Mild traumatic brain injury (mTBI) commonly affects adults of working age and a key goal for their recovery is returning to work. However, successful return to work after mTBI is challenging, and many individuals experience difficulties with employment even months after their injury. One of the key factors affecting return to work outcomes is fear avoidance, which is the avoidance of activities that might trigger mTBI symptoms, such as headaches or anxiety. However, encouraging people with mTBI to pace their return to work in order to avoid these triggers can unintentionally reinforce fear avoidance. Further investigation into the association between fear avoidance and return to work after mTBI was therefore needed to identify when triggers occur during recovery in order to better target interventions.
This study aimed to investigate the relationship between fear avoidance and return to usual work-related activity after mTBI. The researchers analyzed data collected from 175 adults attending outpatient concussion services who were less than 3 months post-injury at enrollment. The researchers collected clinical and self-report measures and assessed return to work outcomes at 3 months after injury (time 1) and 6-9 months later (time 2). They found that:
- Participants with persistently high levels of fear avoidance at time 1 were less likely to be at their usual back to work levels at time 2.
- Participants with low fear avoidance at time 1 or who were able to transition from high to low avoidance between times 1 and 2, were more likely to have returned to usual levels of work by 6–9 months.
- Older age was associated with fear avoidance and lower odds of returning to their usual levels of work.
- Workplace accommodations and pacing interventions can be useful early after mTBI for some, but potentially unhelpful for those who are highly fear avoidant.
These findings suggests that fear avoidance can change over time, and that interventions that target fear avoidance may be helpful in improving return to work outcomes after mTBI. Clinicians could consider treatment approaches that specifically target psychological processes that might mediate relationships between fear avoidance and return to activity after mTBI.
Snell DL, Faulkner JW, Williman JA, Silverberg ND, Theadom A, Surgenor LJ, Hackney J, Siegert RJ. Fear avoidance and return to work after mild traumatic brain injury. Brain Injury. (April 2023).