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Disability and Rehabilitation Sep 2021Individuals with traumatic brain injury (TBI) often present injury-related cognitive and behavioural sequelae hindering a successful professional outcome, even many...
PURPOSE
Individuals with traumatic brain injury (TBI) often present injury-related cognitive and behavioural sequelae hindering a successful professional outcome, even many years after injury. The aim of this study was to investigate cognitive and behavioural factors predicting vocational outcome in the post-acute stages (≥one year) of TBI.
METHODS
A systematic review of empirical research about vocational outcome of individuals with TBI was conducted. Studies published in PubMed and PsycINFO from 1 January 1998 to 31 May 2019 were screened. Only studies using the same injury severity criteria (the Glasgow Coma Scale score and/or the duration of post-traumatic amnesia) were selected.
RESULTS
We found that (1) self-reported symptoms, (2) Functional Independence Measure and Mayo-Portland Adaptability Inventory Scores, (3) alcohol abuse and mood disorders, and (4) Differentiated Outcome Scale Cognitive Scores in individuals with TBI were highly predictive of the vocational outcome.
CONCLUSION
This systematic review emphasized the link between cognitive and behavioural functioning and vocational rehabilitation in individuals with TBI. However, scientific literature lacks cognitive and behavioural models predicting vocational outcome of these individuals, including academic or vocational training. Such models would allow clinicians to improve vocational guidance of these individuals.Implications for rehabilitationCognitive and behavioural assessment is highly important even many years after traumatic brain injury, especially in a social and professional rehabilitation context.Clinicians should integrate objective measures of cognition and behaviour in post-acute phases of traumatic brain injury.Identifying vocational outcome related cognitive and behavioural patterns of functioning would allow clinicians to improve vocational guidance of adults with traumatic brain injury.
Topics: Brain Injuries, Traumatic; Cognition; Glasgow Coma Scale; Humans; Rehabilitation, Vocational; Vocational Education
PubMed: 31865773
DOI: 10.1080/09638288.2019.1706105 -
Frontiers in Psychology 2020Technology is changing the way organizations and their employees need to accomplish their work. Empirical evidence on this topic is scarce. The aim of this study is to...
Technology is changing the way organizations and their employees need to accomplish their work. Empirical evidence on this topic is scarce. The aim of this study is to provide an overview of the effects of technological developments on work characteristics and to derive the implications for work demands and continuous vocational education and training (CVET). The following research questions are answered: What are the effects of new technologies on work characteristics? What are the implications thereof for continuous vocational education and training? Technologies, defined as digital, electrical or mechanical tools that affect the accomplishment of work tasks, are considered in various disciplines, such as sociology or psychology. A theoretical framework based on theories from these disciplines (e.g., upskilling, task-based approach) was developed and statements on the relationships between technology and work characteristics, such as complexity, autonomy, or meaningfulness, were derived. A systematic literature review was conducted by searching databases from the fields of psychology, sociology, economics and educational science. Twenty-one studies met the inclusion criteria. Empirical evidence was extracted and its implications for work demands and CVET were derived by using a model that illustrates the components of learning environments. Evidence indicates an increase in complexity and mental work, especially while working with automated systems and robots. Manual work is reported to decrease on many occasions. Workload and workflow interruptions increase simultaneously with autonomy, especially with regard to digital communication devices. Role expectations and opportunities for development depend on how the profession and the technology relate to each other, especially when working with automated systems. The implications for the work demands necessary to deal with changes in work characteristics include knowledge about technology, openness toward change and technology, skills for self- and time management and for further professional and career development. Implications for the design of formal learning environments (i.e., the content, method, assessment, and guidance) include that the work demands mentioned must be part of the content of the trainings, the teachers/trainers must be equipped to promote those work demands, and that instruction models used for the learning environments must be flexible in their application.
PubMed: 32457688
DOI: 10.3389/fpsyg.2020.00918 -
Frontiers in Neurology 2023Return-to-work is a key rehabilitation goal for many working aged stroke survivors, promoting an overall improvement of quality of life, social integration, and... (Review)
Review
INTRODUCTION
Return-to-work is a key rehabilitation goal for many working aged stroke survivors, promoting an overall improvement of quality of life, social integration, and emotional wellbeing. Conversely, the failure to return-to-work contributes to a loss of identity, lowered self-esteem, social isolation, poorer quality of life and health outcomes. Return-to-work programmes have largely focused on physical and vocational rehabilitation, while neglecting to include mood and fatigue management. This is despite the knowledge that stroke results in changes in physical, cognitive, and emotional functioning, which all impact one's ability to return to work. The purpose of this systematic review is to conduct a comprehensive and up-to-date search of randomised controlled trials (RCTs) of return-to-work programmes after stroke. The focus is especially on examining components of mood and fatigue if they were included, and to also report on the screening tools used to measure mood and fatigue.
