Early Vocational Rehabilitation Research Articles

Early vocational rehabilitation and psychological support for trauma patients to improve return to work (the ROWTATE trial): study protocol for an individually randomised controlled multicentre pragmatic trial

BackgroundModerately severe or major trauma (injury severity score (ISS) > 8) is common, often resulting in physical and psychological problems and leading to difficulties in returning to work. Vocational rehabilitation (VR) can improve return to work/education in some injuries (e.g. traumatic brain and spinal cord injury), but evidence is lacking for other moderately severe or major trauma.MethodsROWTATE is an individually randomised controlled multicentre pragmatic trial of early VR and psychological support in trauma patients. It includes an internal pilot, economic evaluation, a process evaluation and an implementation study. Participants will be screened for eligibility and recruited within 12 weeks of admission to eight major trauma centres in England. A total of 722 participants with ISS > 8 will be randomised 1:1 to VR and psychological support (where needed, following psychological screening) plus usual care or to usual care alone. The ROWTATE VR intervention will be provided within 2 weeks of study recruitment by occupational therapists and where needed, by clinical psychologists. It will be individually tailored and provided for ≤ 12 months, dependent on participant need. Baseline assessment will collect data on demographics, injury details, work/education status, cognitive impairment, anxiety, depression, post-traumatic distress, disability, recovery expectations, financial stress and health-related quality of life. Participants will be followed up by postal/telephone/online questionnaires at 3, 6 and 12 months post-randomisation. The primary objective is to establish whether the ROWTATE VR intervention plus usual care is more effective than usual care alone for improving participants’ self-reported return to work/education for at least 80% of pre-injury hours at 12 months post-randomisation. Secondary outcomes include other work outcomes (e.g. hours of work/education, time to return to work/education, sickness absence), depression, anxiety, post-traumatic distress, work self-efficacy, financial stress, purpose in life, health-related quality of life and healthcare/personal resource use. The process evaluation and implementation study will be described elsewhere.DiscussionThis trial will provide robust evidence regarding a VR intervention for a major trauma population. Evidence of a clinically and cost-effective VR intervention will be important for commissioners and providers to enable adoption of VR services for this large and important group of patients within the NHS.Trial registrationISRCTN: 43115471. Registered 27/07/2021.

“I’ve still got a job to go back to”: the importance of early vocational rehabilitation after stroke

Purpose Returning to work is an important goal after stroke, not only as a recovery indicator but also for facilitating independent living and improved social identity. The aim of this study was to explore the lived experiences of vocational rehabilitation and the return to work pathway after stroke. Method Qualitative data were collected through semi-structured interviews with purposively selected participants who had participated in a vocational rehabilitation trial. All participants were employed at the time of their stroke and were community-living. Interviews were undertaken by occupational therapists and were transcribed verbatim before data were thematically analysed using a framework approach. Results Sixteen participants were interviewed, seven received specialist vocational rehabilitation and nine received usual clinical rehabilitation. Three major themes were identified which highlighted the importance of tailored vocational rehabilitation to address the challenges that arise when returning to the workplace. Stroke survivors perceived the most beneficial components of the specialist vocational rehabilitation intervention to be employer liaison support, fatigue management, and support for cognition and executive processing skills. Conclusions Vocational rehabilitation was perceived to provide an opportunity to influence working after stroke, although areas of unmet need were highlighted. Findings provide direction for the development of future stroke-specific vocational rehabilitation programs.

Using Co-Design To Develop A Hospital-Based Vocational Rehabilitation Intervention For Adults With Acquired Brain Injury

