Short-Term and Long-Term Outcomes of a Vocational Rehabilitation Program for Patients with Acquired Brain Injury in The Netherlands.

There was no comparison group, so the high return-to-work rates cannot be attributed to the vocational rehabilitation program alone. The program included many components and stakeholders, including the patient, employer, co-worker, occupational physician, rehabilitation team, partner, weekly occupational therapist support, on-the-job training, and round table meetings; the contribution of any single component cannot be separated. Only patients employed before injury, motivated to return, with an employer willing to participate, and not dependent in activities of daily living were included, so the results do not apply to all people with acquired brain injury. Short-term return to work meant performing useful tasks for the employer, not paid work, while long-term follow-up used paid work, making the two time points not directly comparable. Long-term follow-up varied from 3 to 6 years and relied on a self-designed questionnaire, with 2 patients dead, 6 lost to follow-up, and long-term task adjustment data too inconsistent to report. The study was done in one Dutch centre, and Dutch law requiring employer and employee effort during the first two years of sick leave may have influenced the short-term results.

Do not read the 86% short-term return to work as proof that this vocational rehabilitation program caused employment. The study had no comparison group, included selected patients who were employed before injury and had employer support, and 26% had already started working before the program.