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Simpson GK, McRae P, Gates TM, Daher M, Johnston D, Cameron ID. A vocational intervention that enhances return to work after severe acquired brain injury: A pragmatic trial. Ann Phys Rehabil Med 2023; 66:101787. [PMID: 37890426 DOI: 10.1016/j.rehab.2023.101787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Following a severe acquired brain injury, individuals often have low return to work rates. The Vocational Intervention Program (VIP), a partnership of Brain Injury Rehabilitation Program community rehabilitation centres with external vocational rehabilitation providers in New South Wales, Australia, was developed to facilitate a return to competitive employment for working-age people. OBJECTIVES To evaluate the efficacy of the VIP partnership model, this intervention was compared to outcomes from a health-based brain injury vocational rehabilitation centre (H-VR) or community brain injury rehabilitation centres ("treatment as usual"; TAU). METHODS A 3-arm non-randomized controlled trial was conducted among the 12 adult rehabilitation centres of the NSW Brain Injury Rehabilitation Program. The VIP arm was delivered by 6 community rehabilitation centres in partnership with 3 external private Vocational Rehabilitation providers. The H-VR arm was delivered by 1 health-based vocational rehabilitation centre and the 5 remaining centres delivered TAU. Competitive employment status ("Yes"/"No") and clinician ratings of disability and participation were collected pre- and post-intervention, and at 3-month follow-up. Multilevel models were conducted to investigate change over time by treatment arm. RESULTS In total, 148 individuals with severe brain injury were included in the trial: n = 75 (VIP), n = 33 (H-VR) and n = 40 (TAU). Sixty-five people (of 108, 60%) completed the VR intervention. A significant arm-by-time interaction was found, with higher return to work rates from pre- to post-intervention in VIP and H-VR arms compared to TAU (P = 0.0002). Significant arm-by-time interactions also indicated improved work-related participation and independent living skills from pre- to post-intervention in VIP and H-VR compared to the TAU arm (P < 0.05). These improvements were maintained at 3-month follow-up. CONCLUSIONS The VIP improved return to competitive employment at comparable rates to the specialist H-VR. Larger-scale adoption of the VIP model could provide significant improvements in vocational rehabilition sevices to support people in their return to work following severe brain injury. ANZCTR TRIAL REGISTRY NUMBER ACTRN12622000769785.
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Affiliation(s)
- Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia.
| | - Philippa McRae
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney, NSW, Australia
| | - Thomas M Gates
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Maysaa Daher
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney, NSW, Australia
| | - Deborah Johnston
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Ian D Cameron
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia
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Watter K, Murray A, McLennan V, Vogler J, Ehlers S, Jeffery S, Nielsen M, Kennedy A. Clinician perspectives of ABI vocational rehabilitation in Queensland. BRAIN IMPAIR 2023; 24:371-394. [PMID: 38167193 DOI: 10.1017/brimp.2023.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Services to support adults with acquired brain injury (ABI) and return to work goals are varied. In Queensland, Australia, return to work goals may be addressed through private or publicly funded rehabilitation services or through publicly funded employment programs. No set frameworks or processes are in place to guide clinicians in providing vocational rehabilitation to adults with ABI, and the extent to which services address clients' vocational goals and/or provide vocational rehabilitation is unknown. METHOD This qualitative study investigated the clinical practice and experiences of allied health rehabilitation clinicians (n = 34) to identify current practice in providing vocational rehabilitation to adults with ABI, including pathways and services; models, frameworks and tools; and recommendations for ideal services. Focus groups and online surveys were conducted, with data analysed via content analysis. RESULTS ABI vocational rehabilitation was inconsistently delivered within and across services in Queensland, with differences in access to services, aspects of vocational rehabilitation provided and timeframes for rehabilitation. Five key themes were identified regarding ABI vocational rehabilitation and service delivery in Queensland: Factors influencing ABI and return to work; Service provision; ABI vocational rehabilitation processes (including assessment tools and interventions); Service gaps; and Ideal ABI vocational rehabilitation services. DISCUSSION These findings can inform clinical practice and development, and current and future service delivery models for ABI vocational rehabilitation.
