Intervention Studies Exploring Productivity Following ABI

Country/Study Design/N




Trexler et al. (2016)
Ninitial=44, Nfinal=42

Population: ABI. Treatment Group (TG, n=22): Mean Age=33.0yr; Mean Time Post Injury=63.2d. Control Group (CG, n=22): Mean Age=39.5yr; Mean Time Post Injury=64.4d.
Treatment: Participants were randomized to receive resource facilitation services (TG) or standard outpatient care (CG). Outcomes were assessed at baseline and after 15mo of treatment.
Outcome Measures: Return to Work (RTW), Vocational Independence Scale (VIS), Mayo-Portland Adaptability Inventory (MPAI).


  1. RTW was 69% in TG and 50% in CG.
  2. Both groups improved on VIS at follow-up, but TG showed significantly greater improvement than CG (p=0.027).
  3. Both groups returned to productive activity (VIS>2) at follow-up, but TG was significantly more likely than CG (p=0.027).
  4. There was no statistically significant effect of time (p=0.139) and group (p=0.813) on MPAI Participation Index, nor interaction between group and time (p=735).

Man et al. (2013)
Hong Kong

Population: TBI; Artificial Intelligence Group (n=20): Mean GCS=10.25. Psychoeducational Group (n=20): Mean GCS=10.05.
Intervention: Patients were randomly assigned to 12 sessions of Artificial Intelligence Virtual Reality training (treatment) or conventional psychoeducational programme (control). Outcomes were assessed at 1, 3 and 6mo.
Outcome Measure: Wisconsin Card Sorting Test–computer version 4 (WCST), Tower of London Test, Vocational Cognitive Rating Scale, Employment status.

  1. Participants in the treatment group performed better across all measures, but only WCST-errors (p=0.02) and WCST-conceptual level response (p<0.01) were significant.
  2. Both groups showed significant improvements in employment outcomes (p=0.04 and p=0.018, respectively), but there was no significant difference between groups.
  3. The treatment group showed significant improvement in self-efficacy (p=0.018) from pre- to post-test but control group did not. However, there was no significant difference between the two groups.
  4. There were no statistically significant differences in employment rates between groups.

Bonneterre et al. (2013)

Population: TBI; Gender: Male=80, Female=20.
Intervention: Patients attended a vocational rehabilitation program (SPASE).Two interviews were conducted; one over the phone and one with a vocational rehabilitation specialist from the SPASE workplace reintegration programme.
Outcome Measure: Return to work.

  1. Compared to pre injury, significantly more individuals were at work after treatment (p=0.001).
  2. Workplace support was a highly significant factor in returning to work in the short term (<3 years; p<0.001) and in the medium term (>3 years; p=0.01).
  3. Regularity of assistance (p=0.05) and physical disabilities (p=0.05) both affected workplace reintegration in the short term.

Radford et al. (2013)
United Kingdom
Ninitial=94, Nfinal=79

Population: TBI; Mean Age=34.3yr; Gender: Male=63, Female=16; Severity: Mild=40, Moderate=16, Severe=38.
Intervention: Patients were assigned to vocational rehabilitation (treatment, n=34) or usual care (control; n=45). Outcomes were assessed 3, 6, and 12mo.
Outcome Measure: Return to work.

  1. At each time point, a greater percentage of the treatment group returned to work or school compared to the controls.
  2. At 1yr, 75% of the treatment group returned to work compared to 60% of the controls.
  3. 13 of 14 patients with ‘minor’ TBI in the treatment group returned to work by 3mo compared to 14 of 25 in the control group (p=0.03).


Watanabe (2013)

Population: TBI; Mean Age=36.7yr; Gender: Male=247, Female=53; Severity: Moderate=48, Severe=247, Unavailable=5.
Intervention: Patients attended an inpatient rehabilitation program with supported employment.
Outcome Measure: Employment status, Activities of Daily Living (ADL), Barthel Index (BI).

  1. Group A (BI score <20) and Group B (20<BI score<80) displayed significant gains in ADL (p>0.05), but Group A was not fully independent in ADL.
  2. 35.7% of Group C (BI score of >80) and 10.7% of Group B, but none of Group A, returned to work or school.


Bergquist et al. (2012)

Population: TBI=96, Stroke=15, Other=43; Mean Age=35.5yr; Gender: Male=108, Female=46.
Intervention: Participants attended the Mayo Clinic Comprehensive Day Treatment Programme and identified goals at three levels: Personal, Short-term, and Graduation. Goal attainment was recorded and follow-up was completed at 1yr.
Outcome Measure: Goal Attainment Scale (GAS), Independent Living Scale (ILS), Vocational Independence Scale (VIS).

