Development of a Vocational Rehabilitation Intervention to support Return to Work and Wellbeing following Major Trauma: A Person-Based Approach

Radford, Kathryn; Kettlewell, Jade; das Nair, Roshan; Morriss, Richard; Holmes, Jain; Kellezi, Blerina; Timmons, Stephen; Jones, Trevor; Tressider, Hereward; Andrews, Isobel; Bridger, Kay; Patel, Priya; Lindley, Rebecca; De Dios Perez, Blanca; Statham, Abigail; Jones, Tadeusz; Hoffman, Karen; James, Marilyn; Kendrick, Denise; ROWTATE study team

Abstract

Objectives: Major trauma centres save lives but rehabilitation to support return-to-work (RTW) is lacking. This paper describes development of a vocational rehabilitation intervention (the ROWTATE intervention) to support RTW following traumatic injury.

Design: Sequential and iterative Person Based Approach in 4 stages: Stage 1: review of evidence about the efficacy and mechanisms of RTW interventions; Stage 2: Interviews (n=38) and focus groups (n=25) with trauma survivors and service providers in five UK major trauma centres (MTCs) to identify the issues, and challenges faced post-injury. Stage 3: Co-design workshops (n=43) with trauma stakeholders in MTCs to conceptually test and identify intervention delivery barriers/enablers. Stage 4: meetings (n=7) with intervention development working group (IDWG) to: a) generate guiding principles, b) identify key intervention features (process, components, mechanisms) to address unmet rehabilitation needs; c) generate a logic model and programme theory to illustrate how the intervention works; d) develop a training package to support delivery.

Results: Trauma survivors described unmet needs relating to:- early advice about RTW; psychological support; pain management; hidden disabilities (e.g. fatigue); estimating recovery; and community, amputee and musculoskeletal rehabilitation. Mechanisms of effective interventions identified in the review included early intervention, co-location, employer engagement, case coordination and work accommodations. Intervention features identified by IDWG members (n=13) from stages 1 and 2 were: use of stepped-care approaches by occupational therapists (OTs) and clinical psychologists (CPs), OT/CP formulation for complex cases, assessment of mental health problems, individually-tailored rehabilitation including vocational goal setting, cross-sector coordination/communication, employer engagement, phased RTW, education/advice for family/employers, exploration of work alternatives, ongoing review of physical and mental health needs, work stability monitoring. Conceptual testing ratified the logic model. Geography and long waiting lists were identified as potential delivery barriers.

Conclusions: Real-world testing of the intervention is underway in a randomised controlled trial.

Citation

Radford, K., Kettlewell, J., das Nair, R., Morriss, R., Holmes, J., Kellezi, B., Timmons, S., Jones, T., Tressider, H., Andrews, I., Bridger, K., Patel, P., Lindley, R., De Dios Perez, B., Statham, A., Jones, T., Hoffman, K., James, M., Kendrick, D., & ROWTATE study team. (2024). Development of a Vocational Rehabilitation Intervention to support Return to Work and Wellbeing following Major Trauma: A Person-Based Approach. BMJ Open, 14(10), Article e085724. https://doi.org/10.1136/bmjopen-2024-085724

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2024
• Online Publication Date: Oct 4, 2024
• Publication Date: 2024-10
• Deposit Date: Jul 22, 2024
• Publicly Available Date: Jul 22, 2024
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 10
• Article Number: e085724
• DOI: https://doi.org/10.1136/bmjopen-2024-085724+
• Keywords: Vocational rehabilitation, Return-to-Work, traumatic injury, biopsychosocial, , complex intervention development, implementation, occupational therapy, clinical psychology
• Public URL: https://nottingham-repository.worktribe.com/output/37425611
• Publisher URL: https://bmjopen.bmj.com/content/14/10/e085724