{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:15:24Z","timestamp":1783318524748,"version":"3.54.6"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rising costs and increasing complexity place growing pressure on healthcare and social security systems worldwide. For people with acquired brain injury (ABI), successful return to work (RTW) depends not only on medical recovery but also on timely, coordinated support across healthcare, social security, vocational integration, and employment systems. Although Switzerland provides comprehensive healthcare and social protection, services relevant to RTW remain highly fragmented, posing substantial challenges for sustainable employment after ABI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed (1) to develop a system-level understanding of current RTW service pathways for people with ABI in Switzerland, with particular attention to interactions, discontinuities, and coordination gaps across sectors, and (2) to describe key features of an optimized, lifelong RTW service pathway as a reference for planning and coordinating services to support sustainable employment across the working life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>The study applied an Integrated Knowledge Translation (IKT) approach, involving researchers, people with ABI, representatives of patient organizations, healthcare professionals, vocational integration specialists, employers' representatives, and social insurance stakeholders as active project partners. Following a three-stage process\u2014information gathering, mapping of current (\u201cas-is\u201d) service pathways, and identification of the key features of an optimized pathway\u2014we combined evidence from prior qualitative research with newly collected data from online surveys of Swiss neurorehabilitation clinics and cantonal disability insurance offices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Current RTW service pathways for people with ABI were mapped, revealing substantial fragmentation across settings and actors. Key gaps were identified and grouped into four interrelated themes: information, coordination, communication, and financing. These gaps affect multiple transition points and limit continuity of support over time. Through iterative discussion and refinement within the IKT framework, core elements of an optimized RTW service pathway were identified to support individuals with ABI, professionals, and employers in facilitating sustainable work participation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A pathway-oriented perspective highlights how fragmented services and coordination failures undermine sustainable employment after ABI. This study identifies critical gaps in current RTW service pathways and outlines both short-term practice-oriented measures and longer-term structural and policy-level directions for improvement. Actively involving stakeholders across sectors enhances the relevance and feasibility of pathway-level recommendations and increases the likelihood of their implementation in practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2026.1754914","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:38:38Z","timestamp":1783316318000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Towards optimizing the service pathway \u201cback to work\u201d for people with acquired brain injury"],"prefix":"10.3389","volume":"6","author":[{"given":"Katarzyna","family":"Karcz","sequence":"first","affiliation":[{"name":"Swiss Paraplegic Research, Work and Integration Group, Nottwil","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priska","family":"Fritsche","sequence":"additional","affiliation":[{"name":"FRAGILE Suisse Patient Organization, Z\u00fcrich","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Geisen","sequence":"additional","affiliation":[{"name":"Institute for Integration and Participation, University of Applied Sciences for Social Work North-Western Switzerland, Olten","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Keller","sequence":"additional","affiliation":[{"name":"FRAGILE Suisse Patient Organization, Z\u00fcrich","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benno","family":"Muff","sequence":"additional","affiliation":[{"name":"Disability Office Lucerne, Integration Department, Lucerne","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Riemer-Kafka","sequence":"additional","affiliation":[{"name":"Social Security and Labour Law, Professor Emerita, University of Lucerne, Lucerne","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Staudenmann","sequence":"additional","affiliation":[{"name":"Rehabilitation Clinic Bellikon, Work-orientated Rehabilitation Bellikon","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Zimmermann-Gerster","sequence":"additional","affiliation":[{"name":"Employers\u2019 Association, Social Policy Department, Z\u00fcrich","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika E.","family":"Finger","sequence":"additional","affiliation":[{"name":"Swiss Paraplegic Research, Work