<h3>Research Objectives</h3> Although recommendations are for vocational rehabilitation to commence soon after injury, there are acknowledged challenges to commencing this activity during hospitalisation, when clinical goals are more often centred on basic activities (such as self-care and mobility). This study aimed to develop a vocational rehabilitation intervention for people who have suffered brain injury, that is suitable for delivery in an inpatient rehabilitation setting. <h3>Design</h3> Using an action-research design, this study followed a participatory, intervention mapping approach to develop and pilot the intervention. <h3>Setting</h3> Specialist inpatient brain injury rehabilitation unit, Melbourne, Australia. <h3>Participants</h3> Stakeholder participants included n=14 allied health clinicians (including occupational therapists, speech and language therapists, physiotherapists, clinical and neuropsychologists and social workers) who worked in collaboration with researchers (n=2) to co-design the vocational rehabilitation intervention process. An open invitation was extended to clinicians to participate in the intervention mapping process. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Systematic literature review identified the barriers and enablers to providing work-focussed interventions in the inpatient setting. Qualitative focus groups and document review were used iteratively to identify intervention objectives and outcomes, before intervention strategies were developed and trialed. <h3>Results</h3> Early vocational rehabilitation interventions should be delivered in partnership with the patient, clinicians, family and their social network (inclusive of the workplace). A comprehensive, five phase program was developed: (i) orientation to the worker role, (ii) building awareness of work activities, (iii) improving core work skills, (iv) improving job-specific skills, (v) discharge planning from the program. <h3>Conclusions</h3> Co design offered an excellent opportunity to develop an intervention which supported an interdisciplinary team to embed vocational rehabilitation into usual hospital-based rehabilitation. <h3>Author(s) Disclosures</h3> Study is funded by the Transport Accident Commission through the small grants scheme. Natasha Lannin is supported by the Australian Heart Foundation Future Leader Fellowship (102055).

Results from phase one of an early intervention vocational rehabilitation trial for people with spinal cord injury conducted in Queensland, Australia

BACKGROUND: The Back2Work Early Intervention Vocational Rehabilitation (EIVR) program was developed in response to the low employment rate of people with spinal cord injuries (SCI) and their lack of access to early, specialised vocational rehabilitation (VR). The program has been delivered by qualified rehabilitation counsellors to hospital patients with newly acquired SCI since 2016. OBJECTIVE: The objective of the study was to evaluate the effectiveness and consumer perspective of the Back2Work EIVR program. METHODS: The program was evaluated using a mixed-methods, longitudinal, prospective design. RESULTS: Data analysis revealed a return to work rate (RTW) of 43% by 12 months post-discharge. Qualitative data indicated positive participant experiences with the program, emphasising the hopefulness brought about by early vocational support. CONCLUSIONS: The Back2Work program has a positive impact on participants’ RTW outcomes, through the provision of early specialist vocational rehabilitation interventions. This includes building a positive culture around RTW after SCI and engagement with employers to maximise the likelihood of timely and sustainable re-employment. The RTW outcomes and emergent themes will help inform service development in the field of early vocational rehabilitation after SCI.

Early vocational rehabilitation after spinal cord injury: A survey of service users

BACKGROUND: Early vocational rehabilitation following spinal cord injury (SCI) improves return to work (RTW) outcomes, but there is limited information about who benefits from such interventions, why and in what contexts. OBJECTIVE: We aimed to describe demographic and clinical characteristics and RTW outcomes of adults with SCI who received early vocational rehabilitation. We sought to identify key mechanisms of early vocational rehabilitation. METHODS: This is a cross-sectional survey of people with SCI recruited from the New Zealand Spinal Trust Vocational Rehabilitation Service, who had sustained an SCI within the previous five years. RESULTS: Of the 37 people who responded to the survey, 54% returned to paid work (90% of whom retained their pre-injury employment). Those in autonomous roles returned to work faster with greater odds of returning to their pre-injury employer and role. Participants highlighted the importance of feeling hopeful about RTW while still in the spinal unit as a key mechanism of effect within the early vocational intervention. CONCLUSIONS: Findings suggested key mechanisms of early vocational intervention could be framed by models of hope. However, for gains to be optimised, continuity of support beyond the acute stage was suggested as an area for future research.

