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Brown H, Kennard K, Tyreman R, Alim-Marvasti A, Wilcox M, Quick T. Return to work following brachial plexus injury: A cross-sectional study. HAND THERAPY 2023; 28:144-150. [PMID: 38031573 PMCID: PMC10683714 DOI: 10.1177/17589983231205446] [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: 07/17/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023]
Abstract
Background Qualitative studies following Brachial Plexus Injury (BPI) suggest that return to employment has a major influence on life satisfaction and psychological well-being. However, few studies have focused on return to work following BPI. The physical strain and intensity of an occupation may influence the ability of an individual to return to employment. This study aimed to provide information about the impact of workload intensity on employment status following BPI. Methods This is an observational, retrospective study of 74 participants who responded to a postal questionnaire, sharing information regarding their employment status pre- and post-BPI. The reported occupations were assessed for workload intensity and assigned a Reichsausschuss für Arbeitszeitermittlung (REFA) classification by two assessors. Results Forty-one out of 74 participants (57%) had to change their employment following their BPI. Changes in occupation were more likely if the pre-injury REFA score was 3 or 4 (n = 22). In the Complete plexus injury group (n = 8), 100% changed occupation. In the Partial plexus injury group (n = 66) 50% changed occupation. Hand dominance had no significant influence on change of employment (p = 0.37). Conclusion This study is the first to focus on the impact of BPI on employment status and workload intensity. Just over half the participants did not maintain the same employment following their BPI and one in five became unemployed. Future research should review the factors that contribute to the inability to return to work. This may direct enhancements in rehabilitation provision and enable healthcare services to focus on facilitating individuals back to the workplace.
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Affiliation(s)
- Hazel Brown
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, UK
- Centre for Nerve Engineering, University College London, London, UK
- School of Pharmacy, University College London, London, UK
| | - Kate Kennard
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Rosalyn Tyreman
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ali Alim-Marvasti
- Queen Square Institute of Neurology, University College London, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
- University College Hospital, London, UK
| | - Matthew Wilcox
- Centre for Nerve Engineering, University College London, London, UK
- School of Pharmacy, University College London, London, UK
| | - Tom Quick
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, UK
- Centre for Nerve Engineering, University College London, London, UK
- School of Pharmacy, University College London, London, UK
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De Dios Pérez B, das Nair R, Radford K. A mixed-methods feasibility case series of a job retention vocational rehabilitation intervention for people with multiple sclerosis. Disabil Rehabil 2023:1-12. [PMID: 36850038 DOI: 10.1080/09638288.2023.2181411] [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: 07/27/2022] [Revised: 01/29/2023] [Accepted: 02/11/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To ascertain the feasibility and acceptability of delivering a job retention vocational rehabilitation intervention [MSVR] for people with multiple sclerosis (pwMS) in a community setting. Secondary objectives included determining whether MSVR was associated with changes in quality of life, fatigue, mood, cognition, workplace accommodations, work instability, work self-efficacy, and goal attainment. METHODS Single-centre mixed-methods feasibility case series. RESULTS 15 pwMS and three employers received 8.36 (SD = 4.48) and 1.94 (SD = 0.38) hours of MSVR respectively over three months. The intervention predominantly addressed managing cognition, fatigue, and negotiating reasonable accommodations. Four healthcare professionals were recruited to clarify clinical information.The intervention was feasible to deliver, and there was a significant positive impact on goal attainment immediately following MSVR (t(14) = 7.44, p = .0001, d = 1.9), and at months 3 (t(13) = 4.81, p = .0001, d = 1.28), 6 (t(11) = 4.45, p = .001, d = 1.28), and 12 (t(9) = 5.15, p = .001, d = -2.56). There was no impact on quality of life, fatigue, mood, cognition, workplace accommodations, work instability, and work self-efficacy. In post-intervention interviews, participants reported that MSVR was acceptable. Four themes were derived regarding the context, employer engagement, empowerment through knowledge, and intervention components and attributes. CONCLUSION It was feasible and acceptable to deliver MSVR. Participants better understood their MS, became more confident managing problems at work and attained their work-related goals.IMPLICATIONS FOR REHABILITATIONPeople with multiple sclerosis (MS) experience problems at work because of the interaction between symptoms and environmental factors (e.g., co-workers' attitudes).Vocational rehabilitation for people with MS and their employers should be tailored in terms of content and intensity.People with MS can be empowered at work by learning about MS and how their symptoms fluctuate over time.Understanding legal responsibilities and examples of accommodations at work can be beneficial for employers.
