JCPSLP Vol 22 No 1 2020

Table 3. Quality of life outcomes

Outcomes

Baseline

End of program 3-month follow-up

Quality of life, mean (SD) SF-12 (Physical Component Summary) SF-12 (Mental Component Summary) Work/study status, n (%) Work, full-time (38 hours / week or more) Work, part-time (< 38 hours/ week) Work, casual / locum

40.8 (9.9) 48.2 (8.9)

44.6 (8.4) 48.6 (9.4)

51.4 (8.0) 49.6 (10.7)

5 (26) 5 (26)

4 (21) 3 (16)

0 (0) 3 (16)

0 (0) 0 (0) 1 (5) 1 (5) 14 (74)

0 (0) 1 (5)

1 (5) 0 (0)

Study, full-time Study, part-time Not working or studying, job seeking Not working, not studying 6 (32) 4 (21) 1 (5) Note: Quality of life outcomes (mean (SD)) reported at baseline (n = 9), end of program (n = 9) and 3-month follow-up (n = 5), and Work/study outcomes (n (%)) at baseline (n = 19), end of program (n = 19) and 3-month follow-up (n = 19). 3 (16) 3 (16) 2 (11)

were shown to improve outcomes (Corrigan, 1998). These factors need to be considered within RTW/S programs and contribute to clients being work-ready as a prerequisite to successful return to work options. The emphasis on providing individualized, graded input from a multidisciplinary team of clinicians with expertise in brain injury recovery was vital. This meant negotiation occurred with the work/study places to give accurate information on the individual’s performance abilities. This interaction also allowed for advocating for the individual for specific requirements, in order to get a more successful outcome. Work simulation where the clinician supported the individual to “practice” the task in a similar environment was another intervention used. Although this cannot replicate the true work environment, this can identify difficulties that may arise in order to problem solve these prior to being in the work/study place. Knowledge of activity analysis, being able to grade activities and accurately identify the cognitive demand and components of each activity, was also required and supported as the most effective way to neuroplasticity also needs to be acknowledged as a factor in ABI recovery (Young & Tolentino, 2011). Improvement following ongoing rehabilitation as well as organic recovery denotes the need for long-term interventions from clinicians. The interventions need to be adaptive in response to the changing abilities of the individual, the environment, and work/study opportunities as the individual re-integrates into their occupational roles. This indicates that a long-term approach (beyond 3 months) needs to be embraced by the rehabilitation team, in order to continue to negotiate the potential RTW/S opportunities over time. Methods may include clinicians being accessible to provide accurate information in the manner that it is required (written, diagrams, expectations), a clear return to work program that outlines the specific tasks that can be completed, and the adaptation of time, demand, environment or process for required tasks. Consideration of fatigue (reactive and cumulative) following an ABI also needs to be expected and managed (Joosen, Frings-Dresen & Sluiter, 2013). This may entail completing work tasks when patients are most alert and ensuring clients receive the appropriate education. Limitations A limitation of this observational prospective study was our use of work/study status as the primary measure of the manage a RTW/S program (O’Brien, 2007). Natural improvement over time through brain

success of the participants within the RTW/S program. This limitation was highlighted in the Murphy et al. (2006) study, where they suggested that participants in a RTW/S program can make significant gains in less tangible areas than returning to work or study. For example, through involvement in the RTW/S program, participants may improve compensatory strategy use to manage cognitive impairment, gain awareness into strengths and weaknesses, improve communication skills, and have a more realistic expectation of the future, yet this is not emphasised (Murphy et al., 2006). There are additional factors that need to be considered when a person with an ABI does not successfully return to their previous occupation of work or study. Therefore, alternative ways of measuring success in rehabilitation need to be considered beyond a RTW/S outcome alone. These can be identified as personal development achievements and incorporate increased independence in performing daily functional activities, improved ability to plan and manage household tasks, improved ability to manage fatigue and engagement in daily activities, improved ability to access the community and attend social events, and return to previous role responsibilities of being a friend, parent, partner or confidant (Frostad Liaset & Loràs, 2016). These important occupational life roles have been identified as basic human rights and necessary for living a fulfilled and meaningful life (Wilcock, 2006). Implications The implications for practice arising from this study include the need to be cognisant of the change in quality of life a person may experience when engaging in a RTW/S program. Our approach therefore needs to incorporate personalised input for each participant including: (a) awareness of the individual’s abilities and methods of adaptation, (b) understanding of the specific tasks required within the role, (c) the environment, (d) the level of understanding of both employer and employees/teachers and fellow students, and (e) the support mechanisms that the individual has around them. When these factors are considered within the whole RTW/S context, then the possibility of a more successful outcome is much more likely. This study contributes to the growing body of evidence investigating the effectiveness of RTW/S programs on work and study outcomes. It also highlights the positive impact of participation in RTW/S programs on self-reported quality

51

JCPSLP Volume 22, Number 1 2020

www.speechpathologyaustralia.org.au