Return to work after traumatic brain injury: Systematic review

Objective: To evaluate the evidence on pre- and post-injury predictors of vocational outcome after traumatic brain injury (TBI). Literature selection and critical analysis: The search was conducted on PubMed and Central databases since 1990. A clinical question was formulated according to the PICO framework. Clinical relevance of the selected studies was evaluated following the GRADE framework. Main outcomes and results: The main outcome measures were employment status and return to work after TBI. Methodological quality of most of the relevant 12 controlled and 68 uncontrolled studies included in the review was estimated as very low. There was weak evidence that age, educational level, pre- and post-injury occupational status, severity of TBI, functional status, level of depression and anxiety, gender and race may be predictive for the vocational outcome after TBI. Conclusions and implications for further research: No strong evidence was found that vocational outcomes after TBI could be predicted or improved. There is a need for both experimental and observational well-conducted studies on this important subject. Researchers are strongly encouraged to use unified and standardized terms and scales in further studies. The authors suggest the International Classification of Functioning, Disability and Health (ICF) as the best tool available for this purpose.