Supporting return to study and return to work in the patient with persistent post-concussion symptoms: A biopsychosocial approach

BACKGROUND: Concussion, or mild uncomplicated traumatic brain injury (mTBI), is a common condition that can occur in sports, motor vehicle accidents, falls, assaults/violence and occupational settings. While symptom resolution is usually expected within 2-4 weeks, a minority of patients (up to 30%) experience persistent post-concussion symptoms (PPCS) that impact cognitive, physical and emotional functioning. These prolonged symptoms can interfere with a patient's ability to return to school or work, creating uncertainty for patients, employers and treating practitioners. OBJECTIVE: This article provides an evidence-based clinical approach to supporting return to learning and return to work in patients with PPCS, with a focus on the general practice setting. DISCUSSION: The general practitioner (GP) has a key role in recognising PPCS, educating patients/families, facilitating a stepwise return to cognitive and vocational activity and coordinating multidisciplinary care. This article outlines current return-to-study and return-to-work recommendations, age- and context-specific considerations, guidance on certification, communication with schools and employers and criteria for specialist referral. A biopsychosocial model is emphasised, recognising the interplay between physical symptoms, psychological responses and environmental demands in recovery from concussion.