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Affiliation(s)
- Blanca De Dios Pérez
- Centre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Roshan das Nair
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Health Services Research, SINTEF, Trondheim, Norway
- Institute of Mental Health, Nottinghamshire Healthcare Trust, Nottingham, UK
| | - Kathryn Radford
- Centre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Nottingham, UK
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Dodson MB, Kyi M, Percy TLM, Wadley M, Deeker K, Matheson LN. Use of item response theory to develop a return to work measure for acquired brain injury: The employment feasibility checklist. Work 2023; 74:137-151. [PMID: 36214016 DOI: 10.3233/wor-211055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The 2001 Feasibility Evaluation Checklist (FEC) is an assessment of work readiness for individuals with acquired brain injury (ABI). It establishes the integrity of basic safety, productivity, and interpersonal factors in neurorehabilitation and vocational settings. This study represents an effort to further develop the FEC to increase its clinical utility. OBJECTIVE To redesign the FEC by conducting Item Response Theory (IRT) analyses on the study's results and combining those mathematical calibrations with clinical expert judgement. The result will be a new measure for use in clinical ABI neurorehabilitation and vocational settings: the Employment Feasibility Checklist (EFC). METHODS Seven participants with ABI were administered a situational assessment on multiple occasions by occupational therapists in a community rehabilitation clinic. The FEC was used to assess the participant's performance across three areas of basic employment feasibility: safety, productivity, and interpersonal factors. Results were analyzed with IRT-Rasch analysis and then subjected to clinical expert judgment, resulting in adjustment recommendations for the FEC. RESULTS In this scale development study, IRT analysis of results from 89 observation trials was combined with expert clinical judgment resulting in a redesigned tool with increased clinical utility for persons with ABI. The EFC is a 12-item observational rating scale for employment feasibility constructs of Productivity and Interpersonal Relations, with an additional six-item Workplace Safety subsection. CONCLUSION The EFC is a mathematically calibrated tool designed to gauge feasibility for competitive employment in clients with ABI. The tool may be useful in clinical neurorehabilitation settings and vocational rehabilitation settings.
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Affiliation(s)
| | - Min Kyi
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Kelly Deeker
- Deeker Evaluation Services, LLC, Caseyville, IL, USA
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Holmes JA, Fletcher-Smith JC, Merchán-Baeza JA, Phillips J, Radford K. Developing a method to assess fidelity to a complex vocational rehabilitation intervention in the FRESH trial: a feasibility study. Pilot Feasibility Stud 2022; 8:160. [PMID: 35906683 PMCID: PMC9335967 DOI: 10.1186/s40814-022-01111-2] [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: 09/07/2020] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Determining whether complex rehabilitation interventions are delivered with fidelity is important. Implementation fidelity can differ between sites, therapists delivering interventions and, over time, threatening trial outcomes and increasing the risk of type II and III errors. This study aimed to develop a method of assessing occupational therapists’ fidelity to deliver a complex, individually tailored vocational rehabilitation (VR) intervention to people with traumatic brain injury (TBI) and assess the feasibility of its use in a randomised controlled trial. Methods Using mixed methods and drawing on the intervention logic model, we developed data collection tools to measure fidelity to early specialist TBI VR (ESTVR). Fidelity was measured quantitatively using intervention case report forms (CRF), fidelity checklists and clinical records. Qualitative data from mentoring records, interviews with intervention therapists, participants with TBI, employers and NHS staff at trial sites explored moderators of implementation fidelity. The conceptual framework of implementation fidelity (CFIF) guided measurement and analysis of and factors affecting fidelity. Data were triangulated and benchmarked against an earlier cohort study. Results Fidelity to a complex individually tailored VR intervention could be measured. Overall, OTs delivered ESTVR with fidelity. Different fidelity measures answered different questions, offering unique insights into fidelity. Fidelity was best assessed using a fidelity checklist, intervention CRFs and clinical notes. The OT clinical notes and mentoring records were best at identifying fidelity moderating factors. Interviews added little insight into fidelity moderating factors over and above mentoring or clinical records. Data triangulation offered a comprehensive assessment of fidelity, highlighting limitations of measurement methods and learning for future trials but was resource intensive. Interviews, fidelity visits and analysing clinical notes were also resource intense. Comparing fidelity data to a benchmark and using CFIF as a framework for organising the fidelity assessment helped. Conclusions OTs delivered the VR intervention with fidelity. A fidelity checklist and benchmark plus mentoring may offer a practical and effective way of measuring fidelity and identifying fidelity moderating factors in trials of complex individually-tailored rehabilitation interventions. Mentoring provided real-time indicators of and reasons for fidelity deviations. These methods require further evaluation. Trial registration ISRCTN Registry, ISRCTN38581822 (Registered: 02/01/2014). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01111-2.