METHOD
Searches were performed using 7 electronic databases for RCTs published in English from inception to 4 January 2023. A narrative synthesis of intervention design and outcomes was provided.
RESULTS
The search yielded 5 RCTs that satisfied the selection criteria ( = 626). Three studies included components of mood and fatigue management in the intervention, of which 2 studies found a higher percentage of subjects in the intervention group returning to work compared to those in the control group. The remaining 2 studies which did not include components of mood and fatigue management did not find any significant differences in return-to-work rates between the intervention and control groups. Screening tools to assess mood or fatigue were included in 3 studies.
CONCLUSION
Overall, the findings demonstrated that mood and fatigue are poorly addressed in rehabilitation programmes aimed at improving return-to-work after stroke, despite being a significant predictor of return-to-work. There is limited and inconsistent use of mood and fatigue screening tools. The findings were generally able to provide guidance and recommendations in the development of a stroke rehabilitation programme for return-to-work, highlighting the need to include components addressing and measuring psychological support and fatigue management.
PubMed: 37674875
DOI: 10.3389/fneur.2023.1145705 -
Journal of Occupational Rehabilitation Mar 2020Purpose Despite the desire and ability to work, individuals with childhood onset disabilities are under-represented in employment. Vocational interventions alleviate...
The Impact of Vocational Interventions on Vocational Outcomes, Quality of Life, and Community Integration in Adults with Childhood Onset Disabilities: A Systematic Review.
Purpose Despite the desire and ability to work, individuals with childhood onset disabilities are under-represented in employment. Vocational interventions alleviate some barriers to obtaining and maintaining employment for this population. The research question addressed is: What is the impact of vocational interventions on vocational outcomes, quality of life (QoL), and community integration (CI) in adults with childhood onset neurological disabilities including cerebral palsy (CP), spina bifida, and acquired brain injury (ABI)? Methods A literature search was conducted in multiple electronic databases. All experimental and observational studies with comparator group(s) were included. Two reviewers independently completed titles and abstracts screening, full text screening, data abstraction, and risk of bias assessment. Results Seventeen studies were eligible for final inclusion including three randomized-controlled trials, four non-randomized studies, and ten observational studies. Sixteen of seventeen studies included only individuals with ABI, while one study included individuals with CP. Vocational interventions from experimental studies were mainly components of multi-faceted interventions. Most observational studies were from the United States Vocational Rehabilitation Service. Conclusions Vocational interventions may be effective in improving vocational outcomes, QoL, and CI for individuals with ABI. There is limited experimental evidence on interventions that specifically target employment. Observational data suggest that receiving job placement assistance, on-the-job training and supports, counselling/guidance, maintenance, and supported employment successfully predicted employment outcomes.
Topics: Adult; Brain Injuries; Cerebral Palsy; Child; Community Integration; Disabled Persons; Humans; Quality of Life; Rehabilitation, Vocational; Spinal Dysraphism; Young Adult
PubMed: 31535267
DOI: 10.1007/s10926-019-09854-1 -
The Journal of Head Trauma... 2009Return to work after traumatic brain injury (TBI) is an important outcome but frequently problematic to achieve. Vocational rehabilitation is commonly recommended as a... (Review)
Review
BACKGROUND
Return to work after traumatic brain injury (TBI) is an important outcome but frequently problematic to achieve. Vocational rehabilitation is commonly recommended as a means of facilitating return to work after TBI. However, there are several different approaches to vocational rehabilitation after TBI and little guidance regarding how to identify the best option for a particular context.
OBJECTIVES
To (1) identify approaches most commonly underpinning vocational interventions in TBI and (2) evaluate the evidence for effectiveness, strengths and weaknesses, and application of each approach for the TBI population.
METHODS
Principles of systematic review were used for searching and critiquing articles. Findings are expressed as descriptive synthesis owing to heterogeneity of designs and outcome measures.
RESULTS
Three broad categories of vocational rehabilitation for people with TBI were identified on the basis of models that underpin them-program-based vocational rehabilitation, supported employment, and case coordinated. The characteristics, similarities, differences, and applications of each approach are described, as are their strengths and limitations.
CONCLUSIONS
There is little clear evidence to suggest what should be considered the "best practice" approach to vocational rehabilitation.
Topics: Brain Injuries; Evidence-Based Medicine; Humans; Practice Guidelines as Topic; Rehabilitation, Vocational
PubMed: 19461367
DOI: 10.1097/HTR.0b013e3181a0d458 -
BMJ Open May 2022To synthesise research published on vocational rehabilitation (VR) interventions offered in institutions, by occupational therapists, to mental health service users... (Review)
Review
Scoping review exploring vocational rehabilitation interventions for mental health service users with chronic mental illness in low-income to upper-middle-income countries.