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Affiliation(s)
- Kerrin Watter
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, QLD, Australia
| | - Alena Murray
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, QLD, Australia
| | - Vanette McLennan
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, QLD, Australia
- School of Allied Health Sciences, Griffith University, QLD, Australia
| | - Jessica Vogler
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Shelley Ehlers
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Sarah Jeffery
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Mandy Nielsen
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, QLD, Australia
| | - Areti Kennedy
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, QLD, Australia
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Watter K, Murray A, McLennan V, Vogler J, Jeffery S, Ehlers S, Nielsen M, Kennedy A. A framework to support early team-based provision of vocational rehabilitation for adults with acquired brain injury. Disabil Rehabil 2023:1-13. [PMID: 37525931 DOI: 10.1080/09638288.2023.2239162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE Specialised vocational rehabilitation (VR) following acquired brain injury (ABI) positively impacts return to work, however access to this is limited globally. Providing VR as a component of standard ABI rehabilitation may improve access to VR and influence vocational outcomes. This study aimed to develop an evidence-based framework for the delivery of ABI VR during early transitional community rehabilitation. MATERIALS AND METHODS The development of the ABI VR framework utilised an emergent multi-phase design and was informed by models of evidence-based practice, national rehabilitation standards, guidelines for complex intervention development, model of care and framework development, and the knowledge-to-action framework. Four study phases were undertaken to identify and generate the evidence base, with findings synthesised to develop the ABI VR framework in phase five. RESULTS The framework provides a structure for the systematic delivery of VR as a component of team-based ABI rehabilitation, through five phases of rehabilitation: assessment; goal setting and rehabilitation planning; intervention; monitoring and evaluation; and discharge. It details the activities to be undertaken across the phases using a hybrid model of ABI VR (involving program-based VR and case coordination) and contains service delivery features. CONCLUSION The framework has the potential to translate to other similar service contexts.Implications for rehabilitation:An evidence-based framework has been developed to support the provision of vocational rehabilitation as a component of team-based rehabilitation for adults with acquired brain injury, within the context of early, community rehabilitation.Providing vocational rehabilitation as a component of team-based rehabilitation should improve access to vocational rehabilitation and may positively influence client return to work outcomes.The vocational framework may assist clinicians to identify components of vocational rehabilitation that they can deliver in practice in their own service context.
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Affiliation(s)
- Kerrin Watter
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
- Menzies Institute and School of Allied Health Sciences, Griffith University, Qld, Australia
| | - Alena Murray
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
| | - Vanette McLennan
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
- Menzies Institute and School of Allied Health Sciences, Griffith University, Qld, Australia
| | - Jessica Vogler
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Sarah Jeffery
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Shelley Ehlers
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
| | - Mandy Nielsen
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
- Menzies Institute and School of Allied Health Sciences, Griffith University, Qld, Australia
| | - Areti Kennedy
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia
- The Hopkins Centre, Division of Rehabilitation, Metro South Health and Menzies Institute, Griffith University, Qld, Australia
- Menzies Institute and School of Allied Health Sciences, Griffith University, Qld, Australia
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Slayter J, Journeay WS. Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Workplace Accommodations for Returning to Work After Mild Traumatic Brain Injury. Am J Phys Med Rehabil 2023; 102:e76-e78. [PMID: 36821464 DOI: 10.1097/phm.0000000000002217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Jeremy Slayter
- From Dalhousie Medicine New Brunswick, Faculty of Medicine, Dalhousie University, Saint John, Canada (JS, WSJ); Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada (WSJ); and Providence Healthcare-Unity Health Toronto, Toronto, Canada (WSJ)
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MARTIN RA, JOHNS JK, HACKNEY JJ, BOURKE JA, YOUNG TJ, NUNNERLEY JL, SNELL DL, DERRETT S, DUNN JA. Early Opportunities to Explore Occupational Identity Change: Qualitative Study of Return-To-Work Experiences After Stroke. J Rehabil Med 2023; 55:jrm00363. [PMID: 36748979 PMCID: PMC9926496 DOI: 10.2340/jrm.v55.4825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Rates of return-to-work after stroke are low, yet work is known to positively impact people's wellbeing and overall health outcomes. OBJECTIVE To understand return-to-work trajectories, barriers encountered, and resources that may be used to better support participants during early recovery and rehabilitation. PARTICIPANTS The experiences of 31 participants (aged 25-76 years) who had or had not returned to work after stroke were explored. METHODS Interview data were analysed using reflexive thematic analysis methods within a broader realist research approach. RESULTS Participants identified an early need to explore a changed and changing occupational identity within a range of affirming environments, thereby ascertaining their return-to-work options early after stroke. The results articulate resources participants identified as most important for their occupational explorations. Theme 1 provides an overview of opportunities participants found helpful when exploring work options, while theme 2 explores fundamental principles for ensuring the provided opportunities were perceived as beneficial. Finally, theme 3 provides an overview of prioritized return-to-work service characteristics. CONCLUSION The range and severity of impairments experienced by people following stroke are broad, and therefore their return-to-work needs are diverse. However, all participants, irrespective of impairment, highlighted the need for early opportunities to explore their changed and changing occupational identity.
