Long-Term Return to Work After Mild and Moderate Traumatic Brain Injury: A Systematic Literature Review

Background: Traumatic brain injury (TBI) is referred to as a "silent epidemic" due to its limited awareness in the general public. Nevertheless, it can cause chronic, lifelong physical and cognitive impairments with severe impact on quality of life, resulting in high healthcare costs and loss of employment. To evaluate the outcome after mild and moderate TBI, "return to work (RTW)" is a relevant parameter, reflecting the socio-economic consequences of TBI. Our study aims to summarize RTW-rates to raise awareness on the impact of non-severe TBI. Methods: We performed a systematic literature review screening the databases Medline, Embase and Web of Science for studies reporting RTW in mild to moderate TBI. Studies that reported on RTW after mild or moderate TBI (defined by GCS > 9) in adults, with a minimum follow-up of six months were included. Risk of bias was assessed using the QUIPS tool. Results: We included 13 studies with a total 22,550 patients. The overall RTW rate after at least six months, varies between 37% and 98%. Full RTW is reported in six of the included 13 studies and varies between 12% and 67%. In six studies (46%) the RTW-rate by the end of follow-up was <= 60%, with four studies being from high-income countries. Conclusion: Mild and moderate TBI have a high impact on employment rates with diverging rates for RTW even between high-income countries. Increasing the societal awareness of this silent epidemic is of utmost importance and is one of the missions of the Swiss Brain Health Plan.