Investigation of factors related to employment outcome following traumatic brain injury: a critical review and conceptual model.
OBJECTIVE
The purpose of this article is to critically review the literature to examine factors that are most consistently related to employment outcome following traumatic brain injury (TBI), with a particular focus on metacognitive skills. It also aims to develop a conceptual model of factors related to employment outcome.


METHODS
The first stage of the review considered 85 studies published between 1980 and December 2003 which investigated factors associated with employment outcome following TBI. English-language studies were identified through searches of Medline and PsycINFO, as well as manual searches of journals and reference lists. The studies were evaluated and rated by two independent raters (Kappa=0.835) according to the quality of their methodology based upon nine criteria. Fifty studies met the criteria for inclusion in the second stage of the review, which examined the relationship between a broad range of variables and employment outcome.


RESULTS
The factors most consistently associated with employment outcome included pre-injury occupational status, functional status at discharge, global cognitive functioning, perceptual ability, executive functioning, involvement in vocational rehabilitation services and emotional status.


CONCLUSIONS
A conceptual model is presented which emphasises the importance of metacognitive, emotional and social environment factors for improving employment outcome.
Ownsworth
Tamara
T
Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia. t.ownsworth@shrs.uq.edu.au
McKenna
Kryss
K
D001930:Brain Injuries / Q000523:psychology / Q000534:rehabilitation*; D004651:Employment; D006801:Humans; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D012944:Social Support