Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT

Radford, Kathryn; Sutton, Chris J; Sach, Tracey; Holmes, Jeffrey W.; Watkins, Caroline; Forshaw, Denise; Jones, Trevor; Hoffman, Karen; O’Connor, Rory C.; Tyerman, Ruth; Merchán-Baeza, José Antonio; Morris, Richard; McManus, Emma; Drummond, Avril; Walker, Marion F; Duley, Lelia; Shakespeare, David; Hammond, Alison; Phillips, Julie

doi:10.3310/hta22330

Cited by 42 publications

(86 citation statements)

References 109 publications

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“…Longitudinal studies which evaluate the co-occurrence and association of post-ICU impairments, predictors or return to work and their effects are needed. Also needed are trials of interventions to facilitate return to work, for example, specialist-led vocational70 or combined cognitive and vocational rehabilitation interventions71 such as those used in survivors of traumatic brain injury.…”

Section: Discussionmentioning

confidence: 99%

Return to work after critical illness: a systematic review and meta-analysis

Kamdar

Suri

Suchyta

et al. 2019

Thorax

189

138

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BackgroundSurvivors of critical illness often experience poor outcomes after hospitalisation, including delayed return to work, which carries substantial economic consequences.ObjectiveTo conduct a systematic review and meta-analysis of return to work after critical illness.MethodsWe searched PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from 1970 to February 2018. Data were extracted, in duplicate, and random-effects meta-regression used to obtain pooled estimates.ResultsFifty-two studies evaluated return to work in 10 015 previously employed survivors of critical illness, over a median (IQR) follow-up of 12 (6.25–38.5) months. By 1–3, 12 and 42–60 months’ follow-up, pooled return to work prevalence (95% CI) was 36% (23% to 49%), 60% (50% to 69%) and 68% (51% to 85%), respectively (τ2=0.55, I2=87%, p=0.03). No significant difference was observed based on diagnosis (acute respiratory distress syndrome (ARDS) vs non-ARDS) or region (Europe vs North America vs Australia/New Zealand), but was observed when comparing mode of employment evaluation (in-person vs telephone vs mail). Following return to work, 20%–36% of survivors experienced job loss, 17%–66% occupation change and 5%–84% worsening employment status (eg, fewer work hours). Potential risk factors for delayed return to work include pre-existing comorbidities and post-hospital impairments (eg, mental health).ConclusionApproximately two-thirds, two-fifths and one-third of previously employed intensive care unit survivors are jobless up to 3, 12 and 60 months following hospital discharge. Survivors returning to work often experience job loss, occupation change or worse employment status. Interventions should be designed and evaluated to reduce the burden of this common and important problem for survivors of critical illness.Trial registration numberPROSPERO CRD42018093135.

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Section: Discussionmentioning

confidence: 99%

Return to work after critical illness: a systematic review and meta-analysis

Kamdar

Suri

Suchyta

et al. 2019

Thorax

189

138

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“…Twelve studies from Netherlands [36,[47][48][49][50][51][52][53][54][55][56][57] Nine from England [24,[58][59][60][61][62][63][64][65] Six from USA [66][67][68][69][70][71] Five from Scotland [38,39,[72][73][74] Three from Australia [75][76][77] Three from Canada [78][79][80] Two from Germany [81,82] One from Norway [83] One international [16] One UK study [35] More than 4000 patients with a range of LTNCs were in receipt of interventions: stroke featured in 22 studies, dementia in seven, Parkinson's disease in four, multiple sclerosis and mixed LTNCs in three, Huntingdon's disease in two, motor neurone disease and spinal cord injury in a single study each. The complex interventions delivered were:…”

Section: Resultsmentioning

confidence: 99%

“…Exercise-based interventions in twelve [16,50,51,58,67,68,70,71,73,[76][77][78] Home-based rehabilitation in eight studies [35,36,49,52,53,56,60,82] Psychosocial and educational interventions in seven [48,54,57,64,74,75,83] Communication in three [62,72,79] Continence rehabilitation in three [38,61,65] Motor imagery interventions in two [47,59] Constraint-induced movement therapy in two [63,81] Vocational rehabilitation [24], music therapy [55], oral care [84], memory aids [66], bathing [69], selfmanagement [80] in a single study each More than 400 healthcare professionals delivered the interventions and included, in order of prevalence: occupational therapists, physiotherapists, speech and language therapists, psychologists, music therapists, recreational therapists, nurses, physicians, rehabilitation assistants and social workers. Not all studies reported how many professionals, or which profession was involved.…”