and Integration Group, Nottwil","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2988","DOI":"10.1080\/09638288.2020.1858351","article-title":"The role of occupational participation for people with traumatic brain injury: a systematic review of the literature","volume":"44","author":"Klepo","year":"2022","journal-title":"Disabil Rehabil"},{"key":"B2","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1080\/02699050902838165","article-title":"Prognostic factors of return to work after acquired brain injury: a systematic review","volume":"23","author":"van Velzen","year":"2009","journal-title":"Brain Inj"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1080\/09638280601143356","article-title":"Working after a stroke: survivors\u2019 experiences and perceptions of barriers to and facilitators of the return to paid employment","volume":"29","author":"Alaszewski","year":"2007","journal-title":"Disabil Rehabil"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e0264116","DOI":"10.1371\/journal.pone.0264116","article-title":"A systematic review on integrated care for traumatic brain injury, mental health, and substance use","volume":"17","author":"Chan","year":"2022","journal-title":"PLoS One"},{"key":"B5","doi-asserted-by":"publisher","first-page":"550","DOI":"10.3109\/02699052.2014.995227","article-title":"Return-to-work in patients with acquired brain injury and psychiatric disorders as a comorbidity: a systematic review","volume":"29","author":"Garrelfs","year":"2015","journal-title":"Brain Inj"},{"key":"B6","doi-asserted-by":"publisher","first-page":"847","DOI":"10.3109\/09638288.2016.1162854","article-title":"Work-related difficulties in patients with traumatic brain injury: a systematic review on predictors and associated factors","volume":"39","author":"Scaratti","year":"2017","journal-title":"Disabil Rehabil"},{"key":"B7","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/s1474-4422(17)30279-x","article-title":"The chronic and evolving neurological consequences of traumatic brain injury","volume":"16","author":"Wilson","year":"2017","journal-title":"Lancet Neurol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2128","DOI":"10.1016\/j.apmr.2015.07.020","article-title":"Ten-year employment patterns of working age individuals after moderate to severe traumatic brain injury: a national institute on disability and rehabilitation research traumatic brain injury model systems study","volume":"96","author":"Cuthbert","year":"2015","journal-title":"Arch Phys Med Rehabil"},{"key":"B9","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1136\/jnnp-2019-322424","article-title":"Ischaemic stroke in young adults: a global perspective","volume":"91","author":"Boot","year":"2020","journal-title":"J Neurol Neurosurg Psychiatr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1212\/con.0000000000000833","article-title":"Ischemic stroke in young adults","volume":"26","author":"Putaala","year":"2020","journal-title":"Continuum (Minneapolis, Minn)"},{"key":"B11","first-page":"25","article-title":"Inzidenz und letalit\u00e4t, 5-jahresmittelwert: medizinische statistik der krankenh\u00e4user (MS)","volume-title":"Statistik der Todesursachen (TU) und Statistik der Bev\u00f6lkerung und der Haushalte (STATPOP)","year":"2022"},{"key":"B12","volume-title":"(SSUV) Unfallstatisitk UVG 2020","year":"2022"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e0174847","DOI":"10.1371\/journal.pone.0174847","article-title":"Mild traumatic brain injury (mTBI) and chronic cognitive impairment: a scoping review","volume":"12","author":"McInnes","year":"2017","journal-title":"PLoS One"},{"key":"B14","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1053\/apmr.2001.21985","article-title":"A comparison of acute and postdischarge predictors of employment 2 years after traumatic brain injury","volume":"82","author":"Felmingham","year":"2001","journal-title":"Arch Phys Med Rehabil"},{"key":"B15","doi-asserted-by":"publisher","first-page":"211","DOI":"10.3109\/09638288.2016.1141242","article-title":"Barriers and facilitators associated with return to work after stroke: a qualitative meta-synthesis","volume":"39","author":"Brannigan","year":"2017","journal-title":"Disabil Rehabil"},{"key":"B16","volume-title":"International Perspectives on Spinal Cord Injury","author":"Bickenbach","year":"2013"},{"key":"B17","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1310\/tsr1805-562","article-title":"The effect of vocational rehabilitation on return-to-work rates post stroke: a systematic review","volume":"18","author":"Baldwin","year":"2011","journal-title":"Top Stroke Rehabil"},{"key":"B18","article-title":"Problems at work: reports from the counseling service of Fragile suisse","author":"Zangger","year":"2018"},{"key":"B19","doi-asserted-by":"publisher","first-page":"906567","DOI":"10.3389\/fresc.2022.906567","article-title":"Factors influencing sustainable employment of persons with acquired brain injury (ABI) or spinal cord injury (SCI): a qualitative study evaluating the perspective of health and