title: Return to work after traumatic brain injury: cohort comparison and economic evaluation.
abstract: BACKGROUND
  Returning to work (RTW) in the UK is problematic following TBI. Vocational rehabilitation (VR) is limited and efficacy or costs seldom reported. This study aimed to determine whether a TBI specialist VR intervention (TBI VR) was more effective at work return and retention 12 months after injury than usual care (UC). Secondary aims were to explore the feasibility of collecting economic data to inform a definitive trial.
  
  
  METHODS
  Work outcomes of TBI-VR were compared to UC. Ninety-four participants (40 TBI-VR) with TBI resulting in hospitalization ≥48 hours, who were working at injury were followed up by postal questionnaire at 3, 6 and 12 months post-hospital discharge. Primary outcome was RTW. Secondary outcomes were functional ability, mood and quality-of-life. Health resource use was measured by self-report.
  
  
  RESULTS
  At 12 months, 15% more TBI-VR participants (27% more with moderate/severe TBI) were working than UC (27/36, 75% vs. 27/45, 60%). Mean TBI-VR health costs per person (consultant, GP, therapy, medication) were only £75 greater at 1 year. Secondary outcomes showed no significant baseline differences between groups.
  
  
  CONCLUSIONS
  More TBI-VR participants returned to work than UC. People with moderate/severe TBI benefitted most. This positive trend was achieved without greatly increased health costs, suggesting cost-effectiveness. This study justifies the need for and can inform a definitive Randomized Controlled Trial (RCT).
authors.affiliation: Rehabilitation Research, University of Nottingham, Nottingham, UK. kate.radford@nottingham.ac.uk
authors.forename: Kate
authors.initials: K
authors.lastname: Radford
authors.forename: Julie
authors.initials: J
authors.lastname: Phillips
authors.forename: Avril
authors.initials: A
authors.lastname: Drummond
authors.forename: Tracey
authors.initials: T
authors.lastname: Sach
authors.forename: Marion
authors.initials: M
authors.lastname: Walker
authors.forename: Andy
authors.initials: A
authors.lastname: Tyerman
authors.forename: Naseer
authors.initials: N
authors.lastname: Haboubi
authors.forename: Trevor
authors.initials: T
authors.lastname: Jones
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000534:rehabilitation; D001930:Brain Injuries / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000534:rehabilitation; D004644:Emotions; D004651:Employment; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012050:Rehabilitation, Vocational / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D062707:Return to Work / Q000191:economics; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology