JCPSLP Vol 22 No 1 2020

Method Design This observational, prospective study explored a cohort of people with an ABI who attended an interdisciplinary RTW/S program in Victoria, Australia. The Hospital Human Research Ethics Committee approved this study prior to commencement (332/10). Participants Eligibility criteria included a diagnosis of an ABI and participation in work and/or study prior to their ABI, with an identified RTW/S therapy goal. ABI was defined as including traumatic brain injuries, strokes, brain illness, and any other kind of brain injury acquired after birth, however, did not include degenerative brain conditions such as Alzheimer’s disease or Parkinson’s disease (Brain Injury Australia, 2016). Participants were excluded if they were younger than 17 years, or had significant pre-existing health conditions that may have affected the person’s ability to RTW/S. All participants received intervention from an occupational therapist and/or speech-language pathologist within the neurological outpatient program. The purposive sample was recruited over an 18-month time period. Intervention Participants received an individualised program focused on RTW/S delivered by the appropriate therapist(s). Input from neuropsychology, clinical psychology, physiotherapy was given as necessary and all patients attended outpatient appointments with a rehabilitation physician. Depending on the individual, the RTW/S program included cognitive remediation, social skills training, conversation training, self-awareness remediation and/or motor skill practice. All participants received an ergonomic evaluation with environmental and task modification recommendations. If required, intervention may have additionally included participant and family education, liaison with employer, work simulation and voluntary work trials. The RTW/S therapy interventions and programs were tailored to each client. Individual assessment determined the goals of the RTW/S intervention, which interdisciplinary team members provided. The frequency and duration of the RTW/S program were developed in response to the severity of impairment/s, the level of support from stakeholders, and client ability to learn new strategies. The RTW/S program ranged from as frequent as 3 days per week, to as little as fortnightly or monthly, with frequency of therapy input commonly reducing towards the end of the program. Depending on the individual, the session duration could be as long as 2 hours or as short as a brief telephone call. Data collection Data were collected prospectively on demographics, injury and work/study status for participants who commenced in the RTW/S program between November 2012 and December 2013. Primary delineation of work roles was categorised in accordance with Australia New Zealand Standard Classification of Occupation (ANZSCO) to identify participants’ primary area of work activity. This information was classified under the following categories: managers, professionals, technicians and trades workers, community and personal service workers, administrative and clerical workers, sales workers, machinery/operators and drivers and labourers (Australian Bureau of Statistics, 2013). Secondary delineation of work activity was categorised as:

competitive employment, supported employment, sheltered employment, unemployed, student, retired, homemaker or volunteer. The primary outcome measure of work/study status was collected at the start of the RTW/S program, at the completion of the RTW/S program, and at 3 months following the completion of the program. Classification of work/study status was as follows: (a) full-time work (38 hours per week or more), (b) part-time work (< 38 hours per week), (c) casual or locum work, (d) full-time study (75% or more of full-time course’s study load), or (e) part-time study (< 75% of full-time course’s study load), or (f) not working or studying but job-seeking, or (g) not working or studying. Volunteers, retirees, and unpaid homemakers were not coded on this variable. The secondary outcome measure was the Short Form–12 (SF-12™) Quality of Life assessment (Ware, Kosinski, & Keller, 1996), described below. The measure was completed at baseline, at completion of the RTW/S program, and 3 months after the completion of the program. This assessment was selected as it could be administered in person, by survey or telephone, optimising likelihood of response. An in-person interview with the participant was the first choice of follow-up method. If this was not possible, a telephone interview was attempted and if this was unsuccessful, data was collected using a mail questionnaire or interview with a significant other/family member. The Short Form–12 (SF-12™) Quality of Life questionnaire measures a person’s perceived quality of life and recovery. This brief version asks questions which are comprised of each of the 8 domains of the Short-Form-36 questionnaire (Ware & Sherbourne, 1992), to determine a person’s self-reported quality of life. Both questionnaires have been used previously to measure outcomes in Means, standard deviations (SD), and number (%) for the sample were calculated for baseline demographic, injury and work/study data; missing data were treated as missing. Differences over time within the cohort on primary and secondary outcomes were analysed using chi-squared tests. An estimate of the size of the effect of intervention was identified using a 95% confidence interval (CI). Data were analysed using an intention-to-treat analysis (Pocock, 1983), meaning participants were analysed irrespective of compliance to the program (Hollis & Campbell, 1999). Results Sample Nineteen adults took part in this study; the majority had suffered a stroke (n = 10, 53%); other diagnoses included traumatic brain injury (TBI) (n = 6, 32%) and brain tumour (n = 2, 11%). Ages of participants varied widely, from 17 years to 63 years (mean 40 years, SD 13); all were working or studying at the time of their ABI. Referrals to our RTW/S program had been received from both hospital and community-based organisations. Further demographic and diagnosis data are listed in Table 1. Prior to sustaining an ABI, the majority of participants were employed in a full-time capacity (n = 11, 58%). The average length of time from injury to commencement of the RTW/S program was 115 days (SD = 163). Details of type of occupation of participants are listed in Table 1. persons with an ABI. Data analysis

Top to bottom, Kelly McMahon, Lauren Solomon,

Nicole Austin, and Natasha Lannin

49

JCPSLP Volume 22, Number 1 2020

www.speechpathologyaustralia.org.au