JCPSLP Vol 22 No 1 2020

Expanding possibilities: Foci on reading and interdisciplinary practices

An exploratory prospective study of the association between return to work/study and health and well- being outcomes after acquired brain injury Emma J. Schneider, Kate Lawlor, Ester Roberts, Kelly McMahon, Lauren Solomon, Nicole Austin, and Natasha Lannin

The aim of this study was to explore the relationship between the provision of an interdisciplinary return to work or study (RTW/S) program for persons with acquired brain injury (ABI) and work/study status, and their health and well-being outcomes. A prospective longitudinal research design was utilised. Nineteen adults with an ABI engaged in an individualised, interdisciplinary RTW/S rehabilitation program. Data was collected on work/study status and the Quality of Life (SF-12™) measure at baseline, program completion, and 3-months post program completion. Immediately after and 3 months’ post intervention, 74% of participants had RTW/S in either full-time or a reduced capacity; one quarter were unemployed or no longer studying. Work/study status at the 3-month post intervention time point did not correlate with the SF-12 although self-reported quality of life did increase following the work/study intervention. Involvement in an interdisciplinary RTW/S rehabilitation program demonstrates promise, and is associated with returning successfully to work/study and improved health and well-being after an ABI. A dults with an acquired brain injury (ABI) as a result of stroke or trauma often experience difficulty in resuming activities of daily living and returning to work or study (RTW/S). Approximately 50% of adults return to work following an ABI, dependent on the type of brain injury, country they live in and services available (Cole, Radford, Grant, & Terry, 2013; Wehman, Targett, West, & Kregel, 2005). When a person is unable to return to work or study, a loss of role can occur that can negatively impact the person’s independence, productivity and quality of life (O’Neill et al., 1998). A specialist RTW/S program, therefore, aims to return a person to work or study after an ABI. While there are factors known to improve RTW/S outcomes, there is a lack of agreement and understanding of the best methods and approach for RTW/S programs for people with an ABI.

Many rehabilitation services provide RTW/S (vocational) programs, with the aim of supporting and enabling the individual to return successfully to either their previous work/study place or an alternative work/study place. Furthermore, a successful RTW/S program can give the individual a sense of achievement and fulfillment, leading to an improved quality of life (Wehman et al., 2005). A successful interdisciplinary RTW/S program needs high- level collaboration between the individual, the employer/ teacher and the clinician facilitating the RTW/S, awareness of the person’s level of physical and cognitive abilities, and awareness of the environmental demands (Bjorkdahl, 2010; MaCaden, Chandler, Chandler, & Berry, 2010; O’Brien, 2007). Yet, there are a number of barriers to RTW/S to overcome. Barriers to returning to work have been reported as: the extent of the impairment (e.g., physical or cognitive impairment), the type of work activities (e.g., demand of movement, cognitive planning, concentration), the work environment (e.g., not accessible, too noisy), and the degree of understanding from the clinicians, employers or colleagues regarding ABI (Foreman, Murphy, & Swerissen, 2006; World Health Organization, 2001). Additional factors also include the amount of financial resources (savings, alternative income, compensation/insurance), social supports (family friends, colleagues, manager), the expectations of the industry involved, and the current labour-market demands (Cole et al., 2013; Foreman et al., 2006; World Health Organization, 2001). Clinical practice guidelines (ABIKUS, 2007; NZGG, 2007) recommend vocational rehabilitation programs that are conducted by clinicians trained in vocational needs with specialist knowledge about the person’s health condition, embedded within a specialist program, and monitored for at least 6 months to ensure long-term successful outcomes. Without this specialist knowledge, clinician involvement may in fact reduce employers’ willingness and motivation to support and assist the person to RTW/S (Foreman et al., 2006; Wehman et al., 2005). Current literature demonstrates, however, that guidelines are not necessarily followed and that studies in this area lack sufficient detail to replicate (Phillips et al., 2010). Despite best practice guidelines being available, there is no high-level evidence to guide specific requirements and methods for interventions. This indicates a lack of agreement and understanding of the best methods and approach for RTW/S programs for people with an ABI. The aim of this study, therefore, was to explore the relationship between provision of an interdisciplinary RTW/S program, work/study status, and quality of life.

KEYWORDS BRAIN INJURIES OCCUPATIONAL THERAPY REHABILITATION RETURN TO WORK SPEECH-

LANGUAGE PATHOLOGY

THIS ARTICLE HAS BEEN PEER- REVIEWED

Emma J. Schneider (top), Kate Lawlor (centre) and Ester Roberts

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JCPSLP Volume 22, Number 1 2020

Journal of Clinical Practice in Speech-Language Pathology