OBJECTIVE
To synthesise research published on vocational rehabilitation (VR) interventions offered in institutions, by occupational therapists, to mental health service users (MHSUs) with chronic mental illness, in low-income to upper-middle-income countries (L-UMIC).
DESIGN
This scoping review used Arksey and O'Malley's methodological framework, the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews and Joanna Briggs scoping review guidelines.
DATA SOURCES
We searched PsycInfo, EBSCOhost, HINARI, Google Scholar, Medline, CINAHL, PubMed, Cochrane Library, Scopus, Science Direct and Wiley online library between 15 July and 31 August 2021.
ELIGIBILITY CRITERIA
Sources, published in English between 2011 and 2021, on institution-based VR in occupational therapy for MHSUs who had chronic mental illness in L-UMIC were included. We included primary studies of any design.
DATA EXTRACTION AND SYNTHESIS
Three reviewers used Mendeley to manage identified references, Rayyan for abstract and full-text screening and Microsoft Excel for data extraction. Data were sifted and sorted by key categories and themes.
RESULTS
895 sources were identified, and their title and abstracts reviewed. 207 sources were included for full-text screening. 12 articles from 4 countries (South Africa, India, Brazil and Kenya) were finally included. Types of VR intervention included supported employment, case management and prevocational skills training. Client centeredness, support and empowerment were the key VR principles identified. Teaching of illness self-management, job analysis and matching, job coaching, trial placement, and vocational guidance and counselling were the main intervention strategies reported.
CONCLUSIONS
VR intervention in institutions for MHSUs in L-UMIC revealed the multidimensional uniqueness of individual MHSU's vocational ability, needs and contexts. The interventions allowed client-centred approaches that offer support and empowerment beyond the boundaries of the institutions. Occupational therapists offering VR need to expand their interventions beyond their institutions to contexts where MHSUs are working or intending to work.
Topics: Developing Countries; Employment, Supported; Humans; Mental Disorders; Mental Health Services; Rehabilitation, Vocational
PubMed: 35534058
DOI: 10.1136/bmjopen-2021-059211 -
Patient Education and Counseling Jul 2023To identify and synthesise the experiences and benefits of addressing vocational issues in the provision of healthcare for young people (YP) with long-term conditions... (Review)
Review
Addressing education and employment outcomes in the provision of healthcare for young people with physical long-term conditions: A systematic review and mixed methods synthesis.
OBJECTIVE
To identify and synthesise the experiences and benefits of addressing vocational issues in the provision of healthcare for young people (YP) with long-term conditions (LTCs).
METHODS
We searched 10 bibliographic databases. Restrictions were applied on publication date (1996-2020) and language (English). Two reviewers independently screened records against eligibility criteria. Articles reporting relevant qualitative and/or quantitative research were included. Quality appraisal was undertaken following study selection. Qualitative data were synthesised thematically, and quantitative data narratively. A cross-study synthesis integrated qualitative and quantitative findings.
RESULTS
43 articles were included. Thematic synthesis of qualitative studies (n = 23) resulted in seven recommendations for intervention (psychological support; information/signposting; skills training; career advice; healthcare-school/workplace collaboration; social support; flexible/responsive care). The narrative synthesis summarised results of 17 interventions (n = 20 quantitative studies). The cross-study synthesis mapped interventions against recommendations. Transitional care was the intervention type that most comprehensively met our proposed recommendations.
CONCLUSIONS
Evidence from YP perspectives highlights that vocational development is an important area to address in healthcare provision. Robust intervention studies in this area are lacking.
PRACTICE IMPLICATIONS
Our evidence-based recommendations for intervention can support health professionals to better address vocational issues/outcomes. With minimal adaptations, transitional care interventions would be particularly well suited to deliver this.
Topics: Humans; Adolescent; Health Personnel; Educational Status; Social Support; Workplace; Delivery of Health Care
PubMed: 37086594
DOI: 10.1016/j.pec.2023.107765 -
Brain Injury Feb 2007The purpose of this review was to investigate the efficacy of rehabilitation interventions in acquired brain injury (ABI) rehabilitation to provide guidance for clinical... (Review)
Review
OBJECTIVE
The purpose of this review was to investigate the efficacy of rehabilitation interventions in acquired brain injury (ABI) rehabilitation to provide guidance for clinical practice based on the best available evidence.
METHODS AND MAIN OUTCOMES
A systematic review of the literature from 1980-2005 was conducted focusing on rehabilitation interventions for ABI. The efficacy of a given intervention was classified as strong (supported by at least two randomized controlled trials (RCTs)), moderate (supported by a single RCT), or limited (supported by other types of studies in the absence of RCTs).