  1. Patients living independently (ILS) in the community were significantly more likely to meet their graduation goals (GAS, p<0.02).
  2. At 1yr, more of the ‘goals met’ group were living independently compared to the ‘goals unmet’ group (72% vs. 56%, p<0.05).
  3. At discharge, 62% of the ‘goals met’ group were in community-based employment (VIS) compared to 46% of the ‘goals unmet’ group (p<0.05); at 1yr follow-up the rates were 73% and 51%, respectively (p<0.01).


Kolakowsky-Hayner et al. (2012)
Ninitial=131, Nfinal=77

Population: TBI=80, Spinal Cord Injury=39, Other=12; Mean Age=20.3yr; Gender: Male=89, Female=42; Mean Time Post Injury=503d.
Intervention: Patients were matched with a trained mentor (>2yr post injury) and met with them 3x/mo for the Back on Track to Success Mentoring Program.
Primary Outcomes: Return to work/school, Disability Rating Scale (DRS), Participation Index of the Mayo-Portland Adaptability Inventory (M2PI), Supervision Rating Scale (SRS), Craig Handicap Assessment and Reporting Technique-Short Form (CHART).

  1. 71% the participants were considered a program success (i.e. returned to school/work).
  2. Of the 42 successes, 29 (69.0%) had returned to school and 13 (31.0%) returned to work.
  3. For participants who were successful in the program, CHART subscale increases were shown for cognitive independence (p=0.001) and mobility (p<0.001), as well as improvements on M2PI (p=0.0007), DRS (p<0.001) and SRS (p<0.001).


Trexler et al. (2010)
NInitial=22, NFinal=20

Population: TBI=7, ABI=7, Stroke=6, Other=2; Gender: Male=14, Female=8. 
Intervention: Patients were randomly assigned to a resource facilitation program (treatment, n=9) or standard care (control, n=11).The treatment group was assigned a resource facilitator with the goal to return to work
Outcome Measure: Return to work, Participation Index of the Mayo Portland Adaptability Inventory (M2PI), Patient Health Questionnaire (PHQ-9).

  1. Participation increased for both groups over the course of treatment (p<0.0001).
  2. The interaction between group and time indicated greater improvement in the treatment group (p=0.007), showing a strong impact on return to work and community participation.
  3. 64% of the treatment group were employed compared to 36% of controls.
  4. No significant differences between groups were found on the PHQ-9.



Geurtsen et al. (2008)


*Follow-up study by Geurtsen et al. (2012)

Population: TBI=18, Stroke=3, Other=3; Mean Age=28.5yr; Gender: Male=18, Female=6; Mean Time Post Injury=5.4yr; Mean GCS=5.9. 
Intervention: Patients attended the Brain Integration Program with 3 educational modules: independent living, work and social-emotional. Outcomes were assessed before and after treatment, with follow-up at 1yr and 3yr.
Outcome Measure: Community Integration Questionnaire (CIQ), Centre for Epidemiological Studies-Depression (CES-D), QoL, Employability Rating Scale (ERS), Employment status.

  1. There was an increase in community integration (p=0.001), a decrease in depression (p=0.004), and improvement in their quality of life (p=0.000).
  2. The increase in employability was only significant between discharge and 1yr (p=0.03).
  3. Post program, patients felt a greater sense of independence, with those living independently rising (41.6% to 71%).
  4. Patients working increased from 38% to 58%, with mean hours worked per week increasing from 8 to 15.5.
  5. There were no significant improvements from 1-3yr for community integration (CIQ), employability (ERS), work hours (ERS), emotional well-being (CES-D), and QoL.
  6. From 1-3yr, the number of patients working slightly increased (33 vs. 41) but the number of patients living independently decreased (42 vs. 37).

Vanderploeg et al. (2008)

Population: TBI; Mean Age=32.4yr; Gender: Male=335, Female=25.
Intervention: Patients were randomly assigned to specific cognitive-didactic therapy (n=180) or functional-experiential rehabilitation therapy (n=180) for 1.5-2.5hr over 20-60d.
Outcome Measure: Return to work/school.

  1. Return to work at 1yr for the cognitive group and functional group was 38.9% and 35.4%, respectively. The difference between groups was not significant (p=0.50).

MacLennan & MacLennan (2008)

Population: TBI; Gender: Male=3, Female=0; Mean Age=23.6yr.
Intervention: Individuals participated in a simulated college experience: 16 sessions (1hr), 12 lectures, and 4 exams testing their ability to learn. 
Outcome Measure: Return to work/school.

