Background: In a feasibility trial of early occupational therapy vocational rehabilitation (VR), ... more Background: In a feasibility trial of early occupational therapy vocational rehabilitation (VR), more VR participants were in work at 12 months compared to those who received usual NHS rehabilitation after stroke (UC) (11 [65%] v 6 [35%]) (Radford et al., 2013). However, the longer-term is unknown. Aim: To follow up and explore work status six years post stroke. Method: Postal questionnaires measuring employment, income, mood, functional ability and quality of life (QoL) were sent to participants in an earlier feasibility trial by the lead stroke clinician. Respondents were invited to participate in interviews exploring working six years after stroke. Ethical and HRA approvals obtained (REC 16/EM/0423) Results: Of 48 identified participants, five (10.4%) had died; 19/43 (44.2%) responded. Fourteen were men; mean age 62 (24-78) years. Respondents classified themselves as in paid work 10/19 (53%), voluntary work 3/19 (16%), full time education 1/19 (5%) and solely retired 5/19 (26%). ...
BACKGROUND: Supporting people with multiple sclerosis (MS) at work can be challenging due to the ... more BACKGROUND: Supporting people with multiple sclerosis (MS) at work can be challenging due to the unpredictable nature and myriad of disease-related symptoms, and issues related to the work environment. OBJECTIVE: To explore, amongst people with MS in employment, their experiences of and need for vocational rehabilitation (VR), and perceived barriers and facilitators to implementing VR. METHODS: We conducted 20 semi-structured interviews with people with MS, employers, and healthcare professionals. Interviews were audio-recorded, transcribed, and analysed using the framework method. RESULTS: We identified nine themes reflecting the main MS symptoms (e.g. cognition, fatigue), and environmental factors such as support provided at work (e.g. change of working hours) and workplace characteristics. Providing support tailored to the individual’s needs and early intervention were seen as important attributes for the intervention. The barriers identified referred to lack of resources and con...
et al. Qualitative study exploring factors affecting the implementation of a vocational rehabilit... more et al. Qualitative study exploring factors affecting the implementation of a vocational rehabilitation intervention in the UK major trauma pathway. BMJ Open 2022;12:e060294.
Objective Injuries can have a long-lasting effect on ability to return to work, but there is litt... more Objective Injuries can have a long-lasting effect on ability to return to work, but there is little research on which outcomes are most important to patients. This study aims to identify and prioritise return-to-work outcomes important to patients for evaluating vocational rehabilitation interventions. Methods Nominal group technique focus group with trauma patients. Results Focus group participants ( n = 6) included mostly traumatic brain injuries, a range of occupation types, ages and both genders. Participants identified and prioritised their eight most important outcomes which were: sense of purpose and life satisfaction, understanding the impact of injury, assessment of readiness to return to work, using SMART (specific, measurable, achievable, relevant and time-bound) goals, facilitated reintegration to work, assessing capacity to return to work, collaboration between key stakeholders and improved employer and employee knowledge. Many of these were measures of the process of, ...
Background Little guidance exists regarding how best to upskill and support those delivering comp... more Background Little guidance exists regarding how best to upskill and support those delivering complex healthcare interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed to explore mentors’ roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting the mentoring process and intervention delivery. Methods Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention delivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions of intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were calculated per trial site. Qualitati...
Background: Chronic low back pain (CLBP) is a complex biopsychosocial problem with financial impl... more Background: Chronic low back pain (CLBP) is a complex biopsychosocial problem with financial implications for society. Most LBP is categorized as non-specific CLBP (NS-CLBP); magnetic resonance imaging (MRI) is increasingly used in the investigation of LBP, but has a high false-positive rate for NS-CLBP. Purpose: To explore the psychosocial factors associated with diagnosing NS-CLBP by MRI in Saudi Arabia. Materials and methods: Using a qualitative design, 11 patients with CLBP without a clear medical diagnosis who had received an MRI scan were interviewed using a semi-structured technique, and transcripts were analyzed using framework analysis. Results: Four themes of relevance to the psychosocial consequences of using MRI to diagnose CLBP were identified: (a) impact on social participation after MRI diagnosis, (b) psychological impact of MRI diagnosis, (c) conflicting advice, and (d) patient education. Although some patients expressed a sense of relief following the identification of an objective explanation of their symptoms by MRI, a number of negative consequences were also identified. In particular, fear-avoidance behaviour and anxiety were apparent. Conclusion: The use of MRI scanning in the diagnosis of LBP may lead to psychosocial factors influencing participation in physical and social daily activities.
