Vocational rehabilitation after traumatic brain injury: models and services

A recent systematic review suggests that around 40% of people with traumatic brain injury (TBI) return to work (RTW). Yet in the U.K. currently only a small minority of people with TBI receive vocational rehabilitation (VR) to enable a RTW. Agencies with an interest in developing such services are likely to favour different models of VR.

The primary objective of this paper was to review models of specialist VR after TBI and their outcomes to inform service development across relevant agencies.

A literature review on VR after TBI was undertaken in MEDLINE, EMBASE and PsychINFO (from 1967 to date). Papers reporting models of VR were selected for more detailed consideration.

Illustrative examples of VR models are outlined: brain injury rehabilitation programmes with added VR elements, VR models adapted for TBI, case coordination/resource facilitation models, and consumer-directed models. Models differ, both within and across these four broad categories, in provision of core TBI rehabilitation, work preparation, work trials and supported placements. Methodological variation limits direct comparison of outcomes across models with few comparative or controlled studies.

There is evidence to support the benefits of a wide range of models of specialist VR after TBI. However, there remains a need for controlled studies to inform service development and more evidence on cost-effectiveness to inform funding decisions.