Towards optimizing the service pathway "back to work" for people with acquired brain injury.

Introduction: 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. Objective: 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. Materials and methods: 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-information gathering, mapping of current ("as-is") service pathways, and identification of the key features of an optimized pathway-we combined evidence from prior qualitative research with newly collected data from online surveys of Swiss neurorehabilitation clinics and cantonal disability insurance offices. Results: 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. Conclusions: 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.