title: Systematic review of return to work after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.
abstract: OBJECTIVE
  To synthesize the best available evidence on return to work (RTW) after mild traumatic brain injury (MTBI).
  
  
  METHODS
  MEDLINE and other databases were searched (2001-2012) with terms including "craniocerebral trauma" and "employment." Reference lists of eligible articles were also searched.
  
  
  METHODS
  Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess RTW or employment outcomes in at least 30 MTBI cases.
  
  
  METHODS
  Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables.
  
  
  RESULTS
  Evidence was synthesized qualitatively according to modified Scottish Intercollegiate Guidelines Network criteria and prioritized according to design as exploratory or confirmatory. After 77,914 records were screened, 299 articles were found eligible and reviewed; 101 (34%) of these with a low risk of bias were accepted as scientifically admissible, and 4 of these had RTW or employment outcomes. This evidence is preliminary and suggests that most workers RTW within 3 to 6 months after MTBI; MTBI is not a significant risk factor for long-term work disability; and predictors of delayed RTW include a lower level of education (<11y of formal education), nausea or vomiting on hospital admission, extracranial injuries, severe head/bodily pain early after injury, and limited job independence and decision-making latitude.
  
  
  CONCLUSIONS
  Our findings are based on preliminary evidence with varied patient characteristics and MTBI definitions, thus limiting firm conclusions. More well-designed studies are required to understand RTW and sustained employment after MTBI in the longer term (≥2y post-MTBI).
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: ccancell@uhnresearch.ca.
authors.forename: Carol
authors.initials: C
authors.lastname: Cancelliere
authors.affiliation: Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada; Institute for Work and Health, Toronto, Ontario, Canada; Division of Human Sciences, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Kristman
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Hincapié
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Boyle
authors.affiliation: School of Public Health and Alberta Centre for Injury Control and Research, University of Alberta, Alberta, Edmonton, Canada.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
authors.affiliation: Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå Sweden.
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Stålnacke
authors.affiliation: Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
authors.forename: Catharina
authors.initials: C
authors.lastname: Nygren-de Boussard
authors.affiliation: Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
authors.forename: Jörgen
authors.initials: J
authors.lastname: Borg
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis*; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004522:Educational Status; D006304:Health Status; D006801:Humans; D009790:Occupations; D011379:Prognosis; D062707:Return to Work / Q000706:statistics & numerical data*; D013997:Time Factors; D015599:Trauma Severity Indices
keywords: Craniocerebral trauma; Employment; Rehabilitation; Work