Section: Resultsmentioning

confidence: 99%

Factors affecting the delivery of complex rehabilitation interventions in research with neurologically impaired adults: a systematic review

et al. 2020

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Background Rehabilitation research does not always improve patient outcomes because of difficulties implementing complex health interventions. Identifying barriers and facilitators to implementation fidelity is critical. Not reporting implementation issues wastes research resources and risks erroneously attributing effectiveness when interventions are not implemented as planned, particularly progressing from single to multicentre trials. The Consolidated Framework for Implementation Research (CFIR) and Conceptual Framework for Implementation Fidelity (CFIF) facilitate identification of barriers and facilitators. This review sought to identify barriers and facilitators (determinants) affecting implementation in trials of complex rehabilitation interventions for adults with long-term neurological conditions (LTNC) and describe implementation issues. Methods Implementation, complex health interventions and LTNC search terms were developed. Studies of all designs were eligible. Searches involved 11 databases, trial registries and citations. After screening titles and abstracts, two reviewers independently shortlisted studies. A third resolved discrepancies. One reviewer extracted data in two stages; 1) descriptive study data, 2) units of text describing determinants. Data were synthesised by (1) mapping determinants to CFIF and CFIR and (2) thematic analysis. Results Forty-three studies, from 7434 records, reported implementation determinants; 41 reported both barriers and facilitators. Most implied determinants but five used implementation theory to inform recording. More barriers than facilitators were mapped onto CFIF and CFIR constructs. “Patient needs and resources”, “readiness for implementation”, “knowledge and beliefs about the intervention”, “facilitation strategies”, “participant responsiveness” were the most frequently mapped constructs. Constructs relating to the quality of intervention delivery, organisational/contextual aspects and trial-related issues were rarely tapped. Thematic analysis revealed the most frequently reported determinants related to adherence, intervention perceptions and attrition. Conclusions This review has described the barriers and facilitators identified in studies implementing complex interventions for people with LTNCs. Early adoption of implementation frameworks by trialists can simplify identification and reporting of factors affecting delivery of new complex rehabilitation interventions. It is vital to learn from previous experiences to prevent unnecessary repetitions of implementation failure at both trial and service provision levels. Reported facilitators can provide strategies for overcoming implementation issues. Reporting gaps may be due to the lack of standardised reporting methods, researcher ignorance and historical reporting requirements. Systemic review registration PROSPERO CRD42015020423

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“…However, respondents were mostly high functioning and more likely to be in work, therefore there is a possible response bias. Three similar studies recorded higher response in usual care participants who have returned to work and conversely poor response from usual care participants who did not return to work (Grant, 2016;Phillips, 2013;Radford et al, 2018). Ways of encouraging participants who do not receive intervention and do not return to work need to be found.…”

Section: Feasibilitymentioning

confidence: 94%

Return to work after stroke – Feasibility of 6-year follow-up

Phillips

Gaffney

Phillips

et al. 2018

British Journal of Occupational Therapy

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Introduction: Little is known about long-term work sustainability of stroke survivors. A feasibility trial of early stroke specialist vocational rehabilitation had 32/46 (69.5%) participants available for follow-up at 12 months post stroke. Of these, 19/32 (59.4%) were in work. This study aims to determine the feasibility of longer-term follow-up and explore work status 6 years post stroke. Method: Forty-eight participants fitting criteria for the feasibility trial were sent postal questionnaires measuring employment, income, mood, functional ability and quality of life, and were invited for interview to explore working 6 years after stroke. Ethical approval was obtained. Results: Of the 48 participants, five (10.4%) had died; 19/43 (44.2%) responded. Fourteen were men; mean age 62 (24-78) years. Fourteen (74%) reported working (paid work n ¼ 10, voluntary work n ¼ 3, full-time education n ¼ 1). Five had retired. Most (11/13) remained with preinjury employers. Half (8/15, 53%) reported decreased income since stroke. Compared to one year, median functional ability was marginally higher (extended activities of daily living 63 (IQR 8, range 32-66) to 60 (IQR 9, range 17-66)), but health-related quality of life was lower (EuroQuol Visual Analogue Scale mean 77.4 [SD 11] to 70.7 [SD14]). Six interviewees felt returning to work was the correct decision but struggled with invisible impairments. Conclusion: This study suggests that long-term follow-up is feasible and that those who made a good recovery were more likely to respond. Work remains important to stroke survivors 6 years post stroke.

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Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT

Abstract: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.

Cited by 42 publications

References 109 publications

Return to work after critical illness: a systematic review and meta-analysis

Return to work after critical illness: a systematic review and meta-analysis

Factors affecting the delivery of complex rehabilitation interventions in research with neurologically impaired adults: a systematic review

Return to work after stroke – Feasibility of 6-year follow-up

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