Interventions Supporting Functional Recovery After Traumatic Brain Injury in Public Safety Personnel: A Systematic Review of Outcomes and Work Reintegration Considerations
In brief
Brain injury programs show modest cognitive gains, but work-return evidence stays weak
A review of 21 studies found modest, generally positive improvements in cognitive function after interventions for public safety personnel with traumatic brain injury. But evidence that these programs improve return to work was very uncertain, and only two studies involved civilian personnel such as firefighters or police, limiting how broadly the findings apply.
- Journal
- The Journal of head trauma rehabilitation (Q1)
- Published
- 20 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Maryam Shahzad, Sana Siddiqui, Raihana Premji, Jonathan Jiesheng Liu, Yiting He, Javier Mencia Ledo, et al.
- PMID
- 42897721
- DOI
- 10.1097/HTR.0000000000001219
Why clinicians should know about it
- Picked for Rehabilitation (paper of the day, 23 October 2026): Reviews TBI functional recovery and return-to-work interventions
Abstract
BACKGROUND: Public safety personnel (PSP) face a heightened risk of traumatic brain injury (TBI) and barriers in resuming daily activities and returning to work (RTW). Despite these risks, evidence on interventions targeting functional recovery and participation in this population is scarce. OBJECTIVE: To synthesize evidence on interventions targeting functional recovery and RTW in PSP with TBI. DESIGN: MEDLINE, CINAHL, EMBASE, PsycINFO, and Scopus on January 23, 2026. Eligible studies included PSP with TBI such as armed forces and/or military personnel and law enforcement personnel. Randomized controlled trials, quasi-experimental studies, observational studies, case studies, and mixed methods designs were included. Outcomes were classified using the International Classification of Functioning, Disability, and Health framework and synthesized narratively. Risk of bias was assessed using Joanna Briggs Institute tools, and certainty of evidence was evaluated using GRADE. RESULTS: Twenty-one studies were included (9 randomized controlled trial, 5 cohort, 4 quasi-experimental, 3 case studies). Most studies focused on military populations, with only 2 civilian PSP studies (firefighters and police). Interventions included cognitive rehabilitation, psychological/mental health, interdisciplinary programs, simulation-based training, and physical rehabilitation. Narrative synthesis showed mixed but generally positive, improvements in body function outcomes, and cognitive function within the activity domain. Participation-level outcomes such as RTW were inconsistently defined and underreported. Certainty of evidence ranged from very low for participation outcomes to moderate for functional cognition. CONCLUSION: Interventions for PSP with TBI may support modest, but consistent, improvements in cognitive function; however, there remains low certainty of evidence for meaningful improvements in the participation domains (eg, RTW). The evidence is highly heterogeneous in outcomes and focused on military populations, limiting generalizability across PSP roles.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.