Developing A Conceptual Framework for Early Intervention Vocational Rehabilitation for People Following Spinal Cord Injury.

PURPOSE: Early intervention vocational rehabilitation (EIVR) can improve return to work (RTW) outcomes for people with spinal cord injury (SCI). However, mechanisms explaining how and why EIVR works are not well understood. This study aims to develop a conceptual framework describing key mechanisms of EIVR intervention effect following SCI. METHODS: We synthesised data from a realist literature review with data from interviews of people with SCI (n = 30), a survey of people with SCI who had received EIVR (n = 37), a focus group of EIVR providers and a focus group of community vocational providers. We first synthesised the literature review and interviews to develop an initial programme theory describing the contexts in which mechanisms are activated to produce EIVR outcomes. Then we used data from the survey and focus groups to further refine the EIVR programme theory. Finally, a conceptual framework was developed to support knowledge dissemination. RESULTS: By ensuring consistent messaging across the multi-disciplinary team, EIVR programmes establish and maintain hope that work is possible following injury. Conversations about work allow individuals to determine the priority of work following injury. These conversations can also improve self-efficacy by providing individualized support to envisage pathways toward RTW goals and maintain worker identity. The synthesised study findings highlight the contexts and resources required to trigger activation of these mechanisms. CONCLUSIONS: EIVR key mechanisms of effect are not specific to SCI as a health condition, therefore enabling this framework to be applied to other populations who face similar impairments and return to work barriers.

Comparison of the results of some serological tests for bovine brucellosis.

A total of 1887 bovine sera positive to the Rose Bengal plate test were subjected to other serological tests for bovine brucellosis: the complement fixation test using warm fixation (CFTW),the serum agglutination test (SAT) and the radioimmunoassay (RIA). The SAT was generally much less sensitive than the CFTW. Many sera, however, gave positive reactions in the SAT but no reaction in the CFTW or the RIA. These SAT reactions were attributed to IgM antibody. Comparison between the results of the CFTW and the RIA led to the conclusion that 200 ng could be used as a minimum diagnostic reaction in the RIA.

The diagnostic efficiency of some serological tests for bovine brucellosis.

Results obtained from 1887 sera using three serological tests for bovine brucellosis were compared with a serological classification of sera described as the 'probable infection status'. Sera showing apparent false positive and apparent false negative reactions were identified, and were subjected to supplementary testing as appropriate. The serum agglutination test (SAT) gave 35% apparent false negative reactions and 5% apparent false positives. The complement fixation test (CFT) gave 12% apparent false negative reactions using warm fixation (CFTW) and at least 5% using cold fixation (CFTC). The routine diagnostic system used in Victoria, in which the CFTW is supplemented by the CFTC and the SAT, gave 9% apparent false negative reactions and 2% apparent false positive reactions. The radioimmunoassay gave 1% or 6% apparent false negative reactions, depending on the minimum diagnostic value used. Atypical reactions in the CFT sometimes caused difficulties in diagnosis.

The effects of IgG2 and of antigen concentration on prozoning in the complement fixation test for bovine brucellosis.

Addition of Brucella-specific IgG2 to solutions of Brucella-specific IgG1 initially induced prozoning and at higher concentrations prevented all reaction in the complement fixation test (CFT) for bovine brucellosis. Some infected cattle may be diagnosed as brucellosis-free due to a high ratio of specific IgG2 to IgG1. Increasing the concentration of antigen in the CFT reduced the tendency to prozone.