Acquired brain injury and work participation

There is a lack of evidence and knowledge about acquired brain injury (ABI) and return to work (RTW) especially in case of insurance medicine. Objectives of the thesis were to acquire knowledge about: 1. factors and comorbidities related to RTW of patients with ABI, and 2. effective RTW-interventions for patients with ABI. A training programme was developed and evaluated to increase the knowledge of insurance physicians (IP)s supporting the assessment of functional abilities, prognosis of functioning and evaluation of the RTW process of patients with ABI. Three systematic reviews and interviews with patients with ABI and employers were performed. Strong evidence was found that: 1. a high education level is positively associated with RTW after traumatic ABI, while the length of stay in the rehabilitation process, a low education level and unemployment are negatively associated with RTW. Independence in the activities of daily living (ADL) is positively associated with RTW after non-traumatic ABI and injury-related factors are not associated with RTW; 2. mental disorders, e.g. depression as comorbidities of ABI are negatively associated with RTW; 3. work-directed interventions, in combination with education and coaching effectively improve RTW. According to patients and employers examples of facilitators are e.g. a patient’s drive, barriers for RTW are e.g. sensory overload and fatigue. Solutions for RTW are e.g. workplace adaptations. A one-day, four-hour training programme resulted in a significant increase of IPs’ knowledge over time. The IPs perceived the programme as relevant, useful and appropriate for daily practice