Low post-injury employment rates indicate that returning to work is difficult following traumatic brain injury (TBI). Occupational therapists assist people with TBI to return to work, but rarely is their intervention described. This has hindered research into vocational rehabilitation.
As no existing tool was identified for recording intervention, a proforma was developed for this study. Using best practice guidelines and a consensus of expert opinion, 15 categories of the vocational rehabilitation process were identified. Time spent on each category was recorded in 10-minute units after each occupational therapy session. The records of 21 participants who received occupational therapy focused on vocational rehabilitation were analysed.
The proforma was quick and simple to use. The analysis showed that assessment, work preparation, employer involvement, education and dealing with issues of immediate concern to participants accounted for almost 85% of face-to-face intervention. It also showed that for every 1 hour of face-to-face contact, an additional 2 hours was required for liaison and travel.
This study showed that there is potential for using a proforma for quantifying and describing occupational therapy. This is the basis for further work to enable meaningful comparisons with other services and use in future studies.
BallingerCAshburnALowJRoderickP (1999) Unpacking the black box of therapy – a pilot study to describe occupational therapy and physiotherapy interventions for people with stroke. Clinical Rehabilitation, 13(4), 301–09.
2.
BarnesTHolmesJ (2006) Occupational therapy in vocational rehabilitation. College of Occupational Therapists Specialist Section – Work: Vocational Rehabilitation Toolkit. London: College of Occupational Therapists Specialist Section – Work.
3.
BarnesTHolmesJ (2007) Occupational therapy in vocational rehabilitation: A brief guide to current practice in the UK. London: College of Occupational Therapists Specialist Section – Work.
4.
British Society of Rehabilitation Medicine (1998) Rehabilitation after traumatic brain injury. A working party report of the British Society of Rehabilitation Medicine. London: BSRM.
5.
British Society of Rehabilitation Medicine (2000) Vocational rehabilitation: The way forward. A working party report commissioned by the British Society of Rehabilitation Medicine. London: BSRM.
British Society of Rehabilitation Medicine (2003b) Rehabilitation following acquired brain injury: National Clinical Guidelines. London: Clinical Effectiveness and Evaluation Unit, Royal College of Physicians.
8.
British Society of Rehabilitation Medicine, Jobcentre Plus, Royal College of Physicians (2004) Vocational assessment and rehabilitation after acquired brain injury: Inter-agency guidelines. TyermanAMeehanMJ, eds. Inter-Agency Advisory Group on Vocational Rehabilitation after Brain Injury. London: BSRM, JCP, RCP.
9.
CatalanoDPereiraAPWuMYHoHChanF (2006) Service patterns related to successful employment outcomes of persons with traumatic brain injury in vocational rehabilitation. NeuroRehabilitation, 21(4), 279–93.
10.
CoetzerR (2008) Holistic neuro-rehabilitation in the community: Is identity a key issue?Neuropsychological Rehabilitation, 18(5–6), 766–83.
11.
CreekJIlottICookSMundayC (2005) Valuing occupational therapy as a complex intervention. British Journal of Occupational Therapy, 68(6), 281–84.
12.
De WitLKamsteegtHYadavBVerheydenGFeysHDe WeerdtW (2007) Defining the content of individual physiotherapy and occupational therapy sessions for stroke patients in an inpatient rehabilitation setting. Development, validation and inter-rater reliability of a scoring list. Clinical Rehabilitation, 21(5), 450–59.
13.
Department for Work and Pensions and Department of Health (2008) Improving Health and work:changing lives. The Government's Response to Dame Carole Black's Review of the health of Britain's working-age population. London: Department for Work and Pensions and Department of Health, TSO.
14.
Department of Health (2005) National Service Framework for Long-Term Conditions. London: Department of Health, HMSO.
15.
DeshpandePTurner-StokesL (2004) Survey of vocational rehabilitation services available to people with acquired brain injury in the UK. In: British Society of Rehabilitation Medicine, Jobcentre Plus, Royal College of Physicians (2004)Vocational assessment and rehabilitation after acquired brain injury: Inter-agency guidelines. TyermanAMeehanMJ, eds. Inter-Agency Advisory Group on Vocational Rehabilitation after Brain Injury. London: BSRM, JCP, RCP.