  1. Performance in the college simulation was helpful in predicting success and challenges in college performance.

Walker et al. (2006)

Population: TBI; Mean Age=35yr; Gender: Male=1033, Female=308; Mean GCS=8.
Intervention: Individualized comprehensive inpatient rehabilitation program.
Outcome Measure: Category of Productive Activity, Census Occupational Category, Occupation Group, Functional independence measure, Duration of Unconsciousness.

  1. 55% held skilled positions pre-injury.
  2. Overall 39% returned to competitive employment in any occupation 1yr post injury, 9% were students/retired/ or homemakers, and roughly half were unemployed.
  3. Participants in professional/managerial jobs pre-injury showed 56% return to work compared to those in skilled trades (40%) and manual labour (32%).

O’Neill et al. (2004)
Case Control

Population: TBI; Gender: Male=34, Female=8.
Intervention: Patients who attended the Program Without Walls (PWW; n=21) participants were compared to those receiving traditional vocational rehabilitation services (n=21).
Outcome Measure: Case status at closure, weekly earnings at closure, hours working at closure, cost of case services.

  1. More cases in the intervention group were successfully closed (57% vs. 24%; p=0.03), had higher mean earnings ($328.70 vs. $124.00; p=0.03), and worked more hours on average (32.08 vs. 17.8; p=0.04) compared to controls.
  2. The average cost of case services per PWW consumer was $3586.10 vs. $3326.00 for non-PWW consumers, although this difference was not statistically significant (p=0.43).

Gamble & Moore (2003)

Population: TBI; Mean Age=35.4yr; Gender: Male=800, Female=345.
Intervention: Patients from a public vocational rehabilitation service provider were compared: those with supported employment services (treatment) and those without (control). 
Outcome Measure: Vocational status.

  1. There was a significant difference between those provided with support and those who weren’t for being competitively employed at time of case closure (67.9% vs. 47%, respectively, p<0.003).
  2. Controls had significantly higher earnings per week (p<0.05), worked more hr/wk (p<0.001) and had fewer rehabilitation expenditures (p<0.001) than those who had employment services.

De Kort et al. (2002)
NInitial=25, NFinal=20


Population: ABI; Mean Age=29yr.
Intervention: Patients attended the Come Back Program (CBP) aimed at regaining maximal independence in work and leisure activities. Outcomes were assessed by a chart review and at a mean of 3yr after the program. 
Outcome Measure: Employment status, Living situation.

  1. After CBP, patients showed positive effects in employability and independence of living but not to pre-injury levels.
  2. 14 patients had a job pre injury, and 4 patients within 3mo before CBP.
  3. 10 of 14 with a pre-injury job were employed after CBP, but only 7 were paid and only 3 did the same work as pre-injury.
  4. 10 patients were in a relationship pre injury, 5 patients were in a relationship within 3mo before CBP and 10 after CBP. 


Malec and Degiorgio(2002)

Population: TBI=73, ABI=41; Mean Age=37.4yr; Gender: Male=70, Female=44; Mean Time Post Injury=65.5mo.
Intervention: Patients in 3 different rehabilitation pathways were compared at 1yr: (1) Specialized vocational services (SVS); (2) SVS and community reintegration (1hr/d, 3d/wk); and (3) SVS and comprehensive day treatment (6h/d, 5d/wk). 
Outcome Measure: Mayo-Portland Adaptability Inventory-4 (MPAI-4), Vocational-Independence Scale (VIS), Community-Based Employment (CBE).

  1. VIS outcomes differed significantly between groups at placement (p=0.01) but not at 1yr (p=0.06).
  2. CBE success rates for group 1, 2, and 3 were 77%, 85%, and 84%, respectively (p>0.10).
  3. The number of individuals returning to work for a pre-injury employer did not differ significantly between groups.
  4. In group 3, MPAI-4 scores did not significantly differ between those who were successful and those who were not. 

Klonoff et al. (2001)
Case Series

Population: TBI=113, Stroke=38, Other=13; Mean Age=33.6yr; Gender: Male=108, Female=56; Mean Time Post Injury=13.9mo.
Intervention: Follow up of participants in Work/School re-entry program at the Adult Day Hospital for Neurological Rehabilitation (ADHNR). 
Outcome Measure: Rates of productivity depending on return to work/school.

  1. 25.3% of participants who were productive pre-injury were engaged in the same line of work/school at the same capacity.
  2. 11% returned to the same job as pre-injury with modifications.
  3. 38.3% returned to a different job or school level (mostly lower) or in volunteer or homemaker positions.
  4. Those working/in school at follow-up were significantly younger than the non-productive group (p=0.009).

