Factors influencing retention of patients with traumatic brain injury in the South African National Defence Force

Abstract

Background: Service force members in the military are at an additional risk for traumatic brain injury (TBI) due the nature of their duties. Returning to active service after TBI is not an easy process and service force members with TBI struggle with meeting work demands because of residual functional limitations. Service force members require adequate rehabilitation and support in order to return to work (RTW) and to be retained in military service. Although evidence exists to informrehabilitation for RTW, little is known about the factors that influence retention in the workplace. This study thus sought to investigate factors influencing retention of service force members diagnosed with TBI in active service inthe SANDF after RTW on completion of the vocational rehabilitation programme in occupational therapy. Method: A quantitative descriptive methodology was employed. A questionnaire to determine factors related to retention in the military after return to work of service members with TBI was developed by the researcher based on a review of the literature. Factors covered in the questionnaire included demographics, work and military factors, cognitive factors and rehabilitation and occupational therapy factors. The participants were also evaluated using the Montreal Cognitive Assessment (MoCA) to screen their cognitive function. Results: A sample size of 86 service members was achieved. The results indicated that age is a significant demographic retention factor (p=0.001). Work and military factor findings, showed the following to influence retention: the time it takes a TBI patient to return to work after injury (p=0.005), success in the workplace (p=0.001), reasonable accommodations (p=0.002), communication with supervisor (p=0.045), taking prescribed medication while on duty(p=0.012) and ability to perform military duties (p=0.001). Cognitive factors that influenced retention were concentration (p=0.000), ability to make decisions (p=0.000), ability to problem solve (p=0.000) and memory (p=0.000). Service force members, both those retained and not retained in the SANDF after return to work, reported that they were not rehabilitated using tasks that related to their duties or alternative duties to which they returned and that occupational therapists providing vocational rehabilitation rarely did work site visits. Conclusion: Findings of this study offer evidence that occupational therapists providing vocational rehabilitation should consider the factors demonstrated in this study affecting retention in military service after TBI. Work simulations that are close to the service force members’ military duties are recommended. It is recommended that the transformation management policy looks into the ranking system in the SANDF when considering reasonable accommodations for injured/disabled service force members for appropriate redeploymentinto a rank position. For future research literature indicated that psychosocial trauma was reported to be negatively influencing recovery and exacerbating symptoms of TBI in the military rather than other resultant outcomes of the TBI Further research on the influence of PTSD and substance abuse on TBI patients is recommended. The research on the influence of chronic pain including headaches is recommended. Further research on factors influencing retention of TBI patients from the supervisor’s perspective is recommended.