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Affiliation(s)
- Jain Anne Holmes
- Faculty of Medicine and Health Sciences, Centre for Rehabilitation and Ageing Research, B Floor, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Joanna Clare Fletcher-Smith
- Faculty of Medicine and Health Sciences, Centre for Rehabilitation and Ageing Research, B Floor, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Jose Antonio Merchán-Baeza
- Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), 08500, Vic, Spain
| | - Julie Phillips
- Faculty of Medicine and Health Sciences, Centre for Rehabilitation and Ageing Research, B Floor, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Kathryn Radford
- Faculty of Medicine and Health Sciences, Centre for Rehabilitation and Ageing Research, B Floor, Medical School, Queen's Medical Centre, The University of Nottingham, Nottingham, NG7 2UH, UK
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Klepo I, Sangster Jokić C, Tršinski D. The role of occupational participation for people with traumatic brain injury: a systematic review of the literature. Disabil Rehabil 2020; 44:2988-3001. [PMID: 33306915 DOI: 10.1080/09638288.2020.1858351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Improving participation and quality of life is a desirable goal following traumatic brain injury (TBI). The purpose of this systematic review was to summarize existing findings concerning the role of occupational participation for persons with TBI. METHODS A systematic literature search using four electronic databases was followed by a review of all titles and abstracts. Articles were included if the studies were conducted with adults with TBI, used a qualitative methodology and explored the role or meaning of occupations and occupational participation from the perspectives of individuals with TBI. Following data extraction, a thematic synthesis was conducted. RESULTS A total of 642 articles were identified, of which 14 met all inclusion criteria. Three themes related to the role of occupations for people with TBI emerged: reflecting on change in occupational performance and occupational participation, occupational adaptation, and individual meaning of occupational participation. CONCLUSION The findings demonstrate the significance of occupational participation for people following TBI. Occupational participation enabled better understanding of one's abilities and limitations, assisted in occupational adaptation, and held unique meaning for participants. The findings also highlight the importance of providing long-term services focused on enabling participation in occupations in order to ensure successful adaptation following TBI.Implications for rehabilitationFor persons with TBI, occupational participation enables recognition of changes in their performance, contributes to the process of adaptation and identity (re)construction, fulfils various intrinsic needs and provides a sense of personal meaning.Rehabilitation professionals should recognize persons with TBI as occupational beings and work with individuals to identify the meaning of important occupations in the process of understanding and adapting to changes in capability, performance and participation.The rehabilitation process should focus on enabling persons to perform and participate in the occupations they want, need or are expected to do in their daily lives.National and regional health care systems should ensure that persons with TBI are provided with appropriate physical, social and institutional support and services in order to achieve meaningful occupational engagement.