RESULTS
The majority of interventions were only supported by limited evidence. However, there is moderate evidence that inpatient rehabilitation results in successful return to work and return to duty for the majority of military service members, increasing the intensity of rehabilitation reduces length of stay and improves short-term functional outcomes, and that direct patient involvement in neurorehabilitation goal setting results in significant improvements in reaching and maintaining those goals.
CONCLUSIONS
There is a need for studies of improved methodological quality into ABI rehabilitation.
Topics: Brain Injuries; Disability Evaluation; Evidence-Based Medicine; Humans; Military Personnel; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic; Rehabilitation Nursing; Rehabilitation, Vocational; Self-Help Groups; Social Support; Treatment Outcome
PubMed: 17364528
DOI: 10.1080/02699050701201540 -
Brain Injury Feb 2007We sought to investigate the efficacy of treatment strategies used to manage motor impairments following acquired brain injury (ABI) in order to provide guidance for... (Review)
Review
OBJECTIVE
We sought to investigate the efficacy of treatment strategies used to manage motor impairments following acquired brain injury (ABI) in order to provide guidance for clinical practice based on the best available evidence.
METHODS AND MAIN OUTCOMES
A systematic review of the literature from 1980-2005 was conducted focusing on pharmacological, non-pharmacological, and exercise interventions available for motor impairments post ABI. The efficacy of a given intervention was classified as strong (supported by two or more randomized controlled trials (RCTs)), moderate (supported by a single RCT), or limited (supported by other types of studies in the absence of RCTs).
RESULTS
Thirty-six studies examining a variety of treatment approaches for motor impairments and activity limitations following ABI were evaluated. The majority of interventions are only supported by limited evidence. However, there is strong evidence that serial casting does reduce ankle plantar contractures due to spasticity of cerebral origin, and strong evidence also suggests that partial body weight supported gait training does not provide any added benefit over conventional gait training. There is also moderate evidence to support the use of functional fine motor control retraining to improve motor coordination, tizanidine for upper and lower extremity spasticity, and specific sit-to-stand training to improve functional ability. There is also moderate evidence that casting alone is as effective as casting and Botulinum toxin injections for plantar contractures.
CONCLUSIONS
Although there are a variety of treatment strategies to manage motor impairments and activity limitations following ABI, most are only supported by limited evidence pointing to the need for studies of improved methodological quality in this area.
Topics: Brain Injuries; Cognitive Behavioral Therapy; Humans; Muscle Spasticity; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Recovery of Function; Rehabilitation, Vocational; Treatment Outcome
PubMed: 17364529
DOI: 10.1080/02699050701201383 -
Canadian Journal of Psychiatry. Revue... Jun 2024Co-occurring mental health and substance use disorders (concurrent disorders) lead to significant morbidity in children and youth. Programs for integrated treatment of... (Review)
Review
Components of Outpatient Child and Youth Concurrent Disorders Programs: A Critical Interpretive Synthesis: Composantes des programmes de troubles concomitants des enfants et des jeunes ambulatoires : une synthèse interprétative critique.
OBJECTIVE
Co-occurring mental health and substance use disorders (concurrent disorders) lead to significant morbidity in children and youth. Programs for integrated treatment of concurrent disorders have been developed; however, there exists little guidance outlining their structure and activities. Our objective was to synthesize available information on outpatient child and youth concurrent disorders programs and produce a comprehensive framework detailing the components of such programs.
METHODS
We used a four-stage critical interpretive synthesis design: (1) systematic review of published and grey literature, (2) data abstraction to identify program components and purposive sampling to fill identified gaps, (3) organization of components into a structured framework, (4) feedback from programs. We employed an iterative process by which programs reviewed data abstraction and framework development and provided feedback.
RESULTS
Through systematic review (yielding 1,408 records total and 7 records eligible for inclusion) and outreach strategies (yielding an additional 7 eligible records), we identified 11 programs (4 American, 7 Canadian) and 2 theoretical models from which data could be abstracted. Program activities were categorized into 12 overarching constructs that make up the components of the framework: accessibility, engagement, family involvement, integrated assessment, psychotherapy for patients, psychotherapy for families, medication management, health promotion, case management, vocational support, recreation and social support, and transition services. Program components are informed by the philosophical orientation of the program and models of care. This framework considers health system factors, clinical service factors, program development, and community partnership that impact program structure and activities. Multidisciplinary teams provide care and include addiction medicine, psychiatry, psychology, nursing, social work, occupational therapy, recreation therapy, peer support, and program evaluation.
CONCLUSION
We developed a comprehensive framework describing components of child and youth outpatient concurrent disorders programs. This framework may assist programs currently operating, and those in development, to reflect on their structure and activities.
Topics: Humans; Child; Adolescent; Mental Disorders; Substance-Related Disorders; Ambulatory Care; Mental Health Services; Comorbidity; Canada
PubMed: 37941334
DOI: 10.1177/07067437231212037