The effectiveness of multi-dimensional resilience rehabilitation programs after traumatic physical injuries: A systematic review and meta-analysis

Objective: To synthesize evidence of the effectiveness of socio-ecological resilience rehabilitation programs on returning to work (RTW), self-efficacy, and stress mitigation following traumatic physical injuries. Methods: PubMed, Scopus, Proquest, Cinahl, Web of Science, Clinical Trials Database, and the Cochrane Central Register of Controlled Trials databases were searched. Methodological quality was assessed using the PEDro tool. Study selection: Randomized interventions aimed at promoting resilience. Data extraction: Twenty one studies were reviewed (11,904 participants). Data from 19 studies of high methodological quality were pooled using a random-effects meta-analysis. Mean differences for continuous outcomes and risk ratios for binary outcomes were calculated. Data synthesis: Resilience rehabilitation programs significantly increased the likelihood of ever RTW (OR 2.09, 95% CI 0.99–4.44, p = 0.05), decreased the number of days taken to return to work (mean difference –7.80, 95% CI –13.16 to –2.45, p ≤ 0.001), and increased total self-efficacy scores (mean difference 5.19, 95% CI 3.12–7.26, p < 0.001). Subgroup analyses found that favorable return to work outcomes resulted from programs involving workplace support (p < 0.001) and for people with musculoskeletal or orthopedic injuries (p = 0.02). Conclusions: Compared to rehabilitation programs providing standard care following injuries, programs aimed at developing resilience could improve reemployment outcomes and self-efficacy. Implications for rehabilitation Individual resilience may be an important factor promoting functional recovery after traumatic injury. Resilience rehabilitation programs are effective in enabling patients’ return to work and increasing their self efficacy. In particular, programs involving the workplace are important components for enabling optimal work participation outcomes.