Efficacy of Occupational Therapy Interventions in Facilitating Return to Work in Patients with Traumatic Brain Injury: A Systematic Review

Objective(s): To appreciate the role of occupational therapy in enabling return to work post TBI.
To understand the intervention approaches used by occupational therapists in enabling return to work post TBI.

Data Sources: The following databases were searched: CINAHL, Ovid, PsychInfo, PubMed, & Scopus.

Study Selection: Fifteen articles met the inclusion criteria (articles published within the past 10 years, adults, & received rehabilitation services for RTW). The Preferred Reporting Items for Systematic Reviews and Meta Analyses was used to guide this review.

Data Extraction: Covidence was used to manage the results of the multiple database searches and to eliminate duplicates. The level of evidence was determined using the guidelines from the AOTA based on the Oxford Centre for Evidence-Based Medicine: Level of Evidence. All randomized and nonrandomized controlled trials were screened for bias according to the Cochrane Risk-of-Bias tool. Studies with pre-posttest designs were screened for bias using the National Heart Lung and Blood Institute Quality Assessment Tool, while the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist was used to screen for bias in qualitative studies. Comparisons were made 13 between treatment as usual and specific OT interventions to determine the impact of using such methods. As RTW is a rare outcome for patients with severe TBI, more emphasis was placed on studies with participants diagnosed with mild and moderate TBI. However, studies describing patients with severe TBI were considered if RTW outcomes were addressed. This review was registered in the PROSPERO register under the ID 452554.

Data Synthesis: The most effective intervention approaches that fall under the purview of OT practice to facilitate RTW in individuals with TBI included the use of (i) vocational and work hardening rehabilitation interventions, (ii) a multidisciplinary approach to care, (iii) mental health and cognition focused interventions, and (iv) the Model of Occupational Self Efficacy. Interventions must consider both client and work-related factors to ensure successful outcomes.

Conclusions: There is a moderate level evidence that multidisciplinary and holistic approaches lead to successful RTW and community reintegration outcomes for individuals with TBI. Focusing on client and work-related factors through vocational rehabilitation, cognitive and mental health interventions, and
client-centered models of care is recommended to yield better RTW outcomes for TBI survivors.

Author(s) Disclosures: No conflict of interest