Background Traumatic injuries are common amongst working-age adults. Survivors often experience p... more Background Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work outcomes for a range of conditions but evidence of effectiveness for those with traumatic injuries is lacking. This study assesses feasibility of delivering a vocational rehabilitation intervention to enhance return to work and improve quality of life and wellbeing in people with at least moderate trauma to inform design of a definitive randomised controlled trial (RCT). Methods Non-randomised, single-arm, multi-centre mixed-methods feasibility study with nested case studies and qualitative study. The case studies comprise interviews, observations of clinical contacts and review of clinical records. The qualitative study comprises interviews and/or focus groups. Participants will be recruited from two UK major trauma centres. Participants will comprise 40 ...
International Journal of Environmental Research and Public Health, 2021
Returning to work after traumatic injury can have a range of benefits, but there is currently lit... more Returning to work after traumatic injury can have a range of benefits, but there is currently little research that incorporates patient perspectives to identify outcomes of vocational rehabilitation interventions that are important to survivors. Trauma survivors (n = 17) participated in in-depth semi-structured interviews or focus groups exploring outcomes that were important to them for recovery and return to work. Data were analysed using thematic analysis. Participants identified a range of outcomes that they considered important and necessary to facilitate a successful and sustainable return to work: physical and psychological recovery, purposeful life engagement, managing expectations of recovery, managing expectations about return to work, and employers’ expectations. Our participants advocated for a multifaceted and biopsychosocial understanding of recovery and outcomes that need to be captured for vocational rehabilitation interventions. Implications for practice and researc...
Background: Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising inc... more Background: Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will investigate whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e., usual NHS rehabilitation) is more clinically and cost effective for supporting post-stroke RTW, than UC alone.Methods: 760 stroke survivors and their carers will be recruited from approximately 20 NHS stroke services. A 5:4 allocation ratio will be employed to randomise participants to receive ESSVR plus UC, or UC alone. The individually tailored ESSVR intervention will commence within 12 weeks of stroke onset and be delivered for up to 12 months as necessary by trained RETAKE occupational therapists in the community, participants’ ho...
Background Work problems are common in people with inflammatory arthritis. Up to 50% stop work wi... more Background Work problems are common in people with inflammatory arthritis. Up to 50% stop work within 10 years due to their condition and up to 67% report presenteeism (i.e. reduced work productivity), even amongst those with low disease activity. Job retention vocational rehabilitation (JRVR) may help prevent or postpone job loss and reduce presenteeism through work assessment, work-related rehabilitation and enabling job accommodations. This aims to create a better match between the person’s abilities and their job demands. The objectives of the Workwell trial are to test the overall effectiveness and cost-effectiveness of JRVR (WORKWELL) provided by additionally trained National Health Service (NHS) occupational therapists compared to a control group who receive self-help information both in addition to usual care. Methods Based on the learning from a feasibility trial (the WORK-IA trial: ISRCTN76777720), the WORKWELL trial is a multi-centre, pragmatic, individually-randomised pa...
