Designing an intervention process that embeds work‐focussed interventions within inpatient rehabilitation: An intervention mapping approach

Abstract

Introduction Returning to work is a goal for many people after brain injury. The failure to return to work after injury brings both economic and personal (quality of life) costs to those living with stroke or brain injury, their families, and society. This study explored the barriers to providing work‐focused interventions during hospital‐based rehabilitation and co‐created solutions with rehabilitation providers to increase the provision of work‐focused intervention during inpatient rehabilitation. Methods This study used an Intervention Mapping approach (a six‐step protocol that guides the design of complex interventions) based on an action research methodology. Focus group data, in addition to best evidence from systematic reviews, practice guidelines and key articles were combined with theoretical models for changing behaviour and clinician experience. This was then systematically operationalised into an intervention process using consensus among clinicians. The process was further refined through piloting and feedback from key stakeholders, and group consensus on the final process. Results A detailed five phase return to work intervention process for inpatient rehabilitation was developed. The key features of the process include; having one key allied health clinician to coordinate the process, choosing assessments based on pre‐injury work demands, emphasising the importance of core work skills and considering the most appropriate service for referral at the conclusion of rehabilitation. Conclusion We used a systematic approach, guided by the intervention mapping approach and behaviour change theory to tailor existing workfocused interventions to the inpatient setting.

A Tailored Occupational Therapist–Led Vocational Intervention for People With Stroke: Protocol for a Pilot Randomized Controlled Trial

“…The occupational therapist then compares the client’s capabilities to the worker role requirements to forecast potential challenges that may be faced in the workplace; determine work limits and capabilities; coordinate appropriate supports and resources required from health care professionals, employers, and community services; as well as negotiate workplace adjustments, monitor return to work, and explore alternatives where current work is not feasible or sustainable [ 10 - 12 ]. Rehabilitation interventions then commence with establishing a daily routine in the home and building awareness of the worker role before all participants receive rehabilitation to address core work skills (such as problem solving complex situations or working as part of a team) [ 13 ]. The intervention may also address poststroke fatigue and enable community access through transport training or provide work conditioning to restore physical and cognitive capacity for work, work hardening programs [ 14 ], functional or cognitive capacity evaluations [ 15 ], or job task training before establishing an individualized return-to-work plan for each participant.…”