What Gets Patients to Work Sooner After Brain Injury?

Vocational rehabilitation has proven to be successful in helping patients return to work after brain injury, but is it worth the cost? It's easy to assume additional appointments with therapists and specialists could cause patients to rack up medical bills, but few studies have actually taken the time to analyze the cost-efficacy of such treatments.

In a 2013 study, researchers from the UK studied 94 patients admitted to Nottingham hospitals within 48 hours post brain injury, and monitored their progress for the next 15 months. Half of the patients received vocational rehabilitative (VR) treatments that included individualized interdisciplinary care provided by a team of nurses, occupational therapists, and neuro-pyschologists. The researchers analyzed patient progress and compared their results to patients under usual care (UC).

• At three months, 37% more VR patients had returned to work compared to UC patients. Although most usual care patients were working after one year, there were still 10% more VR patients working compared to UC patients.
• VR patients were less likely to claim welfare benefits after 12 months.
• There were no differences in return to work in those claiming and not claiming compensation.
• Usual care patients stayed in the hospital an average of 11 days longer than VR patients.

The vocational rehabilitation patients did see specialists more frequently but not by a significant amount. That meant there were no major differences in treatment costs between the groups.

• VR patients spent about 75.23 more than the UC patients (about the cost of one occupational therapy session in the UK or $126.91 USD).
• When considering lost wages due to missed work days, UC patients were at a disadvantage. As a result, when taking into account this broader perspective, VR patients had an average annual savings of $1,862 per person ($3141.01 USD).

In addition to preventing lost wages, VR patients were more likely to stay working when they returned to their jobs, instead of dropping out due to lack of support. Those with moderate to severe injuries benefited the most from VR treatments, but even mild TBI patients had better outcomes with VR. That suggests that even those with mild TBI can struggle with reintegrating into the workplace after the injury.

These findings suggest possible treatment options that could aide in the rehabilitation efforts for thousands of soldiers suffering from mild traumatic brain injuries, now called the signature wound of war.

Reference

Radford K, et al. Return to work after traumatic brain injury: cohort comparison and economic evaluation. Brain Injury 2013: 27(5): 507-520.