Return to work after traumatic brain injury: a cohort comparison study and feasibility economic analysis

Background Less than 50% of people return to work after traumatic brain injury. Despite this, specialist traumatic brain injury (TBI) vocational rehabilitation (VR) in the UK is scarce with outcomes, interventions or costs rarely reported. This study aimed to compare the work outcomes and costs of participants receiving specialist TBI VR (specialist group) to those receiving usual care (usual care group) and to describe the content of the specialist intervention. Method People with TBI requiring hospitalisation ≥48 hours in work or education prior to their injury, were followed up by postal questionnaire at 3, 6 & 12 months post hospital discharge. Primary outcomes were work/education. Secondary outcomes were functional ability, mood and quality of life. Specialist intervention was recorded on a proforma specifically developed for the study. Health resource use was by self-report. Results Fifty-four usual care and 40 specialist participants were recruited. At 12 months, 15% more specialist group participants were in work/education than usual care group participants (27/36, 75% v 27/45, 60%). For those with moderate/severe TBI, the difference was 27% (16/23, 70% v 9/21, 43%). Secondary outcomes showed no significant differences between groups at one year. The proforma showed that the specialist intervention was primarily focussed at preparing participants to return to work. It cost £501.53 more in health and social care costs (UK£2007) to return a specialist group participant to work at one year than a usual care participant. Discussion More specialist group participants were working at one year with an extra cost of only £500 per person. This suggests specialist TBI VR may be cost effective. The ability to describe the intervention aids replication and implementation. Conclusion As returning to work is a cost effective outcome for individuals and society, this study justifies the need for further investigation of this TBI VR intervention