Exploring employment following traumatic brain injury in persons who completed an insurer funded vocational rehabilitation program in Australia

Purpose To extend the authors’ previous research by investigating the maintenance of work performance over time and the long-term experience of employment following traumatic brain injury (TBI). Materials and methods Semi-structured interviews were conducted with a sample of 72 individuals with predominantly severe TBI, up to 10-years post-injury. Thematic analysis of transcribed interviews was conducted. Results Four key themes were identified: brain injury influences on work performance and long-term employment; factors optimising long-term employment; and need for compromise and acceptance, which all impacted the final theme, quality of life outcome. While TBI-related difficulties such as fatigue, cognitive, and emotional difficulties still impacted work many years post-injury, work modifications and employer and vocational rehabilitation (VR) support were important factors optimising long-term employment. The timing of return to work (RTW) was also an important and potentially modifiable factor influencing work performance, which appeared to have long-term effects on the maintenance of employment. Support for acceptance of altered career goals is needed. Conclusion Findings support the need for early VR to facilitate employer contact, to maximise adjustment and preparation time before RTW, to educate both employees and employers and to implement work modifications to support continuing employment after TBI. Implications for rehabilitation The maintenance of employment following TBI is of critical importance for financial independence, psychological and social well-being, and improved quality of life. Injury-related difficulties still impact work performance many years after injury requiring individuals with TBI to continue working in modified roles and for reduced hours over the long-term. Ongoing VR and employer support is needed to facilitate long-term work modifications and compensatory strategies to support work performance. Early VR involvement to facilitate employer contact and maximise adjustment and preparation time before returning to work is necessary to avoid the negative and potentially dire consequences of returning too early. Psychological support to facilitate acceptance of role changes and career compromises is also important.

Risk Factors for Disability Pension among Young Adults Diagnosed with Attention-deficit Hyperactivity Disorder (ADHD) in Adulthood

Objective: To investigate risk factors of disability pension (DP) in young adults diagnosed with ADHD in Sweden. Method: In total, 9718 individuals diagnosed with incident ADHD in young adult age (19–29 years) 2006 to 2011, were identified through national registers. They were followed for 5 years and Cox regression models were applied to analyze the DP risk (overall and by sex), associated with socio-demographics, work-related factors, and comorbid disorders. Results: Twenty-one percent of all received DP. Being younger at diagnosis (hazard ratio [HR] = 1.54; 95%confidence interval [CI] 1.39–1.71); low educational level (HR = 1.97; 95%CI 1.60–2.43 for <10 years); work-related factors at baseline (no income from work [HR = 2.64; 95%CI 2.35–2.98] and sickness absence >90 days [HR = 2.48; 95%CI2.17–2.83]); and schizophrenia/psychoses (HR = 2.16; 95%CI 1.66–2.80), autism (HR = 1.87; 95%CI 1.42–2.46), anxiety (HR = 1.34; 95%CI 1.22–1.49) were significantly associated with an increased risk of DP. Similar risk patterns were found in men and women. Conclusion: Work-related factors and comorbid mental disorders need to be highlighted in early vocational rehabilitation for individuals with ADHD.

Consumer perspectives of vocational rehabilitation and return to work following acquired brain injury

AbstractIntroduction:Following acquired brain injury, the goal of return to work is common. While return to work is supported through different rehabilitation models and services, access to vocational rehabilitation varies within and between countries, and global rates of employment post-injury remain low. The literature identifies outcomes from vocational programs and experiences with return to work, yet little is known about individuals’ perceptions and experiences regarding rehabilitation to support their vocational goals and experiences in attempting to return to work.Method:This qualitative study investigated the experiences of community-living adults with acquired brain injury (n = 8; mean age 45 years; mean time post-injury of 5.5 years) regarding their vocational rehabilitation and return to work. Focus groups and semi-structured interviews were conducted, with data analyzed via thematic analysis.Results:Participants identified negative and positive experiences with vocational rehabilitation and return to work. Five overarching themes were identified: addressing vocational rehabilitation in rehabilitation; facilitators of recovery and return to work; the importance and experience of working again; acquired brain injury and identity; and services, systems and policies. Participants also identified five key areas for early vocational rehabilitation services: education; service provision; employer liaison; workplace supports; and peer mentors. Study findings inform current and future practice and service delivery, at a clinical, service and system level.

Back2Work: a new model of early vocational rehabilitation for people with spinal cord injury.