Stroke is the single greatest cause of adult disability in the UK. A quarter of strokes affect pe... more Stroke is the single greatest cause of adult disability in the UK. A quarter of strokes affect people of working age; however, less than half of them return to work. This study described the nature of return to work and the help that people require to go back to work. A total of 46 participants were recruited from one English county. Participants were divided into 2 groups: a group receiving usual care and a group receiving extra rehabilitation. The study assessed their work status, the hours they worked, work accommodations, and what they earned at baseline, 3, 6 and 12 months after stroke. Most people returned to work after a mean of 90 days and stayed with the same employer. However, many people needed changes at work, worked fewer hours and earned less than they did before the stroke. Future research should investigate the implications of work adjustments for stroke survivors and whether the reported reductions in hours, status, roles and responsibilities are viewed as positive or negative. Objective: Stroke is the greatest cause of disability in adults. A quarter of strokes in the UK affect people of working age, yet under half of them return to work after stroke. There has been little investigation into what constitutes "return to work" following stroke. The aim of this study is to describe the work metrics of stroke survivor participants in a feasibility randomized controlled trial of an early stroke-specific vocational rehabilitation intervention. Methods: Retrospective analysis of trial data. Metrics on work status, working hours, workplace accommodations and costs were extracted from trial outcomes gathered by postal questionnaire at 3, 6, and 12 months' post-randomization for 46 stroke participants in a feasibility randomized controlled trial. Participants were randomized to receive vocational rehabilitation (intervention) or usual care (control). Results: Two-thirds (n = 29; 63%) of participants returned to work at some point in the 12 months following stroke. Participants took a mean of 90 days to return to work. Most returned to the same role with an existing employer. Only one-third of participants who were employed full-time at stroke onset were working full-time at 12 months post-stroke. Most participants experienced a reduction in pre-stroke earnings. Workplace accommodations were more common among intervention group participants. More intervention participants than control participants reported satisfaction with work at both 6 and 12 months post-randomization. Conclusion: This study illustrates the heterogeneous nature of return to work and the dramatic impact of stroke on work status, working hours and income. Longitudinal research should explore the socioeconomic legacy of stroke and include clear definitions of work and accurate measures of working hours and income from all sources.
Understanding the needs of children and young people (CYP) with acquired brain injuries (ABI) is ... more Understanding the needs of children and young people (CYP) with acquired brain injuries (ABI) is essential in delivering pathways of care and providing effective rehabilitation. Aim: To identify relevant literature and key themes relating to the nature and extent of needs (met, unmet or unrecognised) of CYP with ABI and their families. Method: Scoping review. Sixteen electronic bibliographic databases were searched using terms relating to children, brain injury and need. Papers were screened against eligibility criteria by two independent reviewers. No date limits were applied. Data was extracted by the lead author regarding the needs of CYP with ABI and their families and thematic analysis conducted to identify the key themes. Methodological quality was not assessed. Results: A total of 28 articles were identified including three systematic reviews, one scoping review, two practice recommendation articles and 22 original research studies. Participants included CYP with ABI, parents, siblings and professionals. Four key themes were identified; CYP-related impairment needs, support needs, return to school and long-term aftercare. Conclusion: CYP with ABI and their families report extensive needs, many of which are often unmet or unrecognised by those supporting the CYP. Needs transcend the health, social care and education domains.
Background: Almost 80% of people have low back pain at least once in their life. Clinical guideli... more Background: Almost 80% of people have low back pain at least once in their life. Clinical guidelines emphasize the use of conservative physiotherapy and the importance of staying active. While the psychological factors predicting poor recovery following surgical intervention are understood, the psychosocial factors associated with poor outcomes following physiotherapy have yet to be identified. Methods: Electronic searches of PubMed, Medline, CINAHL, PsycINFO and EBSCO were conducted using terms relating to psychosocial factors, chronic low back pain, disability and physiotherapy. Papers examining the relationship between psychosocial factors and pain and disability outcomes following physiotherapy were included. Two reviewers selected, appraised and extracted studies independently. Results: In total, 10 observational studies were identified that suggested an association between fear of movement, depression, self-efficacy and catastrophizing in modifying pain and disability outcomes...
Background: Over one million people sustain traumatic brain injury each year in the UK and more t... more Background: Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial. Methods/design: Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face Vs postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determine the sample size for a larger trial. Discussion: To our knowledge, this is the first feasibility randomised controlled trial of a vocational rehabilitation health intervention specific to traumatic brain injury. The results will inform the design of a definitive trial. Trial registration: The trial is registered ISRCTN Number 38581822.