Salazar et al. (2000)

Population: Hospital Group: Mean Age=25yr; Gender: Male=62, Female=5; Mean Time Post Injury=38d; Mean GCS=9.4. Home Group: Mean Age=26yr; Gender: Male=51, Female=2; Mean Time Post Injury=39d; Mean GCS=9.5.
Intervention: Patients were randomly assigned to intensive Hospital Rehabilitation (8wk) or limited Home Rehabilitation.
Outcome Measure: Return to work and/or military duty.

  1. 90% of the hospital group and 94% of the home group had returned to work; there was no significant difference between groups (p=0.51).
  2. 73% of the hospital group and 66% of the home group were fit for active military duty; there was no significant difference between groups (p=0.43).

Malec & Moessner (2000)

Population: TBI=48, ABI=14; Mean Age=34.8yr; Gender: Male=48, Female=14; Severity: Mild=2, Moderate=1, Severe=37, Undetermined=22; Median Time Post Injury=679d.
Intervention: Patients completed a brain injury comprehensive day treatment program. Outcomes were evaluated at the end of the program and at 1yr follow-up.
Outcome Measure: Mayo-Portland Adaptability Inventory (MPAI), Vocational Independence Scale (VIS), Independent Living Scale (ILS), Goal Attainment Scaling (GAS).

  1. Those with mild impaired self-awareness (ISA) showed a decline in ISA on the MPAI from 37% to 29%, and those with moderate to severe ISA declined from 58% to 29%. Overall change after 1yr was found to be significant (p<0.001)
  2. ISA accounted for 23.7% of the variance in GAS scores (p<0.00).
  3. ISA contributed significantly to the prediction of ILS (p<0.01).
  4. There was no significant difference in VIS outcome at 1yr.


Klonoff et al. (1998)
Population: TBI=37, Stroke=19, Other=8; Mean Age=35yr; Gender: Male=44, Female=20.
Intervention: Patients attended a work/school re-entry program (6h/d, 5d/wk).
Outcome Measure: Adjusted outcome scores (productivity at discharge vs impairment at admission), Working alliance ratings, Work eagerness, Work readiness. 
  1. At discharge, 89.5% showed a fair or good adjusted outcome, 62% were gainfully employed or full-time students, with 15.6% returning to the same level of work or school as before the injury.
  2. Patient and family working alliance during treatment correlated with level of successful adjusted outcome (p<0.01).
  3. Work eagerness was found to be significantly related to productivity (p<0.001).
  4. Patients seeking compensation had lower work eagerness (p<0.01) but not lower work readiness.
  5. Those with more severe injuries had better adjusted outcomes than those with less severe injuries.
Wall et al. (1998)
Population: TBI=31, Stroke=3, Other=4; Mean Age=35.38yr; Gender: Male=28, Female=10; Mean Time Post Injury=8.91yr; Severity:  Severe=90%.
Intervention: Patients attended a 16wk Community Based Training Program (CBTP) that combined work adjustment and supported employment concepts. Outcomes were assessed after treatment and at follow-up.
Outcome Measure: Employment status, Modified Job Diagnostic Survey (mJDS).
  1. 58% completed the program. Those who completed the program had a longer length of disability and longer pre-injury work histories than those who did not complete it (p<0.05).
  2. Mean time from program completion to follow-up was 18.67mo, at which point 38% were employed.
  3. 14% of the sample required more than one placement to secure employment and 14% were still in the placement process.
  4. Of those who completed the program, 59% were competitively employed, 24% were unemployed, and 18% were still in the placement process.
  5. For those employed, the mean mJDS score was 25.18 (i.e. they were satisfied with their positions as persons without disabilities).
Buffington & Malec (1997)
Population: TBI=52, ABI=27; Median Age=37yr; Gender: Males=50, Females=30; Mean Time Post Injury=64mo; Severity: Mild=10, Moderate-Severe=35, Unknown=7.
Intervention: Patients received vocational assistance and rehabilitation with follow-up 90d after occupational placement.
Outcome Measure: Vocational Outcome Scale (VOS).
  1. At 3mo, almost 40% were placed, with the majority placed in independent competitive work (VOS level 5).
  2. At 1yr, about 70% of all participants were placed.
  3. Of those placed by 1yr, 74% were in community-based employment (VOS levels 3-5), of which 41% were placed into independent work (VOS level 5).
  4. Of all placements made, 37% were returning to work with the same employer as pre injury, but not necessarily the same job.
  5. Those entering the program at <12mo post injury had significantly faster (3.68 vs. 6.0mo) and better (VOS score of 4.48 vs. 3.74) job placements than those entering the program >12mo post injury (p<0.05).

PEDro=Physiotherapy Evidence Database rating scale score (Moseley et al. 2002).