Presentation T P39

T P39 (Poster Presentation):
Return to work after mild traumatic brain injury: Best evidence synthesis of systematic reviews and meta-analyses

Presented by: Mette Jensen Stochkendahl

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Donovan J1, Cancelliere C1,2, Stochkendahl MJ5, Biscardi M1, Ammendolia C2, Myburgh C4, Cassidy JD1,2,3,4

  1. Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Canada
  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
  3. Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada
  4. Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
  5. Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark



Mild traumatic brain injuries (MTBI) are common, with an incidence now in excess of 600 per 100,000. One year after MTBI, up to 30% of patients continue to report persistent symptoms. Such symptoms impair quality of life and can contribute to limitations in overall functioning, including returning to work (RTW); however, there are no established RTW processes for patients after MTBI. The purpose of this study was to identify and collate RTW systematic reviews and meta-analyses across health conditions to determine if prognostic factors/interventions used for successful RTW in other health conditions might be applied in MTBI.


The overall study design is a systematic review and best evidence synthesis. Medline and 4 other electronic scientific databases were searched from 2004 to September 10, 2013. Included were all systematic reviews and meta-analyses addressing RTW across injury and illness. Eligible studies were appraised using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Data from admissible articles were extracted and entered into evidence tables. The evidence was synthesized qualitatively.


A total of 34,468 records were screened. Of these, 63 were rated as having a low risk of bias and thus form the basis of our findings. Work-related factors (e.g., work accommodation), work-directed RTW interventions (e.g., vocational rehabilitation) and having high expectations of recovery and RTW were all strongly associated with positive RTW outcomes. Having a strong negative association with RTW were primarily personal (e.g., older age), injury (e.g., high pain intensity) and work-related factors (e.g., poor social support). Head-injury specific factors (e.g., GCS, PTA) do not appear important for RTW.


This is the first systematic review of systematic reviews and meta-analyses that has assessed RTW outcomes across different health conditions. Our findings are in line with several recent systematic reviews on prognosis after MTBI and suggest that a biopsychosocial approach can be applied to improve RTW outcomes after MTBI. Also included as part of this approach are interventions that are brief and focused on education and improving self-management strategies as well as those that are workplace-directed.

Schedule Details

Tuesday September 30
12:45 - 13:45 Poster Viewing
Session: Work capacity / ability