Dear Editor, In a recent Editorial of Clinical Rehabilitation , it was pointed out that the adjec... more Dear Editor, In a recent Editorial of Clinical Rehabilitation , it was pointed out that the adjective ‘physical’ in the term ‘physical rehabilitation’ is either unhelpful (because it implies that the difference between mind and body is important in rehabilitation) or worse (because it might reveal prejudice against psychiatric or psychological health problems). The Editorial also argues that use of the framework of the International Classification of Functioning and Health reveals these flaws of logic and offers a coherent unifying model. It may be, however, that this unfortunate adjective has been used in a genuine attempt to separate different styles or packages of rehabilitation, in particular the styles and practice used in psychiatric settings and those in neurological settings (the un-abandoned Cartesian dualism of health services!). One approach is to consider the terms ‘restorative’ and ‘adaptive’ rehabilitation. Restorative rehabilitation models are those that might be used on a stroke unit or for a condition where an improvement in disease and a reduction in impairment are expected. Adaptive rehabilitation is more suitable for progressive conditions, such as dementia. Using the ICF to describe the domains of health, simplified diagrams representing the intervention types used in rehabilitation can be drawn to illustrate the rehabilitation process and the differences between restorative and adaptive rehabilitation. In Figure 1, the elements of rehabilitation that are prominent in restorative rehabilitation are shown in bold, and they particularly include medical treatments and rehabilitation therapies aimed at reducing impairments and their translation into activity limitations. The restorative model is typically time-limited. Note that ‘non-physical’ aspects of care are required in restorative rehabilitation such as reassurance, encouraging behaviour change, and the provision of information. The diagram is re-drawn in Figure 2, which represents adaptive rehabilitation. In this model, there may be little emphasis on attempting to reverse the underlying impairments, but a great deal to gain from optimizing participation from supporting those with whom the patient interacts, by providing skilled and targeted assistance and in environmental modification. The adaptive model is likely to be on-going, as befits the underlying disease that gives rise to the main impairments. These diagrams illustrate that both approaches are rehabilitation approaches, both may use inter-
The view that the profession of occupational therapy will flourish in the 21st century was expres... more The view that the profession of occupational therapy will flourish in the 21st century was expressed before the banking system and financial market collapse in 2008. The profession now competes for scarce resources as austerity measures take effect. A summit meeting at the College of Occupational Therapists, in May 2013, discussed how to improve the profession's understanding and use of health economics. At this meeting, short-, medium-, and longer-term approaches were discussed, with the aim of improving the quality and quantity of publications on economic evaluations in occupational therapy. Despite an increasing number of publications on health economics across professions, occupational therapy lags behind. This focus is now vital for the profession.
International Journal of Therapy and Rehabilitation, 2014
Introduction: Cognitive tests are used to inform recommendations about the safety of people with ... more Introduction: Cognitive tests are used to inform recommendations about the safety of people with dementia to continue driving. The Dementia Drivers’ Screening Assessment (DDSA) is a neuropsychological battery designed to assist in this process. However, it is lengthy to administer and requires materials from various test batteries. Aims: The primary aim of this study was to develop a shortened version of the DDSA for individuals with dementia. Methods: Data on participants with dementia from two studies were analysed. These participants were all drivers with dementia who were identified by community mental health teams and psychiatrists. Each participant was assessed on the DDSA and also assessed on-road by an ‘approved driving instructor’ using the Nottingham Neurological Driving Assessment. Results: This study analysed 102 participants, who had a mean age of 74.0 (SD=7.7) years and of whom 80 (78%) were men. Twenty three drivers were judged to be unsafe and 79 safe. The agreement ...
Introduction: Existing research on vocational rehabilitation following stroke has been criticised... more Introduction: Existing research on vocational rehabilitation following stroke has been criticised for not describing intervention in sufficient detail for replication or clinical implementation. The purpose of this study was to test the feasibility of recording and measuring the content of an early stroke-specific vocational rehabilitation intervention delivered to participants in a feasibility randomized controlled trial, using a proforma previously developed for a study of vocational rehabilitation following traumatic brain injury. Method: The proforma was adapted for use in stroke with input from an expert panel and was used to record intervention content, in 10-minute units, following each intervention session. Findings: Twenty-five people, working or in education at the time of stroke, participated in the study. Two thirds of the therapists' time was spent in face-to-face contact (43%) and liaison with the patient and others (20%). Intervention mainly focused on work prepar...
