Vocational rehabilitation for people with multiple sclerosis in the national health service of the United Kingdom: A realist evaluation

De Dios Perez, Blanca; Booth, Vicky; das Nair, Roshan; Evangelou, Nikos; Hassard, Juliet; Ford, Helen L.; Newsome, Ian; Radford, Kate

Abstract

Background
There is limited evidence about how vocational rehabilitation (VR) for people with multiple sclerosis (MS) can be delivered through the United Kingdom’s (UK) National Health Service (NHS) and how it works.

Aim
To understand the mechanisms and context for implementing a VR intervention for people with MS in the NHS and develop an explanatory programme theory.

Methods
A realist evaluation, including a review of evidence followed by semi-structured interviews. A realist review about VR for people with MS in the NHS was conducted on six electronic databases (PubMed, MEDLINE, PsychINFO, Web of Science, CINAHL, and EMBASE) with secondary purposive searches. Included studies were assessed for relevance and rigour. Semi-structured interviews with people with MS, employers, and healthcare professionals, were conducted remotely. Data were extracted, analysed, and synthesised to refine the programme theory and produce a logic model.

Results
Data from 13 studies, and 19 interviews (10 people with MS, five employers, and four healthcare professionals) contributed to producing the programme theory. The resulting programme theory explains the implementation of VR in the NHS for MS populations, uncovering the complex interplay between the healthcare and employment sectors to influence health and employment outcomes. VR programmes that offer timely support, tailored to the needs of the person with MS, and that support and empower the employee beyond the healthcare context are most likely associated with improved employment outcomes, for example, job retention.

Conclusion
Embedding VR support within the NHS requires substantial cultural and organisational change (e.g., increased staff numbers, training, and awareness about the benefits of work). This study emphasises the need to routinely identify people with MS at risk of job loss and follow a collaborative approach to address employment issues. This realist evaluation provides insight on how to improve the quality of care available to people with MS.

Citation

De Dios Perez, B., Booth, V., das Nair, R., Evangelou, N., Hassard, J., Ford, H. L., Newsome, I., & Radford, K. (2025). Vocational rehabilitation for people with multiple sclerosis in the national health service of the United Kingdom: A realist evaluation. PLoS ONE, 20(2), Article e0319287. https://doi.org/10.1371/journal.pone.0319287

• Journal Article Type: Article
• Acceptance Date: Jan 30, 2025
• Online Publication Date: Feb 25, 2025
• Publication Date: Feb 25, 2025
• Deposit Date: Feb 26, 2025
• Publicly Available Date: Feb 26, 2025
• Journal: PLoS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 20
• Issue: 2
• Article Number: e0319287
• DOI: https://doi.org/10.1371/journal.pone.0319287
• Public URL: https://nottingham-repository.worktribe.com/output/45855210
• Publisher URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0319287