Injury, Inflammation & Recovery Sciences, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK.
Health Division, SINTEF, 7465 Trondheim, Norway.
Int J Environ Res Public Health. 2023 Mar 7;20(6):4694. doi: 10.3390/ijerph20064694.
Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.
了解实施干预措施的人员的哪些属性或特征会影响干预措施的忠实度和患者的结局，对于使干预措施的效果具有现实意义非常重要。这也可能为未来的研究和临床实践中干预措施的实施提供信息。本研究旨在探讨职业治疗师（OT）的属性与其忠实执行早期卒中专科职业康复干预措施（ESSVR）以及卒中幸存者重返工作岗位（RTW）结局之间的关系。39 名 OT 接受了有关其卒中及职业康复方面的经验和知识的调查，并接受了 ESSVR 的培训。2018 年 2 月至 2021 年 11 月期间，ESSVR 在英格兰和威尔士的 16 个地点开展。OT 接受每月的指导以支持 ESSVR 的实施。每个 OT 接受的指导次数记录在 OT 指导记录中。使用针对每个 OT 随机选择的一名参与者进行回顾性案例审查的干预措施组成部分清单评估忠实度。线性和逻辑回归分析探索了 OT 属性、忠实度与卒中幸存者 RTW 结局之间的关系。忠实度得分范围为 30.8%至 100%（平均值：78.8%，标准差：19.2%）。只有 OT 参与指导与忠实度显著相关（b = 0.29，95%CI = 0.05-0.53， < 0.05）。更高的忠实度（OR = 1.06，95%CI = 1.01-1.1， = 0.01）和增加的卒中康复经验年限（OR = 1.17，95%CI = 1.02-1.35）与卒中幸存者积极的 RTW 结局显著相关。本研究的结果表明，指导 OT 可能会提高 ESSVR 的实施忠实度，这也可能与卒中幸存者积极的 RTW 结局相关。结果还表明，具有更多卒中康复经验的 OT 可能能够更有效地支持卒中幸存者重返工作岗位。在临床试验中，为 OT 提供复杂干预措施（如 ESSVR）的技能提升可能需要指导支持，除培训外还需要保证忠实度。