Objective The aim of this article is to describe the development of a novel evidence-based model of early intervention vocational rehabilitation (EIVR) for people with spinal cord injury (SCI). Methods An extensive literature review and background study guided the collaboration of experienced practitioners and researchers in developing and evaluating the innovative Back2Work model of EIVR for people with SCI in Queensland, Australia. The program is undergoing longitudinal mixed-methods evaluation to the end of 2023. Results The model is central to the successful implementation of the EIVR program, delivered by rehabilitation counsellors in the Queensland Spinal Injuries Unit. Back2Work includes a strong focus on maintaining and nurturing the pre-injury occupational bond between injured workers and employers, and aims to create a positive expectation for return to work (RTW) and increase the rate and timeliness of RTW after SCI. Conclusions The Back2Work program has become an integrated component of the multidisciplinary rehabilitation team, with positive early results in RTW outcomes and additional benefits in participants' sense of well-being and hope. What is known about the topic? Vocational intervention after SCI has traditionally been delivered after hospital discharge and considered outside the scope of early intervention approaches. Emerging evidence suggests EIVR, commencing before hospital discharge, can encourage hope and a positive expectancy for employment after SCI, and is showing promising outcomes in supporting people's quality of life and vocational goals. What does this paper add? This article details the process and product of developing and evaluating a novel EIVR model for people with SCI. The model underpins the Back2Work EIVR program being trialled in the Queensland Spinal Injuries Unit, an example of this emerging field of practice within the primary rehabilitation setting. What are the implications for practitioners? The Back2Work program is based on an innovative and evidence-based model of EIVR for people with SCI. The collaborative and empirically driven process of developing, implementing and evaluating the model will be of interest to researchers and practitioners looking to advance practices in vocational rehabilitation after serious injury.

An individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations of early vocational rehabilitation compared with usual care for stroke survivors: study protocol for the RETurn to work After stroKE (RETAKE) trial

BackgroundReturn 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.MethodsSeven hundred sixty 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’ homes or workplaces, and outpatient/inpatient therapy settings, via telephone, email, or SMS text message. Outcome data will be collected via self-report questionnaires administered by post or online at 3, 6, and 12 months follow-up. The primary outcome will be self-reported RTW and job retention at 12 months (minimum 2 h/week). Secondary outcomes will include mood, function, participation, health-related quality of life, confidence, intervention compliance, health and social care resource use, and mortality. An embedded economic evaluation will estimate cost-effectiveness and cost-utility analyses from National Health Service (NHS) and Personal Social Services (PSS) perspectives. An embedded process evaluation will employ a mixed methods approach to explore ESSVR implementation, contextual factors linked to outcome variation, and factors affecting NHS roll-out.DiscussionThis article describes the protocol for a multi-centre RCT evaluating the clinical- and cost-effectiveness of an early vocational rehabilitation intervention aimed at supporting adults to return to work following a stroke. Evidence favouring the ESSVR intervention would support its roll-out in NHS settings.Trial registrationISRCTN, ISRCTN12464275. Registered on 26 February 2018.

Early Vocational Rehabilitation After Serious Injury or Illness: A Systematic Review

The aim of this systematic review was to compile the evidence for early vocational rehabilitation interventions for people with major injury or illness. Embase, Scopus, Cochrane Library, Medline, CINAHL, and Psycinfo databases were searched. Five hundred abstracts were reviewed for eligibility. Full-text review of 125 studies revealed a total of 25 published studies that met the eligibility criteria to be included in this review evaluating early approaches to vocational rehabilitation and return to work. Findings suggest that intervening early with respect to an individual’s vocational goals is imperative, although the definition of “early” varies. Programs achieve better vocational outcomes when specifically employing comprehensive vocational interventions, including vocational assessment, individualized planning, and follow-up support, to ensure a person’s return to employment is timely and sustained. Integration of vocational rehabilitation professionals within a multidisciplinary team and access to advocacy services were shown to be effective inclusions in early vocational rehabilitation programs for people with a serious injury or illness.