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Affiliation(s)
- Ivana Klepo
- Department of Neurorehabilitation, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice, Croatia
| | - Claire Sangster Jokić
- Department of Occupational Therapy, University of Applied Health Sciences, Zagreb, Croatia
| | - Dubravko Tršinski
- Department of Neurorehabilitation, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice, Croatia
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Leary S, Hurford J, Shanahan N. An expert opinion: Vocational rehabilitation after stroke. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2020. [DOI: 10.47795/keec8935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Less than half of people return to work following a stroke. For those who do, their return is often complicated by residual ‘invisible’ symptoms. It is important to ask about work and to provide intervention early in the rehabilitation process. Specialist vocational rehabilitation services can support more complex and long-term interventions, but there is a paucity of service provision which needs to be addressed. One in four strokes occur in people of working age. Return to work is often a key goal for the person with a stroke and important for maintaining quality of life and wellbeing. However, less than half of those in employment return to work after a stroke.
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O'Keefe S, Stanley M, Sansonetti D, Schneider EJ, Kras M, Morarty J, Lannin NA. Designing an intervention process that embeds work-focussed interventions within inpatient rehabilitation: An intervention mapping approach. Aust Occup Ther J 2020; 68:65-77. [PMID: 33078431 DOI: 10.1111/1440-1630.12705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 12/01/2022]
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.
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Affiliation(s)
- Sophie O'Keefe
- Occupational Therapy, School of Science, Health and Engineering, La Trobe University, Melbourne, Vic, Australia
| | | | | | - Emma J Schneider
- Occupational Therapy Department, Alfred Health, Melbourne, Vic, Australia
| | - Marni Kras
- Acquired Brain Injury Unit, Alfred Health, Melbourne, Vic, Australia
| | | | - Natasha A Lannin
- Alfred Health, Melbourne, Vic, Australia.,Brain Recovery & Rehabilitation Group, Department of Neuroscience, Central Clinical School, Alfred Health, Melbourne, Vic, Australia
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Watkin C, Phillips J, Radford K. What is a ‘return to work’ following traumatic brain injury? Analysis of work outcomes 12 months post TBI. Brain Inj 2019; 34:68-77. [DOI: 10.1080/02699052.2019.1681512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Connor Watkin
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Julie Phillips
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Radford
- School of Medicine, University of Nottingham, Nottingham, UK
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9
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Affiliation(s)
- Karen Beaulieu
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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10
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Radford K, Sutton C, Sach T, Holmes J, Watkins C, Forshaw D, Jones T, Hoffman K, O'Connor R, Tyerman R, Merchán-Baeza JA, Morris R, McManus E, Drummond A, Walker M, Duley L, Shakespeare D, Hammond A, Phillips J. Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT. Health Technol Assess 2019; 22:1-124. [PMID: 29863459 DOI: 10.3310/hta22330] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI. OBJECTIVE To assess the feasibility of a definitive, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, specialist VR plus usual care (UC) compared with UC alone on work retention 12 months post TBI. DESIGN A multicentre, feasibility, parallel-group RCT with a feasibility economic evaluation and an embedded mixed-methods process evaluation. Randomisation was by remote computer-generated allocation. SETTING Three NHS major trauma centres (MTCs) in England. PARTICIPANTS Adults with TBI admitted for > 48 hours and working or studying prior to injury. INTERVENTIONS Early specialist TBI VR delivered by occupational therapists (OTs) in the community using a case co-ordination model. MAIN OUTCOME MEASURES Self-reported RTW 12 months post randomisation, mood, functional ability, participation, work self-efficacy, quality of life and work ability. Feasibility outcomes included recruitment and retention rates. Follow-up was by postal questionnaires in two centres and face to face in one centre. Those collecting data were blind to treatment allocation. RESULTS Out of 102 target participants, 78 were recruited (39 randomised to each arm), representing 39% of those eligible and 5% of those screened. Approximately 2.2 patients were recruited per site per month. Of those, 56% had mild injuries, 18% had moderate injuries and 26% had severe injuries. A total of 32 out of 45 nominated carers were recruited. A total of 52 out of 78 (67%) TBI participants responded at 12 months (UC, n = 23; intervention, n = 29), completing 90% of the work questions; 21 out of 23 (91%) UC respondents and 20 out of 29 (69%) intervention participants returned to work at 12 months. Two participants disengaged from the intervention. Face-to-face follow-up was no more effective than postal follow-up. RTW was most strongly related to social participation and work self-efficacy. It is feasible to assess the cost-effectiveness of VR. Intervention was delivered as intended and valued by participants. Factors likely to affect a definitive trial include deploying experienced OTs, no clear TBI definition or TBI registers, and repatriation of more severe TBI from MTCs, affecting recruitment of those most likely to benefit/least likely to drop out. LIMITATIONS Target recruitment was not reached, but mechanisms to achieve this in future studies were identified. Retention was lower than expected, particularly in UC, potentially biasing estimates of the 12-month RTW rate. CONCLUSIONS This study met most feasibility objectives. The intervention was delivered with high fidelity. When objectives were not met, strategies to ensure feasibility of a full trial were identified. Future work should test two-stage recruitment and include resources to recruit from 'spokes'. A broader measure covering work ability, self-efficacy and participation may be a more sensitive outcome. TRIAL REGISTRATION Current Controlled Trials ISRCTN38581822. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Radford
