Improving Outcomes for Work-Related Concussions

Abstract

Objective: This study assessed the efficacy of a neurocognitive screening evaluation and brief therapy model to improve RTW outcomes for workers who experienced mild head injuries. Methods: Patients referred were evaluated using a neurocognitive and psychological screening battery. Work-focused cognitive behavioral therapy was provided when appropriate, addressing the role of negative emotional adjustment and functional sleep disturbance in prolonging recovery. Results: Average time to RTW was 7 weeks post-evaluation, despite workers being off an average of 10 months between injury and referral dates. Overall, 99% were released to full-duty work without restrictions or accommodations. Conclusions: This study demonstrates the favorable outcomes achieved via a structured, clinically driven program for workers who experience head-involved injuries, validating previous research on the importance of recognizing the role of psychological factors in prolonging concussion recovery.

Treatment and Management of Work-Related Mild Traumatic Brain Injury in Physical Medicine and Rehabilitation

“…The number of work-related mTBI cases continues to increase, 16 imposing a large societal, economic, and healthcare burden due to high costs associated with treatment, rehabilitation, and lost productivity 32–34 . The effects of work-related mTBI are multifactorial, impacting a patients physical, emotional, and social well-being 22 …”

“…20,21 Several guidelines for the diagnosis and treatment of mTBI exist, but they are not routinely used and are often institution and provider dependent. 21,22 Providers frequently involved in the follow-up care of these patients include, but are not limited to, primary care, neurology, orthopedics, neurosurgery, otolaryngology, ophthalmology, psychiatry, neuropsychology, and PM&R. Additional services, such as physical therapy, occupational therapy, and speech therapy, are also typically part of a patient's treatment regimen. 23,24 According to Martini et al, 20 referrals after an mTBI are largely dependent on where the patient received their initial evaluation.…”

“…[32][33][34] The effects of work-related mTBI are multifactorial, impacting a patients physical, emotional, and social well-being. 22 While most mTBI patients make a complete recovery, it is estimated that 10%-25% 23,35 continue to experience persistent symptoms that preclude full or partial return to preinjury occupational duties often resulting in prolonged disability. 4,13,15 Symptoms are generally considered persistent when they are present for more than 3 mos.…”

“…After an initial evaluation where life-threatening intracranial complications have been ruled out with physical examination and in some cases neurological imaging, there is significant variability regarding the appropriate diagnosis, treatment, follow-up, and referrals for patients presenting with a work-related mTBI 20,21 . Several guidelines for the diagnosis and treatment of mTBI exist, but they are not routinely used and are often institution and provider dependent 21,22 …”

Neurocognitive and Symptom Validity Testing for Post–COVID-19 Condition in a Workers Compensation Context

“…The modal number of therapy sessions after administration of the NCSE in that study was one, and the duration of recovery for PCS claimants was reduced overall from a pre-NCSE duration of more than 10 months, to a post-NCSE duration of 7 weeks. 29 Employees who experience delays in recovery and RTW after COVID-19 report significant mental health concerns such as anxiety, depressed mood, general stress/burnout, and posttraumatic stress. [30][31][32][33][34] This has been an especially problematic issue for frontline workers who are exposed to a combination of risk factors such as work-related chronic and acute stress as well as potential re-exposure.…”