Exploring the ‘status quo’ in vocational rehabilitation and employment outcomes following spinal cord injury

BACKGROUND: An exploratory baseline study was conducted to ascertain the state of play in the field of spinal cord injury, vocational rehabilitation and employment in Queensland, Australia. OBJECTIVE: The aim of this study was to establish the rate of return to work and better understanding of vocational expectations and the vocational rehabilitation culture in the Queensland Spinal Injuries Unit, prior to the introduction of an early vocational rehabilitation intervention for people with spinal cord injury. METHODS: A mixed methods approach was utilised, involving administration of either an online survey tool or paper questionnaire to people who had sustained a spinal cord injury within the preceding three years. Statistical analysis of the quantitative data and thematic analysis of the qualitative free-text data was undertaken with the 34 eligible responses. RESULTS: The findings demonstrate a dramatic change in the rate of employment following spinal cord injury, and a lack of vocationally focused support whilst participants were undergoing in-patient rehabilitation. CONCLUSIONS: The study indicates a return to work rate of approximately 35%, and provides support for an individualised vocational rehabilitation intervention, fully integrated into the multidisciplinary spinal injuries unit rehabilitation program.

Early vocational rehabilitation for patients with spinal injury: a qualitative research study of service providers

Background/Aims: Early intervention is among the factors frequently associated with positive vocational rehabilitation outcomes. However, vocational rehabilitation is not generally a core component of inpatient rehabilitation for individuals with spinal cord injury, who traditionally have poor vocational outcomes. This study explored the perceptions of vocational coordinators providing early and integrated vocational rehabilitation services in the inpatient hospital settings and their opinions regarding the structures and processes of the interventions. Methods: All the four vocational coordinators involved in providing early integrated vocational services at the three spinal units in New South Wales, Australia were interviewed (in-depth) as key informants using a semi-structured approach. Transcripts of the interviews were created via audio recordings, transcribed verbatim, and the contents were analysed thematically. Findings: Many benefits were seen for vocational coordinators working within a multidisciplinary team in the hospital settings chiefly providing and promoting vocationally oriented therapy. Timing of service provision was not the overarching issue given the optional and voluntary nature of the intervention. The counselling role was seen as eminent given the challenging and (occasionally confronting) nature of working with newly injured individuals. Conclusions: The key nature of service provision being patient-centred and paced, within the context of a supportive spinal cord injury rehabilitation team, seemed to engender much hope and optimism, which are salient for newly injured individuals with spinal cord injury in the hospital setting.

Benefit Duration and Return to Work Outcomes in Short Term Disability Insurance Programs: Evidence from Temporary Disability Insurance Program.

Purpose The Workforce Innovation and Opportunity Act strengthens the vocational rehabilitation program's focus on providing early intervention services to keep workers with disabilities in the workforce. At the same time, some have suggested that short-term disability insurance (STDI) programs may hold promise as an early intervention service, helping people with disabilities stay in the labor force and avoid needing longer-term benefits. Rhode Island is one of five states with a mandatory STDI program. We examine the extent to which Rhode Island STDI claimant characteristics are correlated with partial return-to-work (PRTW) benefit receipt and certain STDI benefit receipt duration measures.Methods Our study used administrative data from 2011 to 2014 to explore Rhode Island's STDI program-called the Temporary Disability Insurance program-and regression analysis to estimate the correlations of interest. Results Regression adjusted estimates revealed that claimants opting to receive PRTW benefits earned more and received benefits for fewer weeks than claimants opting to not receive PRTW benefits. We also observed significant correlations between duration of benefit receipt and claimant characteristics such as diagnosis and treating healthcare provider specialty. Conclusions Findings suggest that STDI claimants with certain characteristics are more likely to receive benefits for a long duration or not receive PRTW benefits, signaling that they might benefit from early Vocational Rehabilitation supports and services that would allow them to remain productive members of the workforce and avoid long term benefit receipt.

Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries.

The design was a narrative review. The objective of the study was to investigate the potential for early vocational rehabilitation (VR) interventions for people with spinal cord injury (SCI) in overcoming barriers in returning to work, and to pinpoint factors contributing to effectiveness in early VR intervention for this population. The setting was at Queensland, Australia. Synthesis of the findings of a literature search of online databases ProQuest and CINAHL, using keywords relating to the employment situation and VR of people with SCI. Themes were identified and analysed in accordance with the research objectives. Despite increasing government commitment to the workforce and social participation of people with disabilities, Australians living with SCI have significantly diminished employment outcomes compared with the general population. Current VR approaches usually do not commence until some months post discharge, potentially missing a window of opportunity to preserve pre-existing employment or assist in vocational decision making. The review found that there are opportunities for enhancing VR service provision following SCI, namely integrating the VR programme within the primary rehabilitation team thus facilitating early VR intervention. Emerging evidence shows promising results for early intervention in VR; however, questions remain regarding ideal intervention approaches, and it is clear that further empirical investigation is required to support the use of early intervention models post SCI. The study was sponsored by Motor Accident Insurance Commission (MAIC).

