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Can stroke specific vocational rehabilitation (SSVR) be delivered and measured?: feasibility RCT and economic analysis

Radford, Kathryn A.; Grant, Mary; Sinclair, Emma; Terry, Jane; Sampson, Christopher James; Edwards, Claire; Walker, Marion F.; Lincoln, Nadina; Drummond, Avril E.R.; Phillips, Julie; Watkins, Louise; Rowley, Emma; Brain, Nicola; Guo, Boliang; Jarvis, M.; Jenkinson, M.

Authors

Mary Grant

Emma Sinclair emma.sinclair@nottingham.ac.uk

Jane Terry

Christopher James Sampson chris.sampson@nottingham.ac.uk

Claire Edwards

Marion F. Walker

Nadina Lincoln Nadina.Lincoln@nottingham.ac.uk

AVRIL DRUMMOND avril.drummond@nottingham.ac.uk
Professor of Healthcare Research

Julie Phillips julie.phillips@nottingham.ac.uk

Louise Watkins

Emma Rowley Emma.Rowley@nottingham.ac.uk

Nicola Brain

M. Jarvis

M. Jenkinson



Abstract

Background:

A quarter of UK strokes occur in working age people. Fewer than half resume work. Rehabilitation frequently fails to address work needs and evidence for post-stroke vocational rehabilitation is lacking. This pilot trial tested the feasibility of delivering SSVR and measuring its effects and costs compared to usual care (UC).

Method:


Previously employed stroke survivors (SS) aged ≥16 recruited from a stroke unit were randomised to receive SSVR or UC. Exclusion criteria: refusing consent; not intending to work, medical preclusion. Primary outcomes: occupational and benefit status. Mood, function, participation, quality of life and resource use were measured using standardized and bespoke postal questionnaires at 3, 6 and 12 months. Service use was cross-referenced in 10% of participants and costs calculated.

Results:

46/126 patients screened (36 men, mean 56 (SD 12.7, 18-78 years) were recruited in 15 months; 40 declined. Most (29) had NIHSS scores ≤ 15, were in professional roles (65%), self-employed (21.7%) at onset. 32 available at 12-month follow-up, with poorer response (61%) among UC. Intervention successfully deployed in 22/23 cases. 39% returned to work at 12 months - twice as many in SSVR. More depression and productivity loss in UC, especially at 6 mths. Cross-referencing for 5 participants involved 51 phone calls, 23 letters/emails. Self-reported and actual service use data were discrepant. SS underestimated GP& consultant and overestimated therapy input.

Discussion:


SSVR can be delivered and its effects and costs measured. More reliable methods of capturing service use, income and benefit data and clearer definitions of work are needed.

Conclusion:


Findings inform the definitive trial.

Journal Article Type Article
Publication Date Mar 5, 2014
Journal Clinical Rehabilitation
Print ISSN 0269-2155
Electronic ISSN 1477-0873
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 28
Issue 4
APA6 Citation Radford, K. A., Grant, M., Sinclair, E., Terry, J., Sampson, C. J., Edwards, C., …Jenkinson, M. (2014). Can stroke specific vocational rehabilitation (SSVR) be delivered and measured?: feasibility RCT and economic analysis. Clinical Rehabilitation, 28(4), https://doi.org/10.1177/0269215513506172
DOI https://doi.org/10.1177/0269215513506172
Publisher URL http://journals.sagepub.com/doi/pdf/10.1177/0269215513506172
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
Additional Information Proceedings of the SRR Summer 2013 meeting

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Can Stroke Specific Vocational Rehabilitation AAM.pdf (279 Kb)
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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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