ABSTRACT

Individuals with mild traumatic brain injury (mTBI) may experience protracted symptoms affecting their ability to work. Several actors may facilitate or act as a barrier to a successful return to work (RTW). This qualitative study used semi-structured in-depth interviews with 22 adults with mTBI at 2–5 years post injury, targeting experiences of how different actors facilitated or acted as a barrier in the RTW process, and encompassed the mTBI trajectory from the acute phase to the post-acute phase. A thematic analysis with a hermeneutical phenomenological approach was used to analyse data. Three main themes emerged. (1) Worker–employer relationship: Workplace accommodations such as decreased working hours, modified working conditions, and support from co-workers were lacking. (2) The role of the general practitioner: The general practitioner was lacking treatment and referral opportunities and failed to provide the patient with relevant and individualized guidance. (3) Municipal case management: Participants perceived being met with distrust by social workers, follow-up assessments were too frequent, unnecessary, and did not target concussion, and rehabilitation was referred too late. Clinical practice guidelines to improve referral to relevant concussion rehabilitation in case of persistent symptoms are needed to inform clinicians, employers, and public institutions to facilitate a successful RTW.

摘要

轻度创伤性脑损伤 (mTBI) 的个体可能会出现影响其工作能力的长期症状。多个参与者可能会促进或阻碍成功重返工作岗位 (RTW)。这项定性研究在受伤后 2-5 年对 22 名患有 mTBI 的成年人进行了半结构化的深度访谈，针对不同参与者如何促进或充当 RTW 过程中的障碍的经验，并涵盖了急性期的 mTBI 轨迹进入急性期。使用解释学现象学方法进行主题分析来分析数据。出现了三个主要主题。(1) 工人-雇主关系：缺乏工作场所的便利，例如减少工作时间、改变工作条件和同事的支持。(2) 全科医生的作用：全科医生缺乏治疗和转诊机会，未能为患者提供相关和个性化的指导。(3) 市政个案管理：参与者认为被社工不信任，后续评估过于频繁，不必要，没有针对脑震荡，康复转介太晚。需要临床实践指南以在症状持续存在的情况下改进相关脑震荡康复的转诊，以告知临床医生、雇主和公共机构以促进成功的 RTW。没有必要，也没有针对脑震荡，康复治疗也为时已晚。需要临床实践指南以在症状持续存在的情况下改进相关脑震荡康复的转诊，以告知临床医生、雇主和公共机构以促进成功的 RTW。没有必要，也没有针对脑震荡，康复治疗也为时已晚。需要临床实践指南以在症状持续存在的情况下改进相关脑震荡康复的转诊，以告知临床医生、雇主和公共机构以促进成功的 RTW。