Absence of conflict of interest.
Citation
Highlights
- The study's objective was to examine the impact of the Rehabilitation Hospital of Indiana Resource Facilitation (RHI RF) program on employment outcomes.
- The authors used a nonexperimental design to compare return-to-work outcomes between RHI RF patients and patients that did not receive the RHI RF intervention. The primary data sources included data from previous study cohorts and group data on the current cohort of clinical patients discharged from the RHI RF program.
- The study found a significant relationship between the RHI RF program and an increased likelihood of returning to work as well as higher return-to-work success rates.
- This study receives a low evidence rating. This means we are not confident that the estimated effects are attributable to RHI RF program; other factors are likely to have contributed.
Intervention Examined
Rehabilitation Hospital of Indiana Resource Facilitation (RHI RF)
Features of the Intervention
Resource Facilitation (RF) is an individualized treatment that connects patients with acquired brain injury and their caregivers to community-based resources and services to help them overcome the barriers to returning to work. At the Rehabilitation Hospital of Indiana (RHI), the RF program was funded by the Health Resources and Services Administration (HRSA) in 2009 and involved collaboration between patients, their support systems, and facilitators. The facilitators are individuals within the RHI RF program who provide assistance and supports to patients for navigating systems and making informed decisions to achieve their employment goals. The RHI RF model draws on findings from a best practice guide from 16 RF programs in the U.S. that was completed by the Brain Injury Association in 2001. The program served individuals who experienced a brain injury and sought to return to work post-injury.
Features of the Study
The authors used a nonexperimental design to examine the impact of the RHI RF program on return-to-work. Data for the intervention group was drawn from the current cohort of clinical patients who were discharged from the RHI RF program. Data for the comparison group was drawn from two previous RCT cohorts of clinical patients who did not receive RF services. Since the two groups were selected from two different data sources, the eligibility requirements differed for each. Eligibility requirements for the intervention group included: 1) a diagnosis of an acquired brain injury; 2) a return-to-work or post-secondary school goal; 3) no active psychosis; 4) no alcohol or drug abuse that would interfere with goal attainment; and 5) no severe physical, cognitive, or neurobehavioral impairment that would likely inhibit them from becoming competitively and independently employed. Eligibility requirements for the comparison group included: 1) a traumatic brain injury (TBI) or diffuse encephalopathy or intracranial hemorrhage; 2) 18 to 60 years old; 3) a native English speaker or a non-native speaker with translation assistance from a relative or translator; 4) had been employed at the time of brain injury; 5) have a return-to-work goal after injury; 6) no acute psychosis or the emergence of psychosis during the study; and 7) no history of treatment for substance abuse during the preceding two years.
The study sample included 243 patients, with 210 in the intervention group and 33 the comparison group. The sample was predominantly male (67%), White (92%), with an average age of 39 years. The intervention group included a higher proportion of patients with moderate to severe TBI (72%) relative to the comparison group (52%). Also, the average age of intervention members at time of injury was younger (29.6 years) than the comparison group members (40.3 years). Comparison group data were collected from 2008 to 2013 while data for the intervention group were collected from 2009 to 2012. The authors used statistical tests to compare the return-to-work success rates and predict employment status between intervention and comparison group members. A successful return-to-work outcome was defined as sustaining employment for 90 days following attainment of employment.
Findings
Employment
- The study found a significant relationship between the RF program and higher return-to-work success rates. The study also found a significant relationship between the RF program and higher likelihood of returning to work.
Considerations for Interpreting the Findings
While the authors did account for similarity in baseline age, gender, and race/ethnicity between the groups (as required by the protocol), they did not include sufficient controls for the significant, preexisting differences in brain injury diagnosis type, age at injury, and years post injury between the groups before program participation. These preexisting differences between the groups—and not the RHI RF intervention—could explain the observed differences in outcomes. Therefore, the study is not eligible for a moderate causal evidence rating, the highest rating available for nonexperimental designs.
Causal Evidence Rating
The quality of causal evidence presented in this report is low because the authors did not ensure that the groups being compared were similar before the intervention. This means we are not confident that the estimated effects are attributable to the RHI RF program; other factors are likely to have contributed.