We are pleased that the National Institute for Health and Care Excellence thought it important to... more We are pleased that the National Institute for Health and Care Excellence thought it important to develop guidelines for the management of patients with stroke.1 We are also reassured by the position taken by the Guideline Development Group (GDG)—that the evidence pointed to intervention improving function and mobility, but that there was little evidence to support one type of intervention over another.2 However, despite the GDG’s intentions to facilitate innovations in practice,3 there is a serious risk that …
Background: In a feasibility trial of early occupational therapy vocational rehabilitation (VR), ... more Background: In a feasibility trial of early occupational therapy vocational rehabilitation (VR), more VR participants were in work at 12 months compared to those who received usual NHS rehabilitation after stroke (UC) (11 [65%] v 6 [35%]) (Radford et al., 2013). However, the longer-term is unknown. Aim: To follow up and explore work status six years post stroke. Method: Postal questionnaires measuring employment, income, mood, functional ability and quality of life (QoL) were sent to participants in an earlier feasibility trial by the lead stroke clinician. Respondents were invited to participate in interviews exploring working six years after stroke. Ethical and HRA approvals obtained (REC 16/EM/0423) Results: Of 48 identified participants, five (10.4%) had died; 19/43 (44.2%) responded. Fourteen were men; mean age 62 (24-78) years. Respondents classified themselves as in paid work 10/19 (53%), voluntary work 3/19 (16%), full time education 1/19 (5%) and solely retired 5/19 (26%). ...
BACKGROUND: Supporting people with multiple sclerosis (MS) at work can be challenging due to the ... more BACKGROUND: Supporting people with multiple sclerosis (MS) at work can be challenging due to the unpredictable nature and myriad of disease-related symptoms, and issues related to the work environment. OBJECTIVE: To explore, amongst people with MS in employment, their experiences of and need for vocational rehabilitation (VR), and perceived barriers and facilitators to implementing VR. METHODS: We conducted 20 semi-structured interviews with people with MS, employers, and healthcare professionals. Interviews were audio-recorded, transcribed, and analysed using the framework method. RESULTS: We identified nine themes reflecting the main MS symptoms (e.g. cognition, fatigue), and environmental factors such as support provided at work (e.g. change of working hours) and workplace characteristics. Providing support tailored to the individual’s needs and early intervention were seen as important attributes for the intervention. The barriers identified referred to lack of resources and con...
et al. Qualitative study exploring factors affecting the implementation of a vocational rehabilit... more et al. Qualitative study exploring factors affecting the implementation of a vocational rehabilitation intervention in the UK major trauma pathway. BMJ Open 2022;12:e060294.
Objective Injuries can have a long-lasting effect on ability to return to work, but there is litt... more Objective Injuries can have a long-lasting effect on ability to return to work, but there is little research on which outcomes are most important to patients. This study aims to identify and prioritise return-to-work outcomes important to patients for evaluating vocational rehabilitation interventions. Methods Nominal group technique focus group with trauma patients. Results Focus group participants ( n = 6) included mostly traumatic brain injuries, a range of occupation types, ages and both genders. Participants identified and prioritised their eight most important outcomes which were: sense of purpose and life satisfaction, understanding the impact of injury, assessment of readiness to return to work, using SMART (specific, measurable, achievable, relevant and time-bound) goals, facilitated reintegration to work, assessing capacity to return to work, collaboration between key stakeholders and improved employer and employee knowledge. Many of these were measures of the process of, ...
Background Little guidance exists regarding how best to upskill and support those delivering comp... more Background Little guidance exists regarding how best to upskill and support those delivering complex healthcare interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed to explore mentors’ roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting the mentoring process and intervention delivery. Methods Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention delivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions of intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were calculated per trial site. Qualitati...
Background: Chronic low back pain (CLBP) is a complex biopsychosocial problem with financial impl... more Background: Chronic low back pain (CLBP) is a complex biopsychosocial problem with financial implications for society. Most LBP is categorized as non-specific CLBP (NS-CLBP); magnetic resonance imaging (MRI) is increasingly used in the investigation of LBP, but has a high false-positive rate for NS-CLBP. Purpose: To explore the psychosocial factors associated with diagnosing NS-CLBP by MRI in Saudi Arabia. Materials and methods: Using a qualitative design, 11 patients with CLBP without a clear medical diagnosis who had received an MRI scan were interviewed using a semi-structured technique, and transcripts were analyzed using framework analysis. Results: Four themes of relevance to the psychosocial consequences of using MRI to diagnose CLBP were identified: (a) impact on social participation after MRI diagnosis, (b) psychological impact of MRI diagnosis, (c) conflicting advice, and (d) patient education. Although some patients expressed a sense of relief following the identification of an objective explanation of their symptoms by MRI, a number of negative consequences were also identified. In particular, fear-avoidance behaviour and anxiety were apparent. Conclusion: The use of MRI scanning in the diagnosis of LBP may lead to psychosocial factors influencing participation in physical and social daily activities.