16.
EvansCCShererMNakase-RichardsonRManiTIrbyJWJr (2008) Evaluation of an interdisciplinary team intervention to improve therapeutic alliance in post-acute brain injury rehabilitation. Journal of Head Trauma Rehabilitation, 23(5), 329–38.
17.
FrankAThurgoodJ (2006) Vocational rehabilitation in the UK: Opportunities for health-care professionals. International Journal of Therapy and Rehabilitation, 13(3), 126–34.
18.
GeurtsenGJvan HeugtenCMMartinaJDGeurtsAC (2010) Comprehensive rehabilitation programmes in the chronic phase after severe brain injury: A systematic review. Journal of Rehabilitation Medicine, 42(2), 97–110.
19.
GrosswasserZMelamedSAgranovEKerenO (1999) Return to work as an integrative outcome measure following traumatic brain injury. Neuropsychological Rehabilitation, 9(3/4), 493–504.
HartTDijkersMFraserRCiceroneKBognerJAWhyteJMalecJWaldronB (2006) Vocational services for traumatic brain injury: Treatment definition and diversity within model systems of care. Journal of Head Trauma Rehabilitation, 21(6), 467–82.
22.
HuangHCChungKCLaiDCSungSF (2009) The impact of timing and dose of rehabilitation delivery on functional recovery of stroke patients. Journal of the Chinese Medical Association, 72(5), 257–64.
23.
JohanssonUBernspängB (2001) Predicting return to work after brain injury using occupational therapy assessments. Disability and Rehabilitation, 23(11), 474–80.
24.
KendallEMuenchbergerHGeeT (2006) Vocational rehabilitation following traumatic brain injury: A quantitative synthesis of outcome studies. Journal of Vocational Rehabilitation, 25(3), 149–60.
25.
KuipersPFosterMCarlsonGMoyJ (2003) Classifying client goals in community-based ABI rehabilitation: A taxonomy for profiling service delivery and conceptualizing outcomes. Disability and Rehabilitation, 25(3), 154–62.
26.
MurphyLChamberlainEWeirJBerryANathaniel-JamesDAgnewR (2006) Effectiveness of vocational rehabilitation following acquired brain injury: Preliminary evaluation of a UK specialist rehabilitation programme. Brain Injury, 20(11), 1119–29.
27.
O'BrienL (2007) Achieving a successful and sustainable return to the workforce after ABI: A client-centred approach. Brain Injury, 21(5), 465–78.
OwnsworthTMcKennaK (2004) Investigation of factors related to employment outcome following traumatic brain injury: A critical review and conceptual model. Disability and Rehabilitation, 26(13), 765–83.
30.
van VelzenJMvan BennekomCAEdelaarMJSluiterJKFrings-DresenMH (2009) How many people return to work after acquired brain injury? A systematic review. Brain Injury, 23(6), 473–88.
31.
Vocational Rehabilitation Association (2007) VRA Standards of practice. Report of the Standards Task Group. (Chair: Kovacs G). Glasgow: VRS.
WagnerAKHammondFMSasserHCWiercisiewskiD (2002) Return to productive activity after traumatic brain injury: Relationship with measures of disability, handicap, and community integration. Archives of Physical Medicine and Rehabilitation, 83(1), 107–14.
34.
WalkerWCMarwitzJHKreutzerJSHartTNovackTA (2006) Occupational categories and return to work after traumatic brain injury: A multicenter study. Archives of Physical Medicine and Rehabilitation, 87(12), 1576–82.
35.
WhyteJ (2009) Directions in brain injury research: From concept to clinical implementation. Neuropsychological Rehabilitation, 19(6), 807–23.
36.
WhyteJHartT (2003) It';s more than a black box; it's a Russian doll: Defining rehabilitation treatments. American Journal of Physical Medicine and Rehabilitation, 82(8), 639–52.
37.
SonAH Willemse-VanRibbersGMVerhagenAPStamHJ (2007) Prognostic factors of long-term functioning and productivity after traumatic brain injury: A systematic review of prospective cohort studies. Clinical Rehabilitation, 21(11), 1024–37.
