whole process was conducted
by two reviewers who had to attain a consensus. Studies were required to: (1) be original
quantitative research articles, (2) concern civilian working-age adults with moderate-to-severe
TBI and (3) assess employment outcome or employment stability (for wage only). Nineteen
studies met inclusion criteria and were included in the review.
Evidence was collected from regression coefficients, correlations or other analysis
types appropriate for prognostic modelling. Quality appraisal was performed by two
independent researchers in accordance with the guidelines of the National Institute
of for Health and Clinical Excellence (NICE) for prognostic studies.
Evidence was found for being employed and white-collar occupations as pre-injury facilitators
of return to work. Low Glasgow Coma Scale, long time to follow commands and prolonged
hospital stays can be considered acute barriers. High levels of disability and weak
memory performance were identified as functional barriers. Insurance status and year
of injury were found as possible environmental facilitators.
While there was a reasonable amount of evidence about pre-injury and injury variables,
literature on modifiable factors related to functioning and the patient's environment
remains scarce. Future studies should focus on this domain to increase predictive
accuracy as well as enable targeted advancements in the fields of rehabilitation and
policymaking in order to improve the vocational prognosis of patients with TBI.
No conflict of interest to declare.