Background Traumatic injuries are common amongst working-age adults. Survivors often experience p... more Background Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work outcomes for a range of conditions but evidence of effectiveness for those with traumatic injuries is lacking. This study assesses feasibility of delivering a vocational rehabilitation intervention to enhance return to work and improve quality of life and wellbeing in people with at least moderate trauma to inform design of a definitive randomised controlled trial (RCT). Methods Non-randomised, single-arm, multi-centre mixed-methods feasibility study with nested case studies and qualitative study. The case studies comprise interviews, observations of clinical contacts and review of clinical records. The qualitative study comprises interviews and/or focus groups. Participants will be recruited from two UK major trauma centres. Participants will comprise 40 ...
International Journal of Environmental Research and Public Health, 2021
Returning to work after traumatic injury can have a range of benefits, but there is currently lit... more Returning to work after traumatic injury can have a range of benefits, but there is currently little research that incorporates patient perspectives to identify outcomes of vocational rehabilitation interventions that are important to survivors. Trauma survivors (n = 17) participated in in-depth semi-structured interviews or focus groups exploring outcomes that were important to them for recovery and return to work. Data were analysed using thematic analysis. Participants identified a range of outcomes that they considered important and necessary to facilitate a successful and sustainable return to work: physical and psychological recovery, purposeful life engagement, managing expectations of recovery, managing expectations about return to work, and employers’ expectations. Our participants advocated for a multifaceted and biopsychosocial understanding of recovery and outcomes that need to be captured for vocational rehabilitation interventions. Implications for practice and researc...
Background: Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising inc... more Background: Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will investigate whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e., usual NHS rehabilitation) is more clinically and cost effective for supporting post-stroke RTW, than UC alone.Methods: 760 stroke survivors and their carers will be recruited from approximately 20 NHS stroke services. A 5:4 allocation ratio will be employed to randomise participants to receive ESSVR plus UC, or UC alone. The individually tailored ESSVR intervention will commence within 12 weeks of stroke onset and be delivered for up to 12 months as necessary by trained RETAKE occupational therapists in the community, participants’ ho...
Background Work problems are common in people with inflammatory arthritis. Up to 50% stop work wi... more Background Work problems are common in people with inflammatory arthritis. Up to 50% stop work within 10 years due to their condition and up to 67% report presenteeism (i.e. reduced work productivity), even amongst those with low disease activity. Job retention vocational rehabilitation (JRVR) may help prevent or postpone job loss and reduce presenteeism through work assessment, work-related rehabilitation and enabling job accommodations. This aims to create a better match between the person’s abilities and their job demands. The objectives of the Workwell trial are to test the overall effectiveness and cost-effectiveness of JRVR (WORKWELL) provided by additionally trained National Health Service (NHS) occupational therapists compared to a control group who receive self-help information both in addition to usual care. Methods Based on the learning from a feasibility trial (the WORK-IA trial: ISRCTN76777720), the WORKWELL trial is a multi-centre, pragmatic, individually-randomised pa...