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Affiliation(s)
- Rachelle A. MARTIN
- Burwood Academy Trust, Christchurch,Department of Medicine, University of Otago Wellington
| | | | | | - John A. BOURKE
- Burwood Academy Trust, Christchurch,Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin
| | | | - Joanne L. NUNNERLEY
- Burwood Academy Trust, Christchurch,Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch
| | - Deborah L. SNELL
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch
| | - Sarah DERRETT
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jennifer A. DUNN
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch
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McRae P, Kobel C, Lukersmith S, Simpson G. What Does It Take to Get Somebody back to Work after Severe Acquired Brain Injury? Service Actions within the Vocational Intervention Program (VIP 2.0). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159548. [PMID: 35954914 PMCID: PMC9368610 DOI: 10.3390/ijerph19159548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022]
Abstract
Little is known about service actions delivered in the complex intervention of vocational rehabilitation (VR) for people with severe acquired brain injury (ABI). Scale-up of the Vocational Intervention Program (VIP) across the 12 Community teams of the NSW Brain Injury Rehabilitation Program provided an opportunity to analyse the intensity and profile of actions delivered in providing VR programs. Seventy-two participants with severe TBI were supported in returning to either pre-injury employment (FastTrack, FT, n = 27) or new employment (NewTrack, NT, n = 50), delivered by two types of VR providers (Disability Employment Service DES; private providers). VR providers documented their service actions in hours and minutes, using the Case Management Taxonomy, adapted to VR. The NT pathway required significantly higher levels of intervention in comparison to FT (25 h, five minutes vs. 35 h, 30 min, p = 0.048, W = 446). Case coordination was the most frequent service action overall (41.7% of total time for FT, 42.3% for NT). DES providers recorded significantly greater amounts of time undertaking engagement, assessment and planning, and emotional/motivational support actions compared to private providers. Overall duration of the programs were a median of 46 weeks (NT) and 36 weeks (FT), respectively. This study helps illuminate the profile of VR interventions for people with severe TBI.
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Affiliation(s)
- Philippa McRae
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney, NSW 2065, Australia
| | - Conrad Kobel
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW 2500, Australia;
| | - Sue Lukersmith
- Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia;
| | - Grahame Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia;
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Sydney, NSW 2065, Australia
- Correspondence:
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Karcz K, Schiffmann B, Schwegler U, Staubli S, Finger ME. Facilitators and Barriers to Sustainable Employment After Spinal Cord Injury or Acquired Brain Injury: The Person's Perspective. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:872782. [PMID: 36188977 PMCID: PMC9397900 DOI: 10.3389/fresc.2022.872782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022]
Abstract
Background Sustaining employment after initial return to work represents a major challenge for people with a disability. While individuals with spinal cord injury (SCI) and acquired brain injury (ABI) make a prime example for this challenge, their view on factors supporting and hindering sustainable employment have rarely been investigated in depth so far. Purpose To examine facilitators and barriers to sustainable employment, as perceived by persons with SCI or ABI. Methods Fourteen focus groups and four individual interviews were conducted and thematically analyzed. Results Perceived facilitators and barriers to sustainable employment reflected the three biopsychosocial areas of personal, impairment-related and environmental factors. For both condition groups, key facilitators included environmental factors (i.e., aspects of the work organization, the workplace, supportive private and work environment) and personal factors (i.e., the ability to self-advocate, to communicate and to learn how to live with one's own disability). Major barriers comprised injury-related impairments, including decreased mobility and pain for people with SCI and fatigue and limited cognitive resources for persons with ABI, as well as environmental factors related to insurance procedures and the social security system for both conditions. Conclusions The biopsychosocial factors identified in our study as well as their interplay should receive particular attention to optimally support sustainable employment in vocational integration and work retention practice. Interventions should particularly focus on the empowerment of those affected as well as on the creation of supportive work environments that match their abilities and needs.
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Affiliation(s)
- Katarzyna Karcz
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Urban Schwegler
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Monika E Finger
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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