The RETurn to work After stroKE (RETAKE) trial: Findings from a mixed-methods process evaluation of the Early Stroke Specialist Vocational Rehabilitation (ESSVR) intervention

A key goal for working age stroke survivors is to return to work, yet only around 50% achieve this at 12 months. Currently, there is limited evidence of effectiveness of early stroke-specialist vocational rehabilitation (ESSVR) interventions from randomised controlled trials. This study examined fid...

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Published in:PloS one Vol. 19; no. 10; p. e0311101
Main Authors: Clarke, David James, Powers, Katie, Trusson, Diane, Craven, Kristelle, Phillips, Julie, Holmes, Jain, McKevitt, Christopher, Bowen, Audrey, Watkins, Caroline Leigh, Farrin, Amanda J., Wright-Hughes, Alexandra, Sach, Tracey, Chambers, Rachel, Radford, Kate
Format: Journal Article
Language:English
Published: United States Public Library of Science 09.10.2024
Public Library of Science (PLoS)
Subjects:
Accuracy
Adult
Biology and Life Sciences
Blood vessels
Data analysis
Data collection
Disability
Employers
England
Evaluation
Female
Health services
Humans
Informed consent
Intervention
Ischemia
Longitudinal Studies
Male
Managers
Medical personnel
Medicine and Health Sciences
Middle Aged
Occupational Therapists
Ordination
Rehabilitation
Rehabilitation, Vocational - methods
Return to Work
Site fidelity
Social Sciences
Stroke
Stroke Rehabilitation - methods
Vocational rehabilitation
England
United Kingdom > UK
Wales
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:A key goal for working age stroke survivors is to return to work, yet only around 50% achieve this at 12 months. Currently, there is limited evidence of effectiveness of early stroke-specialist vocational rehabilitation (ESSVR) interventions from randomised controlled trials. This study examined fidelity to ESSVR and explored social and structural factors which may have influenced implementation in the RETurn to work After stroKE (RETAKE) randomised controlled trial. Mixed-methods process evaluation assessing intervention fidelity and incorporating longitudinal case-studies exploring stroke survivors' experiences of support to return to work. Normalisation Process Theory, and the Conceptual Model for Implementation Fidelity, informed data collection and analysis. Sixteen sites across England and Wales participated in RETAKE. Forty-eight occupational therapists (OTs), supported by 6 mentors experienced in vocational rehabilitation (VR), delivered the intervention (duration 12 months) between February 2018 and April 2022. Twenty-six participants (15 ESSVR, 11 usual care (UC)) were included in longitudinal case-studies. An additional 18 participants (8 ESSVR and 10 UC) were interviewed once. Nineteen OTs, 6 mentors and 19 service managers were interviewed. Fidelity was measured for 39 ESSVR participants; mean fidelity score was 78.8% (SD:19.2%, range 31-100%). Comparison of the experiences of ESSVR and UC participants indicated duration and type of support to return to work were perceived to be better for ESSVR participants. They received early, co-ordinated support including employer liaison and workplace adjustments where appropriate. In contrast, UC participants reported limited or no VR or return to work support from health professionals. Typically, UC support lasted 2-8 weeks, with poor communication and co-ordination between rehabilitation providers. Mentor support for OTs appeared to increase fidelity. Service managers indicated ESSVR would enhance post-stroke services. ESSVR was valued by participants and was delivered with fidelity; implementation appeared to be facilitated by mentor support for OTs.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0311101