Purpose: The purpose of this article is to critically review the literature to examine factors that are most consistently related to employment outcome following traumatic brain injury (TBI), with a particular focus on metacognitive skills. It also aims to develop a conceptual model of factors related to employment outcome. Method: The first stage of the review considered 85 studies published between 1980 and December 2003 which investigated factors associated with employment outcome following TBI. English-language studies were identified through searches of Medline and PsycINFO, as well as manual searches of jourls and reference lists. The studies were evaluated and rated by two independent raters (Kappa=0.835) according to the quality of their methodology based upon nine criteria. Fifty studies met the criteria for inclusion in the second stage of the review, which examined the relationship between a broad range of variables and employment outcome. Results: The factors most consistently associated with employment outcome included pre-injury occupatiol status, functiol status at discharge, global cognitive functioning, perceptual ability, executive functioning, involvement in vocatiol rehabilitation services and emotiol status. Conclusions: A conceptual model is presented which emphasises the importance of metacognitive, emotiol and social environment factors for improving employment outcome.
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