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Disabil Rehabil. 2012;34(3):179-88. doi: 10.3109/09638288.2011.591881.

Towards developing a guideline for vocational evaluation following traumatic brain injury: the qualitative synthesis of clients' perspectives.

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Graduate Department of Rehabilitation Science, University of Toronto, Ontario, Canada.



This paper is a qualitative synthesis of clients' perspectives of the elements significant to return to work following traumatic brain injury (TBI). This is part of a larger review, completed to provide the evidence base for a vocational evaluation guideline.


Processes outlined in the Cochrane Handbook of Systematic Review guided the full review including: developing review questions, search strategies and selection criteria; quality appraisal; data extraction, analysis and synthesis; drawing conclusions. Four data bases (i.e. Medline, Embase, PsychInfo, Cochrane) were searched for relevant qualitative studies. Evidence tables were used to extract data from studies and thematic analysis employed to analyze the qualitative data.


Analysis of clients' perspectives on return to work resulted in four key themes including the following: 1) meaning of work; 2) process of return to work and reconciling new identities; 3) opportunities to try versus risks of failure; 4) significance of supports. Themes are discussed in relation to vocational evaluation and findings from other syntheses.


Vocation evaluation should include the assessment of: the meaning clients ascribe to work following a TBI and their post-injury goals; clients' self-perceptions of work competency, work readiness and anticipated challenges with return to work; and the available supports.

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