Employment after Traumatic Brain Injury (TBI): A cohort comparison study. Aim of feasibility study. Inclusion Criteria

Transcription

1 Employment after Traumatic Brain Injury (TBI): A cohort comparison study Julie Phillips, Occupational Therapist University of Nottingham/ Nottingham Traumatic Brain Injury Service Return to work after traumatic brain injury (TBI) Main goal after TBI (Carlson et al 2006) Low rates of post injury employment: 41% in work at 1 year (Van Velzen 2009) Patchy UK provision (Deshpande et al. 2004) Is VR targeted at returning people with TBI to work effective in UK? Is it cost effective? Aim of feasibility study Was a specialist TBI service (including occupational therapy (OT) aimed at return to work/education), more effective at getting people back to work/education, than routine care? Was a specialist service cost effective compared to routine care? Can we describe the OTVR delivered? Compared 2 groups of TBI patients Specialist service = Nottingham Traumatic Brain Injury Service Minor TBI OT only Method Routine care = Patients outside the catchment area Recruitment =4 weeks post hospital discharge Postal Follow up 3,6 and 12 months post recruitment Inclusion Criteria Over 16 years old Had a documented TBI requiring an inpatient stay 48 hours Were in or intending to be in paid or voluntary work or education at the time of the injury Able to give informed consent Specialist Group Nottingham Traumatic Brain Injury service: - 2 wte case managers, 1 wte Cognitive behavioural therapist, 0.6 wte O.T, 0.5 wte psychologist, 1 wte administrator. Clients =GCS 12 (moderate/severe TBI) Approx 40 new clients per year Average team case load = 75 patients Minor TBI clients not eligible for service. For study were offered voc rehab by OT

2 Vocational Rehab Approach Based on best practice guidelines (Tyerman A & Meehan M 2004). Team:- Address work issues Advise not to go back early OT Role:- Assessment Treatment Liaise with employers, tutors, DEA s Advise and carry out monitored graded return to work programmes Outcome measures Primary Return to work/education: yes/no Secondary Functional Ability (BICRO) Mood (HADS) Quality of Life (EQ5D) Recruitment (22 months) 382 potential people identified 130 eligible 94 in study 252 Noneligible people 36 (27.4%) declined 40 Specialist group 54 Usual care group Specialist (n=40) Usual care group (=54) Men 32 () 45 (83%) Mean age (range) 94 Participants 35 years (18-66) 34 years (16-68) In work/education 38 (95%) 53 (96%) Mean GCS (3-15) Mod/severe TBI 26 (65%) 28 (52%) (GCS 3-12) Minor TBI (GCS13-15) 14 (35%) 26 (48%) Baseline length of hospital stay Specialist group in hospital for 11 days less Specialist group = mean12 days (sd 20)* Usual care group = mean 23 days (sd 21)* Specialist group = 3x more likely to report receiving adequate care at 4 weeks post hospital discharge *Using 5% trimmed mean Return to work all participants Percentage in work % at work Pre-injury 4 weeks 3 months 6 months 12 months Interventon group Non intervention 15%

3 Return to work moderate/severe TBI Return to Work minor TBI P ercentage at w ork 8% 27% Pre-injury 4 weeks 3 months 6 months 12 months P e r c e n t a g e i n w o rk 1 37% 1 Pre-injury 4 w eeks 3 months 6 months 12 months Interventon group Non intervention Intervention group Non intervention 12 months post hospital discharge: Secondary outcomes Between groups - No significant in function, mood or quality of life Between people working or not working - Those in work had significantly less anxiety, less depression and reported a higher quality of life Costs over 1 year (UK 2007) Specialist group only cost 75 more per person in Health and social Specialist group 1,862 better off than usual care group in social costs Cost an extra 502 per person to return a person to work in the specialist group 13% more usual care participants were living on only benefits at one year Content analysis Designed a proforma* Recorded OT treatment on patients who received 2 or more sessions of OT in 10 min units Where seen Assessment Current issues Goals Personal ADL Proforma Catergories Cognitive/Executive skills Work preparation Return to work process Education about TBI Miscellaneous Instrumental ADL Liaison Physical issues General issues Psychological issues

4 Content of treatment 66% of the OT intervention directly focused on RTW: Work preparation (23%) Assessment (15%) RTW process (13%) Current issues (15%) No intervention on PADL Number of participants Style of Intervention 2 14 Advice only 7% Treatment only - no direct employer involvement 48% 8 Treatment and employer involvement 28% *DEA s, Occ health doctor, pathway providers 5 Treatment and involvement of others* 17% Top 5 work concessions Distribution of OT time per participant Graded return to work = 88% participants Flexible extra breaks (18%) Decreased hours (18%) Reduced duties (15%) Reduced days (15%) Flexible start/finish times (13%) OT non participant face to face liasion 36% OT face to face with participant 31% OT travel 21% OT admin 11% Summary of OT time 1/3 = face to face intervention 1/3 = Liaison 1/3 = Admin and travel Outcome of Treatment At discharge 25/29 (86%) = work/study Of these, 22/29 (76%) returned to previous employer/college in some capacity 3/29 (1) had started a new job 4/29 (14%) were not working (2 disengaged) Everyone remained in work for 18 months Conclusions Clinical: - Intervention group had increased work rates at all time points - People with moderate and severe TBI showed largest 12 month in RTW rates - Early intervention required Cost - effectiveness - Uncertain if health perspective taken at 1 year Research - Results suggest a larger study is warranted

5 Steering group Dr Kate Radford, University of Central Lancashire, Principal Investigator Dr Avril Drummond, University of Nottingham Dr Marion Walker, University of Nottingham Dr Tracey Sach, University of East Anglia Dr Andy Tyerman, Consultant Clinical Neuro-psychologist Dr Naseer Haboubi, Consultant in Rehabilitation Medicine Trevor Jones, patient representative Thank you Thank you Participants Therapy University of Nottingham Nottingham Traumatic Brain Injury Service (Nottingham University Hospitals) Julie Phillips, Occupational Therapist Nottingham Traumatic Brain Injury Service Nottingham University Hospitals Mobility Centre, City Hospital Campus Hucknall Road Nottingham NG5 1PJ Ext References Carlson, P. M., M. L. Boudreau, J. Davis, J. Johnston, C. Lemsky, M. A. McColl, P. Minnes and C. Smith (2006). 'Participate to learn': A promising practice for community ABI rehabilitation. Brain Inj 20(11): van Velzen, J. M., C. A. van Bennekom, M. J. Edelaar, J. K. Sluiter and M. H. Frings- Dresen (2009). How many people return to work after acquired brain injury?: a systematic review. Brain Inj 23(6): Deshpande, P. and L. Turner-Stokes (2004). Survey of vocational rehabilitation services available to people with acquired brain injury in the UK. M. M. In Tyerman A, editors Vocational assessment and rehabilitation after acquired brain injury: Inter-agency guidelines. Phillips, J. (2010). Return to work after traumatic brain injury: recording, measuring and describing occupational therapy intervention. British Journal of Occupational Therapy73(9): Tyerman A & Meehan M ( 2004). Vocational Assessment and rehabilitation after acquired brain injury, Inter-agency guidelines. British Society of Rehabilitation Medicine, Jobcentreplus, Dept for Work and Pensions, Royal College of Physicians, Clinical Effectiveness and Evaluation Unit