Stroke is the single greatest cause of adult disability in the UK. A quarter of strokes affect pe... more Stroke is the single greatest cause of adult disability in the UK. A quarter of strokes affect people of working age; however, less than half of them return to work. This study described the nature of return to work and the help that people require to go back to work. A total of 46 participants were recruited from one English county. Participants were divided into 2 groups: a group receiving usual care and a group receiving extra rehabilitation. The study assessed their work status, the hours they worked, work accommodations, and what they earned at baseline, 3, 6 and 12 months after stroke. Most people returned to work after a mean of 90 days and stayed with the same employer. However, many people needed changes at work, worked fewer hours and earned less than they did before the stroke. Future research should investigate the implications of work adjustments for stroke survivors and whether the reported reductions in hours, status, roles and responsibilities are viewed as positive or negative. Objective: Stroke is the greatest cause of disability in adults. A quarter of strokes in the UK affect people of working age, yet under half of them return to work after stroke. There has been little investigation into what constitutes "return to work" following stroke. The aim of this study is to describe the work metrics of stroke survivor participants in a feasibility randomized controlled trial of an early stroke-specific vocational rehabilitation intervention. Methods: Retrospective analysis of trial data. Metrics on work status, working hours, workplace accommodations and costs were extracted from trial outcomes gathered by postal questionnaire at 3, 6, and 12 months' post-randomization for 46 stroke participants in a feasibility randomized controlled trial. Participants were randomized to receive vocational rehabilitation (intervention) or usual care (control). Results: Two-thirds (n = 29; 63%) of participants returned to work at some point in the 12 months following stroke. Participants took a mean of 90 days to return to work. Most returned to the same role with an existing employer. Only one-third of participants who were employed full-time at stroke onset were working full-time at 12 months post-stroke. Most participants experienced a reduction in pre-stroke earnings. Workplace accommodations were more common among intervention group participants. More intervention participants than control participants reported satisfaction with work at both 6 and 12 months post-randomization. Conclusion: This study illustrates the heterogeneous nature of return to work and the dramatic impact of stroke on work status, working hours and income. Longitudinal research should explore the socioeconomic legacy of stroke and include clear definitions of work and accurate measures of working hours and income from all sources.
Understanding the needs of children and young people (CYP) with acquired brain injuries (ABI) is ... more Understanding the needs of children and young people (CYP) with acquired brain injuries (ABI) is essential in delivering pathways of care and providing effective rehabilitation. Aim: To identify relevant literature and key themes relating to the nature and extent of needs (met, unmet or unrecognised) of CYP with ABI and their families. Method: Scoping review. Sixteen electronic bibliographic databases were searched using terms relating to children, brain injury and need. Papers were screened against eligibility criteria by two independent reviewers. No date limits were applied. Data was extracted by the lead author regarding the needs of CYP with ABI and their families and thematic analysis conducted to identify the key themes. Methodological quality was not assessed. Results: A total of 28 articles were identified including three systematic reviews, one scoping review, two practice recommendation articles and 22 original research studies. Participants included CYP with ABI, parents, siblings and professionals. Four key themes were identified; CYP-related impairment needs, support needs, return to school and long-term aftercare. Conclusion: CYP with ABI and their families report extensive needs, many of which are often unmet or unrecognised by those supporting the CYP. Needs transcend the health, social care and education domains.
Background: Almost 80% of people have low back pain at least once in their life. Clinical guideli... more Background: Almost 80% of people have low back pain at least once in their life. Clinical guidelines emphasize the use of conservative physiotherapy and the importance of staying active. While the psychological factors predicting poor recovery following surgical intervention are understood, the psychosocial factors associated with poor outcomes following physiotherapy have yet to be identified. Methods: Electronic searches of PubMed, Medline, CINAHL, PsycINFO and EBSCO were conducted using terms relating to psychosocial factors, chronic low back pain, disability and physiotherapy. Papers examining the relationship between psychosocial factors and pain and disability outcomes following physiotherapy were included. Two reviewers selected, appraised and extracted studies independently. Results: In total, 10 observational studies were identified that suggested an association between fear of movement, depression, self-efficacy and catastrophizing in modifying pain and disability outcomes...
Background: Over one million people sustain traumatic brain injury each year in the UK and more t... more Background: Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial. Methods/design: Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face Vs postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determine the sample size for a larger trial. Discussion: To our knowledge, this is the first feasibility randomised controlled trial of a vocational rehabilitation health intervention specific to traumatic brain injury. The results will inform the design of a definitive trial. Trial registration: The trial is registered ISRCTN Number 38581822.
