Replication of a Prospective Randomized Controlled Trial of Resource Facilitation to Improve Return to Work and School After Brain Injury

Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT

“…High attrition rates in studies of TBI populations is a well documented problem. 35,56,[143][144][145] Incentivisation might be key; a recent trial 73 (n = 44) of RF, a vocational intervention in the USA, followed and retained 100% of participants (23 with TBI) to 15 months by incentivising them with a US$100 fee on completion.…”

“…The authors hypothesised that augmenting work rehabilitation with compensatory cognitive training may improve functional outcomes because compensatory interventions can be individually tailored to each person's job search process and job duties. CogSMART sessions were delivered by an employment specialist and included strategies to improve sleep, fatigue, headaches and tension, and compensatory Trexler et al 73 examined the effectiveness of resource facilitation (RF) (i.e. a partnership that supports people to make informed choices and achieve rehabilitation goals, involving active engagement with a previous employer) in 44 people with mild to moderate acquired brain injury (ABI) who were working pre injury (n = 22, 13 with TBI) and a UC control group (n = 22, 10 with TBI).…”

“…However, although this case-co-ordinated approach in ABI seems positive, the trial 73 took place in a single centre, numbers were small and there were only 23 participants with TBI (mostly mild). The intervention was staff resource intensive, requiring three more staff than UC, and lasting for 15 months.…”

“…This suggestion is supported by other TBI rehabilitation studies indicating positive effects of TBI rehabilitation on participation outcomes. 36,73,74 However, future studies would need to be designed to isolate the effects of the VR over and above a comparator. 69,142 On this basis, if the CIQ was the primary outcome for a definitive trial then, based on a linear model (adjusted for baseline CIQ), to achieve 90% power with 5% significance to achieve a minimal important difference of 1.5 points (i.e.…”

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk Overall, current evidence for effectiveness of VR in TBI is limited and inconclusive. Of the five VR trials 37,[70][71][72][73] published to date, three 37,70,72 have been with US military personnel or veterans. Military studies differ from those in civilian populations as participants present with different challenges (e.g.…”