What is the timeline for returning to normal work after a Traumatic Brain Injury (TBI)?

From the Guidelines

Patients with Traumatic Brain Injury (TBI) should return to full activity, including work, when they have remained symptom-free at rest and with increasing levels of physical exertion, as recommended by the Centers for Disease Control and Prevention guideline 1. The timeline for returning to normal work after a TBI varies significantly based on injury severity, with mild TBI patients often returning within weeks while moderate to severe cases may take months or longer. Key considerations for a successful return to work include:

• Gradual and phased return to work, starting at 2-4 hours per day and slowly increasing as tolerated over several weeks
• Medical supervision and close monitoring of symptoms during the transition period
• Implementation of necessary accommodations, such as reduced noise exposure, frequent breaks, memory aids, and modified duties, in collaboration with the healthcare provider and employer
• Potential use of medications like amantadine or methylphenidate to address cognitive issues, and acetaminophen or NSAIDs for headache management, while avoiding opioids when possible 1. It is essential to prioritize symptom management and prevention of exacerbation during the recovery period, as prolonged inactivity beyond the initial 3 days of injury may worsen self-reported symptoms, while physical exercise performed below symptom exacerbation can reduce postconcussive symptoms in active rehabilitation models 1.

From the Research

Timeline for Returning to Normal Work after TBI

The timeline for returning to normal work after a Traumatic Brain Injury (TBI) can vary significantly depending on several factors, including the severity of the injury, individual characteristics, and the type of rehabilitation received.

• Some studies suggest that return to work (RTW) rates can range from 12% to 70% 2.
• A systematic review of cognitive rehabilitation related to mild/moderate TBI found that cognition plays a significant role in predicting and facilitating RTW in patients with TBI 3.
• Vocational rehabilitation approaches, such as program-based vocational rehabilitation, supported employment, and case coordination, can facilitate RTW, but there is little clear evidence to suggest what should be considered the "best practice" approach 4.

Factors Affecting Return to Work

Several factors can affect the success or failure of the RTW program, including:

• Client factors, such as social support, cognitive difficulties, and motivation 5.
• Work factors, such as work modifications, employer support, and financial incentives 5.
• Rehabilitation factors, such as the RTW program, the role of the vocational occupational therapist, and work preparation 5.
• Health-related quality of life, anxiety, and functional ability can also predict complete return to work 6.

Work Outcomes after TBI

Work outcomes after TBI can be heterogeneous, with some individuals achieving a complete return to work, while others may experience reduced working hours, changed job responsibilities, or require workplace accommodations.

• A retrospective cross-sectional analysis found that 59% of moderately to severely injured individuals and 84% of mildly injured individuals returned to work following TBI, but only 16.3% achieved a complete return to work by 12 months 6.
• Many individuals reported reduced working hours and were less content with their job, highlighting the need for further longitudinal research to explore the personal and economic legacy of TBI 6.