Dear Editor, In a recent Editorial of Clinical Rehabilitation , it was pointed out that the adjec... more Dear Editor, In a recent Editorial of Clinical Rehabilitation , it was pointed out that the adjective ‘physical’ in the term ‘physical rehabilitation’ is either unhelpful (because it implies that the difference between mind and body is important in rehabilitation) or worse (because it might reveal prejudice against psychiatric or psychological health problems). The Editorial also argues that use of the framework of the International Classification of Functioning and Health reveals these flaws of logic and offers a coherent unifying model. It may be, however, that this unfortunate adjective has been used in a genuine attempt to separate different styles or packages of rehabilitation, in particular the styles and practice used in psychiatric settings and those in neurological settings (the un-abandoned Cartesian dualism of health services!). One approach is to consider the terms ‘restorative’ and ‘adaptive’ rehabilitation. Restorative rehabilitation models are those that might be used on a stroke unit or for a condition where an improvement in disease and a reduction in impairment are expected. Adaptive rehabilitation is more suitable for progressive conditions, such as dementia. Using the ICF to describe the domains of health, simplified diagrams representing the intervention types used in rehabilitation can be drawn to illustrate the rehabilitation process and the differences between restorative and adaptive rehabilitation. In Figure 1, the elements of rehabilitation that are prominent in restorative rehabilitation are shown in bold, and they particularly include medical treatments and rehabilitation therapies aimed at reducing impairments and their translation into activity limitations. The restorative model is typically time-limited. Note that ‘non-physical’ aspects of care are required in restorative rehabilitation such as reassurance, encouraging behaviour change, and the provision of information. The diagram is re-drawn in Figure 2, which represents adaptive rehabilitation. In this model, there may be little emphasis on attempting to reverse the underlying impairments, but a great deal to gain from optimizing participation from supporting those with whom the patient interacts, by providing skilled and targeted assistance and in environmental modification. The adaptive model is likely to be on-going, as befits the underlying disease that gives rise to the main impairments. These diagrams illustrate that both approaches are rehabilitation approaches, both may use inter-
The view that the profession of occupational therapy will flourish in the 21st century was expres... more The view that the profession of occupational therapy will flourish in the 21st century was expressed before the banking system and financial market collapse in 2008. The profession now competes for scarce resources as austerity measures take effect. A summit meeting at the College of Occupational Therapists, in May 2013, discussed how to improve the profession's understanding and use of health economics. At this meeting, short-, medium-, and longer-term approaches were discussed, with the aim of improving the quality and quantity of publications on economic evaluations in occupational therapy. Despite an increasing number of publications on health economics across professions, occupational therapy lags behind. This focus is now vital for the profession.
International Journal of Therapy and Rehabilitation, 2014
Introduction: Cognitive tests are used to inform recommendations about the safety of people with ... more Introduction: Cognitive tests are used to inform recommendations about the safety of people with dementia to continue driving. The Dementia Drivers’ Screening Assessment (DDSA) is a neuropsychological battery designed to assist in this process. However, it is lengthy to administer and requires materials from various test batteries. Aims: The primary aim of this study was to develop a shortened version of the DDSA for individuals with dementia. Methods: Data on participants with dementia from two studies were analysed. These participants were all drivers with dementia who were identified by community mental health teams and psychiatrists. Each participant was assessed on the DDSA and also assessed on-road by an ‘approved driving instructor’ using the Nottingham Neurological Driving Assessment. Results: This study analysed 102 participants, who had a mean age of 74.0 (SD=7.7) years and of whom 80 (78%) were men. Twenty three drivers were judged to be unsafe and 79 safe. The agreement ...
Introduction: Existing research on vocational rehabilitation following stroke has been criticised... more Introduction: Existing research on vocational rehabilitation following stroke has been criticised for not describing intervention in sufficient detail for replication or clinical implementation. The purpose of this study was to test the feasibility of recording and measuring the content of an early stroke-specific vocational rehabilitation intervention delivered to participants in a feasibility randomized controlled trial, using a proforma previously developed for a study of vocational rehabilitation following traumatic brain injury. Method: The proforma was adapted for use in stroke with input from an expert panel and was used to record intervention content, in 10-minute units, following each intervention session. Findings: Twenty-five people, working or in education at the time of stroke, participated in the study. Two thirds of the therapists' time was spent in face-to-face contact (43%) and liaison with the patient and others (20%). Intervention mainly focused on work prepar...
We are pleased that the National Institute for Health and Care Excellence thought it important to... more We are pleased that the National Institute for Health and Care Excellence thought it important to develop guidelines for the management of patients with stroke.1 We are also reassured by the position taken by the Guideline Development Group (GDG)—that the evidence pointed to intervention improving function and mobility, but that there was little evidence to support one type of intervention over another.2 However, despite the GDG’s intentions to facilitate innovations in practice,3 there is a serious risk that …
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Papers by Kate Radford