work professionals","volume":"3","author":"Finger","year":"2023","journal-title":"Front Rehabil Sci"},{"key":"B20","doi-asserted-by":"publisher","first-page":"872782","DOI":"10.3389\/fresc.2022.872782","article-title":"Facilitators and barriers to sustainable employment after spinal cord injury or acquired brain injury: the person\u2019s perspective","volume":"3","author":"Karcz","year":"2022","journal-title":"Front Rehabil Sci"},{"key":"B21","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1080\/02699050802158243","article-title":"Perspectives of survivors of traumatic brain injury and their caregivers on long-term social integration","volume":"22","author":"Lefebvre","year":"2008","journal-title":"Brain Inj"},{"key":"B22","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/978-3-030-24334-0_17","article-title":"A human rights perspective on work participation","volume-title":"Handbook of Disability, Work and Health","author":"Bickenbach","year":"2020"},{"key":"B23","doi-asserted-by":"publisher","year":"","DOI":"10.1007\/978-3-030-24334-0_17"},{"key":"B24","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1136\/jech.2006.047456","article-title":"The effects of ill health on entering and maintaining paid employment: evidence in European countries","volume":"61","author":"Schuring","year":"2007","journal-title":"J Epidemiol Community Health"},{"key":"B25","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1136\/oemed-2013-101591","article-title":"Influence of poor health on exit from paid employment: a systematic review","volume":"71","author":"Van Rijn","year":"2014","journal-title":"Occup Environ Med"},{"key":"B26","volume-title":"Good Jobs for all in a Changing World of Work: The OECD job Strategy","year":"2018"},{"key":"B27","volume-title":"Fiscal Sustainability of Health Systems: How to Finance More Resilient Health Systems When Money is Tight?","year":"2024"},{"key":"B28","doi-asserted-by":"publisher","first-page":"101013","DOI":"10.1016\/j.lanwpc.2024.101013","article-title":"Overcoming silos in health care systems through meso-level organisations\u2014a case study of health reforms in New South Wales, Australia","volume":"44","author":"Peiris","year":"2024","journal-title":"Lancet Reg Health West Pac"},{"key":"B29","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12992-020-00592-1","article-title":"It\u2019s far too complicated\u2019: why fragmentation persists in global health","volume":"16","author":"Spicer","year":"2020","journal-title":"Global Health"},{"key":"B30","volume-title":"Sickness, Disability and Work: Breaking the Barriers: A Synthesis of Findings Across OECD Countries","year":"2010"},{"key":"B31","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/978-3-662-46432-8_2","volume-title":"Gesundheitswesen der Schweiz. Health Technology Assessment","author":"Widrig","year":"2015"},{"key":"B32","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1186\/s12913-024-11128-3","article-title":"Risk factors and service gaps affecting a sustainable work: a qualitative multi-stakeholder analysis in the context of persons with acquired brain injury living in Switzerland","volume":"24","author":"Karcz","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"B33","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/978-1-4614-6214-9_6","article-title":"Work disability models: past and present","volume-title":"Handbook of Work Disability: Prevention and Management","author":"Costa-Black","year":"2013"},{"key":"B34","first-page":"59","article-title":"The work disability paradigm and its public health implications","author":"Loisel","year":"2013"},{"key":"B35","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1023\/A:1020270407044","article-title":"Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors","volume":"12","author":"Franche","year":"2002","journal-title":"J Occup Rehabil"},{"key":"B36","article-title":"Clinical pathways as a quality strategy","volume-title":"Improving Healthcare Quality in Europe: Characteristics, Effectiveness and Implementation of Different Strategies. Health Policy Series","author":"Rotter","year":"2019"},{"key":"B37","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1186\/s12913-022-08079-y","article-title":"The use of co-production, co-design and co-creation to mobilise knowledge in the management of health conditions: a systematic review","volume":"22","author":"Grindell","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1049182","DOI":"10.3389\/fresc.2023.1049182","article-title":"Prioritizing risk factors and identifying target areas to address with interventions to improve sustainable employment of persons with a brain injury or a spinal cord injury\u2014a multi-stakeholder consensus process","volume":"4","author":"Finger","year":"2023","journal-title":"Front Rehabil Sci"},{"key":"B39","doi-asserted-by":"publisher","first-page":"876389","DOI":"10.3389\/fresc.2022.876389","article-title":"Factors related to sustainable employment of people with acquired brain injury or spinal cord injury: the employer\u2019s