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Chris Sutton
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jain Holmes
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Caroline Watkins
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Denise Forshaw
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Trevor Jones
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Karen Hoffman
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Rory O'Connor
- Academic Department of Rehabilitation Medicine, School of Medicine, University of Leeds, Leeds, UK
| | - Ruth Tyerman
- Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | | | - Richard Morris
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma McManus
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Avril Drummond
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Marion Walker
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lelia Duley
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Alison Hammond
- Health Sciences Research Centre, University of Salford, Salford, UK
| | - Julie Phillips
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Whitehead PJ, Drummond AER, Parry RH, Walker MF. Content and acceptability of an Occupational Therapy intervention in HomEcare Re-ablement Services (OTHERS). Br J Occup Ther 2018. [DOI: 10.1177/0308022618766844] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Despite clear compatibilities between the tenets of occupational therapy and re-ablement, there is limited research on occupational therapy in homecare reablement services. This article describes an occupational therapy intervention that was delivered as part of a feasibility randomised controlled trial (Occupational Therapy intervention in HomEcare Re-ablement Services), and evaluates whether the intervention was acceptable to participants. Method There were three phases: (1) a bespoke pro forma was completed, recording the activities undertaken after each therapy visit; (2) an acceptability questionnaire was sent to every intervention participant and (3) semi-structured interviews were completed with key informants who received the intervention. Results The principal activities undertaken were assessment, case management, goal-setting, advice and support, and practising activities in relation to bathing/showering or kitchen activities. Participants particularly valued the advice and support provided. However, there were difficulties due to fluctuations in circumstances and with activities of daily living outside the home within the 6 week timescale. Conclusion An intervention focusing on activities of daily living within the home was acceptable for participants and consistent with their goals; however, they also had goals beyond personal activities of daily living and the timescale of the re-ablement episode. Further research should focus on extended activities of daily living, beyond this time-limited period.
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Affiliation(s)
- Phillip J Whitehead
- Associate Professor, Department of Social Work, Education and Community Wellbeing, Northumbria University, UK
| | - Avril ER Drummond
- Professor, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Ruth H Parry
- Professor, Department of Social Sciences, Loughborough University, UK
| | - Marion F Walker
- Professor and Associate Pro-Vice Chancellor, School of Medicine, University of Nottingham, UK
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Holmes J, Phillips J, Morris R, Bedekar Y, Tyerman R, Radford K. Development and evaluation of an early specialised traumatic brain injury vocational rehabilitation training package. Br J Occup Ther 2016. [DOI: 10.1177/0308022616651645] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In a feasibility randomised controlled trial, training was developed to equip occupational therapists to deliver early specialised traumatic brain injury vocational rehabilitation in the English National Health Service (NHS). Method The package was developed by experts in vocational rehabilitation and traumatic brain injury, and included a manual, direct instruction by six trainers and opportunity for mentorship by four therapists. Following training, therapists were interviewed regarding the effectiveness and ease of use of the package. Interviews were analysed using the framework approach. Results Five trained therapists were interviewed regarding the package. Results were organised into six categories: (1) motivation to participate in research; (2) impact of the learning environment; (3) changing confidence levels over time; (4) growing appreciation of complexities about the intervention; (5) acceptability of the training package; and (6) lessons for future implementation. Conclusion The therapists reported acquiring the knowledge necessary to implement the intervention. The data indicate that the training packages require detailed descriptions of the interventions being taught for local implementation in the NHS and for future research. The training materials are valued by therapists but require time for familiarisation, and reminders from mentors help put training into practice. The therapists have concerns about implementing the interventions within a research context, which researchers should address.
