Interventions Supporting Functional Recovery After Traumatic Brain Injury in Public Safety Personnel: A Systematic Review of Outcomes and Work Reintegration Considerations

BACKGROUND: Public safety personnel (PSP) face a heightened risk of traumatic brain injury (TBI) and barriers in resuming daily activities and returning to work (RTW). Despite these risks, evidence on interventions targeting functional recovery and participation in this population is scarce. OBJECTIVE: To synthesize evidence on interventions targeting functional recovery and RTW in PSP with TBI. DESIGN: MEDLINE, CINAHL, EMBASE, PsycINFO, and Scopus on January 23, 2026. Eligible studies included PSP with TBI such as armed forces and/or military personnel and law enforcement personnel. Randomized controlled trials, quasi-experimental studies, observational studies, case studies, and mixed methods designs were included. Outcomes were classified using the International Classification of Functioning, Disability, and Health framework and synthesized narratively. Risk of bias was assessed using Joanna Briggs Institute tools, and certainty of evidence was evaluated using GRADE. RESULTS: Twenty-one studies were included (9 randomized controlled trial, 5 cohort, 4 quasi-experimental, 3 case studies). Most studies focused on military populations, with only 2 civilian PSP studies (firefighters and police). Interventions included cognitive rehabilitation, psychological/mental health, interdisciplinary programs, simulation-based training, and physical rehabilitation. Narrative synthesis showed mixed but generally positive, improvements in body function outcomes, and cognitive function within the activity domain. Participation-level outcomes such as RTW were inconsistently defined and underreported. Certainty of evidence ranged from very low for participation outcomes to moderate for functional cognition. CONCLUSION: Interventions for PSP with TBI may support modest, but consistent, improvements in cognitive function; however, there remains low certainty of evidence for meaningful improvements in the participation domains (eg, RTW). The evidence is highly heterogeneous in outcomes and focused on military populations, limiting generalizability across PSP roles.