Early access to vocational rehabilitation for inpatients with spinal cord injury: A qualitative study of staff perceptions.

Early intervention is among the factors frequently associated with more positive vocational rehabilitation outcomes; however, vocational rehabilitation is not generally a core component of inpatient rehabilitation following spinal cord injury. This qualitative study explored the opinions and perceptions of health professionals regarding InVoc, an early vocational rehabilitation intervention provided to spinal cord injury unit inpatients. The aim of this evaluation was to determine the critical elements of the InVoc programme, and whether it was perceived as successfully implemented in the hospital setting. Twenty-five medical and allied health staff working in the 3 Spinal Cord Injury Units in New South Wales, Australia, participated in the qualitative study. Three staff focus-group discussions were conducted and data analysed thematically. Four themes emerged: timeliness of the intervention, support and advocacy, value of early intervention, and conflicting messages to patients. Three critical programme elements were identified: flexibility, coordinators working on the ward, and good communication between all staff. Early vocational rehabilitation was perceived as appropriate and successfully implemented in the spinal injury unit in-patient setting, addressing an existing gap in patient care. The InVoc programme was seen to assist patients identify the possibility of returning to work and/or education. The importance of programme flexibility was highlighted.

Evaluation of the implementation of the protocol of an early vocational rehabilitation intervention for people with acquired brain injury

Purpose: The purpose of this study was to evaluate (1) the feasibility of an early vocational rehabilitation (EVR) protocol in the standard rehabilitation process, (2) promoting factors and barriers encountered with the EVR protocol, and (3) perceived effectiveness of the protocol in facilitating return to work (RTW) following acquired brain injury (ABI). Method: A pre- and post-process evaluation was performed in a Dutch rehabilitation center. Dependent variables were feasibility (defined by the usability on process level and fulfillment of usability expectations), promoting factors and barriers, and perceived effectiveness of the protocol. Usability (defined by 13 performance and timing goals) was evaluated with existing forms and registrations. Fulfillment of usability expectations, perceived promoting factors and barriers, and perceived effectiveness were investigated with questionnaires. Data of 23 patients were available for process evaluation. Nine rehabilitation professionals, 10 patients with ABI, nine employers, and six occupational physicians completed the questionnaires. Results: Two-thirds of the performance goals and one-fourth of the timing goals were reached. All respondents cited the structured protocol as a promoting factor. Thirty-two of the thirty-four participants perceived the protocol as being suitable facilitating RTW after ABI. Conclusions: The EVR protocol provides a structured strategy to focus on RTW during standard rehabilitation. It is now possible to implement and test the protocol in other rehabilitation settings.Implications for RehabilitationThe early vocational rehabilitation (EVR) facilitates an interdisciplinary and systematic focus on return to work during rehabilitation of people with acquired brain injury.The feasibility of the EVR protocol has been tested.The EVR protocol is ready for implementation and wider testing in other rehabilitation settings.

Early vocational rehabilitation after acquired brain injury: A structured and interdisciplinary approach

BACKGROUND: There are indications that specialist vocational rehabilitation is beneficial when trying to return to work after acquired brain injury (ABI). OBJECTIVE: To give a description of the Early Vocational Rehabilitation (EVR) protocol and its development in order to make it available for implementation in rehabilitation institutes to strengthen the appearance of these institutes as relevant partners and supporters during the process of (sustaining) return to work of people with ABI. METHODS: The Early Vocational Rehabilitation (EVR) protocol is a process guideline to facilitate the interdisciplinary rehabilitation team to systematically focus on return to work during an early stage of (inpatient or outpatient) rehabilitation of people with ABI. The development was expert based. RESULTS: The EVR protocol consists of four stages: 1) orientation of the rehabilitation team towards the patient’s work; 2) investigating the gap between the patient’s abilities and work; 3) work training; and 4) finalizing EVR. Cooperation among all relevant partners from inside or outside the rehabilitation institute is important for maximally adapting the EVR treatment to the individual (work) situation of the person with ABI. CONCLUSION: The EVR protocol is available for implementation in other rehabilitation institutes. Performing a context analysis for each new context in which it is implemented is recommended.