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Affiliation(s)
- Jain Holmes
- UKOTRF and University of Nottingham PhD Research Fellow, University of Nottingham, UK
| | - Julie Phillips
- Research Occupational Therapist, University of Nottingham, UK
| | | | - Yashashree Bedekar
- Independent Occupational Therapist, Neurological Rehabilitation Specialist, London, UK
| | - Ruth Tyerman
- Buckinghamshire Healthcare Trust, Programme Manager, UK
| | - Kate Radford
- University of Nottingham, Associate Professor in Rehabilitation Research (Long Term Conditions), UK
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Hughes J, Wilberforce M, Symonds E, Bowns I, Challis D. Occupational therapy roles and responsibilities: Development of a standardised measure of time use for staff working with adults in community settings. Br J Occup Ther 2016. [DOI: 10.1177/0308022616640298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction This paper documents the development of a diary schedule to describe the work of occupational therapists of all grades, across a range of adult care groups and community health and social care settings, to permit comparison between them and over time. Method Two sources of information were used to develop the schedule: findings from five focus groups with occupational therapists (46 participants) and analysis of previous research on staff time use undertaken by the Personal Social Services Research Unit at the University of Manchester. It was piloted and evaluated by scrutiny of the schedules, a group interview with participants and meetings with managers. Results Practitioners identified almost 200 activities in their day-to-day work. These were categorised into three principal activity themes: direct care, indirect care and team or service development. The pilot study revealed ease of completion and discernible differences between settings and activities together with suggestions for improvement to the schedule regarding the description of activities and the accompanying guidance. Conclusion A diary schedule and common activity list, covering the full breadth of occupational therapy practice in adult community care, was developed. Whilst its utility in an organisation employing practitioners in multiple settings was demonstrated its wider applicability is unproven.
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Affiliation(s)
- Jane Hughes
- Lecturer, Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Mark Wilberforce
- NIHR Doctoral Research Fellow, Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - Eileen Symonds
- Retired occupational therapist, formerly Head of Service for Rehabilitation and Enablement at Birmingham City Council, Birmingham, UK
| | - Ian Bowns
- Director, Public Health Priorities Limited, Manchester, UK
- Formerly honorary Research Fellow, Personal Social Services Research Unit, University of Manchester, Manchester, UK
| | - David Challis
- Director and Professor of Community Care Research, Personal Social Services Research Unit, University of Manchester, Manchester
- Associate Director, NIHR School of Social Care Research, Manchester, UK
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14
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Coole C, McBean J, Drummond A, Reagon C. The identification of research priorities for UK occupational therapists in work rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.7.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: UK occupational therapists are recognised as having key skills in work rehabilitation, but there is limited evidence to underpin this. In order to use research resources to best effect, it is vital to identify the research priorities of occupational therapists in work rehabilitation. This study aims to gather the views of those with a special interest in the field in order to identify their research priorities. Methods: An online survey was developed and administered electronically to members (n=173) of the College of Occupational Therapists Specialist Section–Work (COTSS–Work). Respondents were asked to: i) prioritise and comment on research areas; ii) propose research questions. A final sample of 42 surveys was collected and analysed thematically. Results: Responses reflected the diversity and complexity of work rehabilitation. Identifying a rank order of research priorities proved challenging as the majority (≥62%) of respondents considered all of the topic areas listed a high priority. Research into the following areas were included in the survey: interventions; outcome measurements; assessments; management and/or service delivery; planning and/or commissioning; and education. However, ‘interventions’ was rated highest overall. Conclusions: Occupational therapists in the UK need more evidence to justify their role in the work and health arena. Greater opportunities are required for occupational therapists in clinical practice, as well as those involved in research, to address areas in which evidence-based practice is lacking and the mechanisms to disseminate this knowledge base.
