Effectiveness of Combining Compensatory Cognitive Training and Vocational Intervention vs. Treatment as Usual on Return to Work Following Mild-to-Moderate Traumatic Brain Injury: Interim Analysis at 3 and 6 Month Follow-Up

Emilie Isager Howe, Silje C R Fure, Marianne Løvstad, Heidi Enehaug, Kjersti Sagstad, Torgeir Hellstrøm, Cathrine Brunborg, Cecilie Røe, Tonje Haug Nordenmark, Helene L Søberg, Elizabeth Twamley, Juan Lu, Nada Andelic, Emilie Isager Howe, Silje C R Fure, Marianne Løvstad, Heidi Enehaug, Kjersti Sagstad, Torgeir Hellstrøm, Cathrine Brunborg, Cecilie Røe, Tonje Haug Nordenmark, Helene L Søberg, Elizabeth Twamley, Juan Lu, Nada Andelic

Abstract

Aims: Knowledge regarding the most effective return to work (RTW) approaches after traumatic brain injury (TBI) is lacking. This trial aimed to compare the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on RTW and work stability after TBI. Methods: We performed a parallel-group randomized controlled trial (RCT) at a TBI outpatient clinic at Oslo University Hospital (OUH), Norway. Patients with a history of mild-to-moderate TBI (n = 116) aged 18-60 were randomized (1:1) by an independent investigator to receive group-based compensatory cognitive training (CCT) and supported employment (SE) (n = 60) or TAU consisting of individualized multidisciplinary treatment (n = 56). Participants were enrolled 2-3 months post-injury. The nature of the intervention prevented blinding of patients and therapists, however, outcome assessors were blinded to group allocation. The primary outcome measure was RTW at 3 and 6 months following study inclusion. Secondary outcomes were work percentage, stability, and productivity. The present study provides results from an interim analysis from the first two planned follow ups, while subsequent publications will present results up to 12 months following study inclusion. Results: Mixed effects models showed no between-group differences in the RTW proportion, work percentage, and hours worked between CCT-SE and TAU from baseline to 6 months. A significantly higher proportion of participants in CCT-SE had returned to work at 3 months when adjusting for baseline differences. The majority of participants who were employed at 3 and 6 months were stably employed. There was a statistically significant within-group improvement on RTW proportion, hours worked and work percentage in both groups. Conclusion: The results revealed no difference between CCT-SE and TAU on work-related outcomes from baseline to 6 months. However, there was a higher RTW proportion in the CCT-SE group compared to TAU at 3 months. Future publications will assess the effectiveness of CCT-SE vs. TAU up to 12 months. Clinical Trial Registration: US National Institutes of Health ClinicalTrials.gov, identifier #NCT03092713.

Keywords: cognitive remediation; randomized controlled trial; return to work; traumatic brain injury; vocational rehabilitation.

Copyright © 2020 Howe, Fure, Løvstad, Enehaug, Sagstad, Hellstrøm, Brunborg, Røe, Nordenmark, Søberg, Twamley, Lu and Andelic.

Figures

Figure 1
Figure 1
CONSORT flow chart.
Figure 2
Figure 2
Estimated proportion of participants working at baseline, 3- and 6 months per treatment group from mixed effects logistic regression analyses. CCT-SE, Compensatory Cognitive Training and Supported Employment; TAU, treatment as usual.
Figure 3
Figure 3
(A) Observed proportion of participants working 0%, <50%, 50–79%, and 80–100% at baseline, 3- and 6 months in the CCT-SE group; (B) observed proportion of participants working 0%, <50%, 50–79%, and 80–100% at baseline, 3- and 6 months in the TAU group. CCT-SE, Compensatory Cognitive Training and Supported Employment; TAU, treatment as usual.

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