Introduction: Patients with mild traumatic brain injury (mTBI) frequently present to the emergency department (ED); however, wide variation in diagnosis and management has been demonstrated in this setting. Sub-optimal mTBI management can contribute to post-concussion syndrome (PCS), affecting vocational outcomes like return to work. This study documented the work-related events, ED management, discharge advice, and outcomes for employed patients presenting to the ED with mTBI. Methods: Adult (>17 years) patients presenting to one of three urban EDs in Edmonton, Alberta with Glasgow coma scale score ≥13 within 72 hours of a concussive event were recruited by on-site research assistants. Follow-up calls ascertained outcomes, including symptoms and their severity, advice received in the ED, and adherence to discharge instructions, at 30 and 90 days after ED discharge. Dichotomous variables were analyzed using chi-square testing; continuous variables were compared using t-tests or Mann-Whitney tests, as appropriate. Work-related injury and return to work outcomes were modelled using logistic or linear regression, as appropriate. Results: Overall, 250 patents were enrolled; 172 (69%) were employed at the time of their injury and completed at least one follow-up. The median age was 37 years (interquartile range [IQR]: 24, 49.5), both sexes were equally represented (48% male), and work-related concussions were uncommon (16%). Work-related concussion was related to manual labor jobs and self-reported history of attention deficit disorder. Patients often received advice to avoid sports (81%) and/or work (71%); however, the duration of recommended time off varied. Most employed patients (80%) missed at least one day of work (median=7 days; IQR: 3, 14); 91% of employees returned to work by 90 days, despite 41% reporting persistent symptoms. Increased days of missed work were linked to divorce, history of sleep disorder, and physician’s advice to avoid work. Conclusion: While work-related concussions are uncommon, most employees who sustain a mTBI at any time miss some work. Many patients experience mTBI symptoms past 90 days, which has serious implications for workers’ abilities to fulfill their work duties and risk of subsequent injury. Workers, employers, and the workers compensation system should take the necessary precautions to ensure that workers return to work safely and successfully following a concussion.

The purpose of this paper is to explore the context of injury and its consequences for the vocational rehabilitation of Australian workers. This report was derived from a secondary analysis of the seventh national survey of Work-Related Injuries by the Australian Bureau of Statistics. This is a stratified, random, multiple household survey of 42,100 private dwellings. Work-related injury affects 1 in every 25 of those who had worked at some time in the last 12 months. There were high probabilities of a workplace injury for those in labouring-type jobs and workers who exceeded 35–39 hours per week. Occupational injury is heterogeneous in nature and but there is clearly a restriction in the range of clientele encountered in rehabilitation. A second implication for professional rehabilitation arises from the type of injury. Work-related injuries in Australia are dominated overwhelmingly by musculoskeletal conditions. Work-related injury is a major cause of disability and there are consistently large numbers of people each year that will be requiring some vocational rehabilitation services.

The aim of the current study was to investigate the relationship between social support and durable return to work (RTW) post occupational injury. A total of 1,179 questionnaires were posted to clients previously receiving vocational rehabilitation services from the Return to Work Assist program in Queensland, Australia. Participants were asked to indicate their current RTW status, in addition to completing questionnaires measuring their relationship with their superior, relationships with colleagues, and social support external to the workplace. The statistical analysis included 110 participants. An ANOVA indicated that participants in the RTW group reported significantly better relationships with their superiors and colleagues than participants in the non-durable RTW group. No significant differences were observed between the RTW, non-durable RTW and no RTW groups on a measure of social support external to the workplace. Although the findings were limited by the low response rate, an evaluation of demographics indicated the respondents were representative of the original target sample. The findings suggested that providing support in the workplace is an important area for intervention and may be a means of increasing durable RTW outcomes.