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Affiliation(s)
- Carol Coole
- Research occupational therapist, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | | | - Avril Drummond
- Professor of healthcare research, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Carly Reagon
- Lecturer, School of Healthcare Studies, Cardiff University, UK
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Radford KA, Phillips J, Jones T, Gibson A, Sutton C, Watkins C, Sach T, Duley L, Walker M, Drummond A, Hoffman K, O'Connor R, Forshaw D, Shakespeare D. Facilitating return to work through early specialist health-based interventions (FRESH): protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2015; 1:24. [PMID: 27965803 PMCID: PMC5154052 DOI: 10.1186/s40814-015-0017-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/29/2015] [Indexed: 11/29/2022] Open
Abstract
Background Over one million people sustain traumatic brain injury each year in the UK and more than 10 % of these are moderate or severe injuries, resulting in cognitive and psychological problems that affect the ability to work. Returning to work is a primary rehabilitation goal but fewer than half of traumatic brain injury survivors achieve this. Work is a recognised health service outcome, yet UK service provision varies widely and there is little robust evidence to inform rehabilitation practice. A single-centre cohort comparison suggested better work outcomes may be achieved through early occupational therapy targeted at job retention. This study aims to determine whether this intervention can be delivered in three new trauma centres and to conduct a feasibility, randomised controlled trial to determine whether its effects and cost effectiveness can be measured to inform a definitive trial. Methods/design Mixed methods study, including feasibility randomised controlled trial, embedded qualitative studies and feasibility economic evaluation will recruit 102 people with traumatic brain injury and their nominated carers from three English UK National Health Service (NHS) trauma centres. Participants will be randomised to receive either usual NHS rehabilitation or usual rehabilitation plus early specialist traumatic brain injury vocational rehabilitation delivered by an occupational therapist. The primary objective is to assess the feasibility of conducting a definitive trial; secondary objectives include measurement of protocol integrity (inclusion/exclusion criteria, intervention adherence, reasons for non-adherence) recruitment rate, the proportion of eligible patients recruited, reasons for non-recruitment, spectrum of TBI severity, proportion of and reasons for loss to follow-up, completeness of data collection, gains in face-to-face Vs postal data collection and the most appropriate methods of measuring primary outcomes (return to work, retention) to determine the sample size for a larger trial. Discussion To our knowledge, this is the first feasibility randomised controlled trial of a vocational rehabilitation health intervention specific to traumatic brain injury. The results will inform the design of a definitive trial. Trial registration The trial is registered ISRCTN Number 38581822. Electronic supplementary material The online version of this article (doi:10.1186/s40814-015-0017-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kathryn A Radford
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH UK
| | - Julie Phillips
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH UK
| | | | - Ali Gibson
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - Chris Sutton
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - Caroline Watkins
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, CD Annex 1.13, Norwich Research Park, Norwich, NR4 7TJ UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C Floor, South Block, QMC, Nottingham, NG7 2UH UK
| | - Marion Walker
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham Queen's Medical Centre (QMC), A Floor, Nottingham, NG7 2UH UK
| | - Karen Hoffman
- Trauma Science, Royal London Hospital, Ward 12D, Whitechapel, E1 1BB London UK
| | - Rory O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Molecular Medicine, University of Leeds, Level D, Martin Wing, Leeds General Infirmary, Leeds, LS1 3EX UK
| | - Denise Forshaw
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE UK
| | - David Shakespeare
- Preston Neuro-Rehab Unit, Lancashire Teaching Hospitals NHS Trust, 32A Watling St, Preston, Lancashire PR2 8DY UK
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Grant M, Radford K, Sinclair E, Walker M. Return to Work after Stroke: Recording, Measuring, and Describing Occupational Therapy Intervention. Br J Occup Ther 2014. [DOI: 10.4276/030802214x14098207541072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Existing research on vocational rehabilitation following stroke has been criticised for not describing intervention in sufficient detail for replication or clinical implementation. The purpose of this study was to test the feasibility of recording and measuring the content of an early stroke-specific vocational rehabilitation intervention delivered to participants in a feasibility randomized controlled trial, using a proforma previously developed for a study of vocational rehabilitation following traumatic brain injury. Method: The proforma was adapted for use in stroke with input from an expert panel and was used to record intervention content, in 10-minute units, following each intervention session. Findings: Twenty-five people, working or in education at the time of stroke, participated in the study. Two thirds of the therapists' time was spent in face-to-face contact (43%) and liaison with the patient and others (20%). Intervention mainly focused on work preparation (21%) and the return to work process (24%). The remaining time was consumed by administration (19%) and travel (18%). Conclusion: The proforma was quick and easy to use and captured the main focus of intervention. This study suggests that it can be used to record stroke-specific vocational rehabilitation intervention content and has potential for wider use in research and clinical practice.
