Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work after stroKE: A pragmatic, parallel-arm multicenter, randomized controlled trial

Radford, K. A.; Wright-Hughes, A.; Thompson, E.; Clarke, D .J.; Phillips, J.; Holmes, J.; Powers, K.; Trusson, D.; Craven, K.; Watkins, C.; Bowen, A.; McKevitt, C.; Stevens, J.; Murray, J. D.; O’Connor, R. J.; Pyne, S.; Risebro, H.; Cameron, R.; Sach, T. H.; Day, F.; Farrin, A. J.; On behalf of the RETAKE Research group

Abstract

Background: Return-to-work is a major goal achieved by fewer than 50% stroke survivors. Evidence on how to support return-to-work is lacking. Aims: This study aimed to evaluate the clinical effectiveness of Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) versus UC alone for helping people return-to-work after stroke. Methods: This pragmatic, multicentre, individually randomized controlled trial with embedded economic and process evaluations compared ESSVR with UC in 21 NHS stroke services across England and Wales. Eligible participants were aged ⩾ 18 years, in work at stroke onset, hospitalized with new stroke and within 12 weeks of stroke. People not intending to return-to-work were excluded. Participants were randomized (5:4) to individually tailored ESSVR delivered by stroke specialist occupational therapists for up to 12 months or usual National Health Service rehabilitation. Primary outcome was self-reported return-to-work for ⩾ 2 h per week at 12 months. Primary and safety analyses were done in the intention-to-treat population. Results: Between 1 June 2018, and 7 March 2022, 583 participants (Mage 54.1 years (SD 11.0), 69% male) were randomized to ESSVR (n = 324) or UC (n = 259). Primary outcome data were available for 454 (77.9%) participants. Intentionto-treat analysis showed no evidence of a difference in the proportion of participants returned-to-work at 12 months (165/257 (64.2%) ESSVR vs 117/197 (59.4%) UC; adjusted odds ratio 1.12 (95% CI: 0.75–1.68), p = 0.5678). There was some indication that older participants and those with more post-stroke impairment were more likely to benefit from ESSVR (interaction p = 0.0239 and p = 0.0959, respectively). Conclusion: To our knowledge, this is the largest trial of a stroke vocational rehabilitation (VR) intervention ever conducted. We found no evidence that ESSVR conferred any benefits over UC in improving return-to-work rates 12 months post-stroke. Return-to-work (for at least 2 h per week) rates were higher than in previous studies (64.2% ESSVR vs 59.4% UC) at 12 months and more than double that observed in our feasibility trial (26%). Interpretation of findings was limited by a predominantly mild–moderate sample of participants and the COVID-19 pandemic. The pandemic impacted the trial, ESSVR and UC delivery, altering the work environment and employer behavior. These changes influenced our primary outcome and the meaning of work in people’s lives; all pivotal to the context of ESSVR delivery and its mechanisms of action. Data access: Data available on reasonable request. Registration: ISRCTN12464275.

Citation

Radford, K. A., Wright-Hughes, A., Thompson, E., Clarke, D. .., Phillips, J., Holmes, J., Powers, K., Trusson, D., Craven, K., Watkins, C., Bowen, A., McKevitt, C., Stevens, J., Murray, J. D., O’Connor, R. J., Pyne, S., Risebro, H., Cameron, R., Sach, T. H., Day, F., …On behalf of the RETAKE Research group. (2024). Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work after stroKE: A pragmatic, parallel-arm multicenter, randomized controlled trial. International Journal of Stroke, https://doi.org/10.1177/17474930241306693

• Journal Article Type: Article
• Acceptance Date: Nov 14, 2024
• Online Publication Date: Nov 29, 2024
• Publication Date: Nov 29, 2024
• Deposit Date: Feb 17, 2025
• Publicly Available Date: Feb 18, 2025
• Journal: International Journal of Stroke
• Print ISSN: 1747-4930
• Electronic ISSN: 1747-4949
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/17474930241306693
• Public URL: https://nottingham-repository.worktribe.com/output/45590912
• Publisher URL: https://journals.sagepub.com/doi/full/10.1177/17474930241306693
• Related Public URLs: https://journals.sagepub.com/doi/pdf/10.1177/17474930241306693