Early access to vocational rehabilitation for spinal cord injury inpatients

To describe a novel early vocational rehabilitation programme (In-Voc) for inpatients with spinal cord injury and to report early vocational outcomes. Observational longitudinal cohort study. One hundred adults with spinal cord injury admitted to spinal units in Sydney, Australia within a 24-month period. In-Voc was offered to all inpatients within the first 6 months of acquired spinal cord injury and was provided by trained vocational consultants. Baseline demographics, opinions about work readiness, details of the vocational services provided and preliminary employment outcomes were documented. The In-Voc programme was relatively short in duration (median 11 weeks, range 3-39 weeks) with a median total of 9.1 h (range 1-75.2 h) of service delivered per participant. At case closure (median 3 weeks post-discharge), 29/84 (34.5%) of participants were in paid employment (7% full-time, 8% part-time, 7% on sick leave, and 12% working with hours unknown), 36% were unemployed (6% seeking work, 16% not seeking work, 14% job seeking status unknown), 13% were students or in-training, and 17% were in vocational rehabilitation. Our research suggests that implementing an early vocational rehabilitation programme with individuals in the hospital setting is feasible and has good potential for enhancing post-injury labour-force participation.

Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision

Purpose: This study aimed to clarify the existing service provision of stroke-specific vocational rehabilitation (VR) in one English county, in order to facilitate future service development. Method: Using soft systems methodology, services in Health, Social Care, Department of Work and Pensions, the voluntary and private sectors, which were identified as supporting return to work after stroke, were mapped using a mixed-methodology approach. Results: A lack of a sanctioned VR pathway meant access to support relied on brokered provision and tacit knowledge. The timing of an intervention was complex and there was a substantial degree of unmet need for mild stroke patients. VR was seen as “non-essential” due to competing commissioning priorities. Service providers from all sectors lacked training and cross-sector partnerships were tenuous and provider roles unclear. Conclusions: Stroke-specific VR should be delivered by an integrated, cross-sector multi-disciplinary team and integrated commissioning between health and other sectors is necessary. Although early intervention is important, support later on in the recovery process is also necessary. Service providers need adequate training to meet the needs of stroke survivors wishing to return to work and better awareness of best practice guidelines. Business cases which demonstrate the efficacy and cost-effectiveness of VR are vital.Implications for RehabilitationThe timeliness of a vocational rehabilitation (VR) intervention is complex; services need to be responsive to the changing needs of the stroke survivor throughout their recovery process and have better mechanisms to ensure re-entry into the stroke pathway is possible.Return to work is a recognised health outcome; health services need to develop better mechanisms for interagency/cross sector working and liaison with employers and not assume that VR is beyond their remit. Therapists and non-health service providers should receive sufficient training to meet the needs of stroke survivors wishing to return to work. Rehabilitation teams must decide how to implement national guidance within existing resources and what training is needed to deploy SSVR.The lack of a sanctioned pathway results in disorganised and patchy provision of VR for stroke survivors; mild stroke patients can fall through the net and receive little or no support. The journey back to work commences at the point of stroke. Mechanisms for identifying acute stroke survivors who were working at onset and for assessing the impact of the stroke on their work need to be put in place. The entire MDT has a role to play. In the absence of a VR specialist, even patients without obvious disability should be referred for ongoing rehabilitation with detailed work assessment and signposted to employment specialists e.g. disability employment advisors EARLY after stroke.Health-based VR interventions can influence work return and job retention. However, therapists must routinely measure work outcomes to inform their business case and be encouraged to demonstrate these outcomes to local commissioners. Commissioners should consider emerging evidence of early VR interventions on reduced length of stay, health and social care resource use and the wider health benefits of maintaining employment.