Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
Centre for Rehabilitation & Ageing Research Medicine/ Injury, Inflammation and Recovery Sciences, School of Medicine, Medical School Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom.
PLoS One. 2024 Oct 9;19(10):e0311101. doi: 10.1371/journal.pone.0311101. eCollection 2024.
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.
对于工作年龄的中风幸存者来说，一个关键目标是重返工作岗位，但只有约 50%的人在 12 个月时实现这一目标。目前，随机对照试验中关于早期中风专科职业康复（ESSVR）干预措施有效性的证据有限。本研究检查了 ESSVR 的保真度，并探讨了可能影响 RETurn to work After stroKE（RETAKE）随机对照试验实施的社会和结构因素。
采用混合方法过程评估，评估干预措施的保真度，并纳入纵向案例研究，探讨中风幸存者重返工作岗位的支持体验。正常化进程理论和实施保真度概念模型为数据收集和分析提供了信息。
英格兰和威尔士的 16 个地点参与了 RETAKE。16 名职业治疗师（OT）在 6 名职业康复经验丰富的导师的支持下，于 2018 年 2 月至 2022 年 4 月期间提供了为期 12 个月的干预措施（ESSVR）。26 名参与者（15 名 ESSVR，11 名常规护理（UC））被纳入纵向案例研究。另外 18 名参与者（8 名 ESSVR 和 10 名 UC）接受了一次采访。19 名职业治疗师、6 名导师和 19 名服务经理接受了采访。对 39 名 ESSVR 参与者进行了保真度测量；平均保真度评分为 78.8%（SD：19.2%，范围 31-100%）。ESSVR 和 UC 参与者体验的比较表明，ESSVR 参与者的返回工作支持的持续时间和类型被认为更好。他们接受了早期、协调的支持，包括雇主联络和适当的工作场所调整。相比之下，UC 参与者报告说，他们没有从健康专业人员那里获得职业康复或重返工作的支持。通常，UC 支持持续 2-8 周，康复提供者之间沟通和协调不佳。导师对 OTs 的支持似乎提高了保真度。服务经理表示，ESSVR 将增强中风后的服务。
ESSVR 受到参与者的重视，并以保真度交付；实施似乎通过导师对 OTs 的支持得到促进。
