Intensive Multi-Disciplinary Outpatient Rehabilitation for Facilitating Return-to-Work after Acquired Brain Injury: A Case-Control Study

Abstract

Objective: Return-to-work is often the most important objective of working-age patients with acquired brain injury, but is often difficult to achieve. There is a lack of evidence for effective treatment. This study aimed to assess the benefit of a multidisciplinary neurorehabilitation in a daytime hospital on return-to-work after an acquired brain injury. Design: Retrospective case-control study. Patients: Acquired brain injury patients between 18 and 65 years of age. Methods: Two periods, before (n = 82 patients) and after (n = 89 patients) the implementation of a daytime hospital in our neuro-rehabilitation unit were compared. Patients followed in the daytime hospital received intensive, interdisciplinary, coordinated, individual and group-level physical, cognitive, and vocational rehabilitation. During the control period, patients received outpatient neurorehabilitation with less intensive treatment without interdisciplinary coordination. The main outcome was the proportion of patients returning to > 50% of their premorbid work activity. Results: Fifty-five percent of patients were able to resume more than 50% of their premorbid work level in the daytime hospital period vs 41% in the control period (p = 0.076). Conclusion: Intensive and coordinated outpatient neurorehabilitation may facilitate return-to-work after an acquired brain injury. LAY ABSTRACT Acquired brain injury is a common health issue, most frequently caused by head trauma or stroke. Acquired brain injury patients of working age often have difficulties in returning to work, which greatly impairs their quality of life. They often receive insufficient rehabilitation care, partly also because of a lack of evidence regarding intensive rehabilitation in this patient group. This study aimed to assess the benefit of multi-disciplinary neurorehabilitation in a daytime hospital on return-to-work after acquired brain injury. The study compared the rate of return-to-work during the first 2 years after implementation of a daytime hospital to a control period of 2 years before. The daytime hospital provided intensive, interdisciplinary, coordinated, individual and group-level physical, cognitive, and vocational rehabilitation. During the control period, patients received outpatient neurorehabilitation with less intensive treatment without interdisciplinary coordination. The results show that more patients were able to resume work, at more than 50% of their premorbid work level, since the introduction of the daytime hospital.

Keywords

• acquired brain injury
• fatigue
• return-to-work
• daytime hospital
• neurorehabilitation
• vocational rehabilitation