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Affiliation(s)
- Mary Grant
- Postgraduate Student, University of Nottingham, Division of Rehabilitation and Ageing, Nottingham
| | - Kathryn Radford
- Associate Professor in Rehabilitation Research (Long-Term Conditions), University of Nottingham, Division of Rehabilitation and Ageing, Nottingham
| | - Emma Sinclair
- Assistant Psychologist, University of Nottingham, Division of Rehabilitation and Ageing, Nottingham
| | - Marion Walker
- Professor in Stroke Rehabilitation, University of Nottingham, Division of Rehabilitation and Ageing, Nottingham
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Hart T, Ferraro M, Myers R, Ellis CA. Opening the Black Box: Lessons Learned From an Interdisciplinary Inquiry Into the Learning-Based Contents of Brain Injury Rehabilitation. Arch Phys Med Rehabil 2014; 95:S66-73. [DOI: 10.1016/j.apmr.2013.03.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/21/2013] [Indexed: 10/25/2022]
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Thomas SA, Russell C, Seed R, Worthington E, Walker MF, Macniven JA, Lincoln NB. An evaluation of treatment integrity in a randomized trial of behavioural therapy for low mood in stroke patients with aphasia. Clin Rehabil 2013; 27:1097-106. [PMID: 23881337 DOI: 10.1177/0269215513489579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the treatment integrity of behavioural therapy for low mood in stroke patients with aphasia. DESIGN Participants were recruited to a multicentre randomized controlled trial (Communication and Low Mood; CALM trial) comparing behavioural therapy with a usual care control group. SUBJECTS Of the 51 participants randomly allocated to receive behavioural therapy, 44 participants completed treatment. METHODS Participants were assessed on measures of disability, language and mood. The number and length of therapy sessions, and therapist was recorded. Allocation of time to therapy components was compared across three phases of therapy. Associations between levels of disability, aphasia, mood and the therapy patients received were determined. Therapy content was compared between centres and at the beginning and end of the trial. RESULTS The mean number of therapy sessions was 9.1 (range 3-18, SD 2.6) and the mean duration of sessions was 58 minutes (range 30-89 minutes, SD 10.7). Allocation of time to each therapy component significantly differed across the three phases of therapy (P < 0.05). There were no significant associations (P > 0.05) between the length and number of sessions and patients' aphasia, mood or disability, suggesting similar levels of therapy were provided regardless of patients' characteristics. The content of therapy showed some differences between centres (P < 0.01) and there was programme drift in some components of therapy. CONCLUSIONS The results support the ability of the therapists to deliver behavioural therapy according to the treatment manual. However there were differences between centres and over time in some components of therapy.
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Affiliation(s)
- Shirley A Thomas
- 1Institute of Work, Health and Organisations, University of Nottingham, UK
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Radford K, Phillips J, Drummond A, Sach T, Walker M, Tyerman A, Haboubi N, Jones T. Return to work after traumatic brain injury: Cohort comparison and economic evaluation. Brain Inj 2013; 27:507-20. [DOI: 10.3109/02699052.2013.766929] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McFeely G. Health at Work: An Analysis of Black's and Frost's Independent Review of Sickness Absence — What can Occupational Therapists Offer? Br J Occup Ther 2012. [DOI: 10.4276/030802212x13418284515956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This opinion piece looks at the recent report on Health at Work — an independent review of sickness absence by Black and Frost, and offers comment on the implications of the review for the profession of occupational therapy. It considers some key proposals from the occupational therapy perspective in order to inform thinking and response to the review. Further, it raises some critical questions and challenges for the profession in responding to and asserting its place at the table in an initiative that has at its heart the fundamental role and skills of occupational therapists.
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