Vocational Rehabilitation To Enhance Return to Work After Trauma: Findings From A Non-Randomised Feasibility Study...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

To assesses the feasibility of delivering a telehealth vocational rehabilitation (VR) intervention to enhance return to work and improve quality of life and wellbeing in people post-trauma. Non-randomised single-arm mixed-methods feasibility study. Participants were recruited from two UK major trauma centres (MTCs). The intervention was delivered virtually (or face-to-face where necessary) in participants' homes. Adult patients (n=10) 16-69 years, admitted to participating UK MTCs with Injury Severity Score (ISS) >8, recruited ≤12 weeks post-injury. Eligible participants were employed (paid or unpaid) or in full-time education at injury onset. Treating occupational therapists (OTs) and clinical psychologists (CPs) (n=6) trained in ROWTATE VR. ROWTATE is an individually-tailored job retention intervention, delivered by OTs, who act as case-coordinators, and CPs. It commences 12-weeks post-injury and is delivered for up to 12 months. It involves: assessing impact of injury;work-focused rehabilitation;planning/monitoring phased return-to-work;liaising with employers/healthcare team;educating patients/employers about injury impact;early identification, monitoring and support for psychological problems. Due to COVID-19, the intervention was adapted for remote delivery (video/phone call) and OTs/CPs trained in remote delivery. Study completion. Intervention fidelity, barriers and enablers to delivery, acceptability and usefulness;acceptability of remote intervention training. At 6 months: 90% started intervention ≤12 weeks post-injury, 103 OT sessions (M=10.3, range 5-19);99% OT sessions delivered remotely, 6 patients referred to CP;22 sessions (M=3.7, range 1-5), 100% remote. Fidelity: OT: 90%-100% across patients, CP: 82%-100% across patients. No participant withdrawals. Treating therapists and all participants found the intervention acceptable. Remote VR training and delivery is feasible and acceptable to OTs/CPs and trauma survivors. Findings have informed a definitive randomised controlled trial. No conflicting interests.

Vocational Rehabilitation To Enhance Return to Work After Trauma: Findings From A Non-Randomised Feasibility Study

Research Objectives To assesses the feasibility of delivering a telehealth vocational rehabilitation (VR) intervention to enhance return to work and improve quality of life and wellbeing in people post-trauma. Design Non-randomised single-arm mixed-methods feasibility study. Setting Participants were recruited from two UK major trauma centres (MTCs). The intervention was delivered virtually (or face-to-face where necessary) in participants’ homes. Participants Adult patients (n=10) 16-69 years, admitted to participating UK MTCs with Injury Severity Score (ISS) >8, recruited ≤12 weeks post-injury. Eligible participants were employed (paid or unpaid) or in full-time education at injury onset. Treating occupational therapists (OTs) and clinical psychologists (CPs) (n=6) trained in ROWTATE VR. Interventions ROWTATE is an individually-tailored job retention intervention, delivered by OTs, who act as case-coordinators, and CPs. It commences 12-weeks post-injury and is delivered for up to 12 months. It involves: assessing impact of injury;work-focused rehabilitation;planning/monitoring phased return-to-work;liaising with employers/healthcare team;educating patients/employers about injury impact;early identification, monitoring and support for psychological problems. Due to COVID-19, the intervention was adapted for remote delivery (video/phone call) and OTs/CPs trained in remote delivery. Main Outcome Measures Study completion. Intervention fidelity, barriers and enablers to delivery, acceptability and usefulness;acceptability of remote intervention training. Results At 6 months: 90% started intervention ≤12 weeks post-injury, 103 OT sessions (M=10.3, range 5-19);99% OT sessions delivered remotely, 6 patients referred to CP;22 sessions (M=3.7, range 1-5), 100% remote. Fidelity: OT: 90%-100% across patients, CP: 82%-100% across patients. No participant withdrawals. Treating therapists and all participants found the intervention acceptable. Conclusions Remote VR training and delivery is feasible and acceptable to OTs/CPs and trauma survivors. Findings have informed a definitive randomised controlled trial. Author(s) Disclosures No conflicting interests.

Qualitative study exploring factors affecting the implementation of a vocational rehabilitation intervention in the UK major trauma pathway.

OBJECTIVES: This study aimed to: (1) understand the context for delivering a trauma vocational rehabilitation (VR) intervention; (2) identify potential barriers and enablers to the implementation of a VR intervention post-trauma. DESIGN: Qualitative study. Data were collected in person or via phone using different methods: 38 semistructured interviews, 11 informal 'walk-through care pathways' interviews, 5 focus groups (n=25), 5 codesign workshops (n=43). Data were thematically analysed using the framework approach, informed by the Consolidated Framework for Implementation Research. SETTING: Stakeholders recruited across five UK major trauma networks. PARTICIPANTS: A variety of stakeholders were recruited (n=117) including trauma survivors, rehabilitation physicians, therapists, psychologists, trauma coordinators and general practitioners. We recruited 32 service users (trauma survivors or carers) and 85 service providers. RESULTS: There were several issues associated with implementing a trauma VR intervention including: culture within healthcare/employing organisations; extent to which healthcare systems were networked with other organisations; poor transition between different organisations; failure to recognise VR as a priority; external policies and funding. Some barriers were typical implementation issues (eg, funding, policies, openness to change). This study further highlighted the challenges associated with implementing a complex intervention like VR (eg, inadequate networking/communication, poor service provision, perceived VR priority). Our intervention was developed to overcome these barriers through adapting a therapist training package, and by providing early contact with patient/employer, a psychological component alongside occupational therapy, case coordination/central point of contact, and support crossing sector boundaries (eg, between health/employment/welfare). CONCLUSIONS: Findings informed the implementation of our VR intervention within the complex trauma pathway. Although we understand how to embed it within this context, the success of its implementation needs to be measured as part of a process evaluation in a future trial.