perspective","volume":"3","author":"Schiffmann","year":"2022","journal-title":"Front Rehabil Sci"},{"key":"B40","doi-asserted-by":"publisher","first-page":"138","DOI":"10.15171\/ijhpm.2019.123","article-title":"Team-Based integrated knowledge translation for enhancing quality of life in long-term care settings: a multi-method, multi-sectoral research design","volume":"9","author":"Keefe","year":"2020","journal-title":"Int J Health Policy Manag"},{"key":"B41","volume-title":"Sustained Gainful Employment After Spinal Cord Injury or Traumatic Brain Injury: A Mixed-methods work Life Course Study","year":"2023"},{"key":"B42","volume-title":"Successful Qualitative Research: A Practical Guide for Beginners","author":"Braun","year":"2013"},{"key":"B43","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1038\/bdj.2008.192","article-title":"Methods of data collection in qualitative research: interviews and focus groups","volume":"204","author":"Gill","year":"2008","journal-title":"Br Dent J"},{"key":"B45","year":""},{"key":"B46","volume-title":"Kreisschreiben \u00fcber die Beruflichen Eingliederungsmassnahmen der Invalidenversicherung","year":"2022"},{"key":"B47","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1056\/NEJMp1410737","article-title":"Australian Health care\u2013the challenge of reform in a fragmented system","volume":"373","author":"Hall","year":"2015","journal-title":"N Engl J Med"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1046\/j.1532-5415.2001.49285.x","article-title":"Fragmentation of care for frail older people\u2013an international problem. Experience from three countries: israel, Canada, and the United States","volume":"49","author":"Clarfield","year":"2001","journal-title":"J Am Geriatr Soc"},{"key":"B49","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1024\/0040-5930\/a001410","article-title":"Acquired brain injury and work participation\u2014a Dutch interdisciplinary guideline for occupational and insurance physicians","volume":"80","author":"Donker-Cools","year":"2023","journal-title":"Ther Umsch"},{"key":"B50","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1186\/s12916-023-03021-3","article-title":"Healthcare fragmentation, multimorbidity, potentially inappropriate medication, and mortality: a Danish nationwide cohort study","volume":"21","author":"Prior","year":"2023","journal-title":"BMC Med"},{"key":"B51","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1001\/jamainternmed.2023.7628","article-title":"Care fragmentation, care continuity, and care coordination\u2014how they differ and why it matters","volume":"184","author":"Kern","year":"2024","journal-title":"JAMA Intern Med"},{"key":"B52","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1370\/afm.971","article-title":"The problem of fragmentation and the need for integrative solutions","volume":"7","author":"Stange","year":"2009","journal-title":"Ann Family Med"},{"key":"B53","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1186\/s12913-024-11316-1","article-title":"Understanding the barriers and facilitators of healthcare services for brain injury and concurrent mental health and substance use issues: a qualitative study","volume":"24","author":"Grewal","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"B54","doi-asserted-by":"publisher","first-page":"2580","DOI":"10.1080\/09602011.2021.1969252","article-title":"The experience of employers of individuals with traumatic brain injury","volume":"32","author":"Libeson","year":"2022","journal-title":"Neuropsychol Rehabil"},{"key":"B55","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1097\/WCO.0b013e3283404258","article-title":"Community integration after severe traumatic brain injury in adults","volume":"23","author":"Truelle","year":"2010","journal-title":"Curr Opin Neurol"},{"key":"B56","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1080\/02699052.2024.2438785","article-title":"Case management for acquired brain injury: a systematic review of the evidence base","volume":"39","author":"Leonard","year":"2025","journal-title":"Brain Inj"},{"key":"B57","first-page":"17","article-title":"Managing the impossible: getting better results in returning catastrophically injured people to work","volume":"18","author":"Cope","year":"","journal-title":"J Workers Compensation"},{"key":"B58","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1017\/S2045796011000059","article-title":"Monitoring service utilization of persons with mental disorders\u2014a case for mapping pathways of care","volume":"20","author":"Katschnig","year":"2011","journal-title":"Epidemiol Psychiatr Sci"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1754914\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:38:42Z","timestamp":1783316322000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1754914\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":58,"alternative-id":["10.3389\/frhs.2026.1754914"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1754914","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"article-number":"1754914"}}