Prognostic factors of return to work after acquired brain injury: a systematic review.

PRIMARY OBJECTIVE To provide insight into the prognostic and non-prognostic factors of return to work (RTW) in people with traumatic and non-traumatic acquired brain injury (ABI) who were working before injury. METHODS A systematic literature search (1992-2008) was performed, including terms for ABI, RTW and prognostic factors. The methodological quality of the studies was determined. Evidence was classified as strong (positive, negative or no), weak or inconsistent. MAIN OUTCOMES AND RESULTS Following classification of the studies, 22 studies were included. Strong evidence was found that 'gender' and 'anatomic location' were not associated with RTW after non-traumatic ABI and that both 'injury severity' (classified by the Glascow Coma Scale) and 'suffering from depression' or 'anxiety' were not associated with RTW after traumatic ABI. In addition strong evidence was found for the negative prognostic value on RTW of the 'inpatient length of stay', after traumatic ABI. Weak evidence was found for the three trainable/treatable factors 'ability to perform activities of daily living', 'residual physical deficits/higher disability level' and 'number of associated injuries'. CONCLUSION Strong evidence was found that six variables either had no association or a negative association with RTW. It is recommended to focus in rehabilitation on the factors for which weak evidence was found but that are trainable/treatable with the goal of improving the process of vocational rehabilitation.