| Title: |
Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work after stroKE: A pragmatic, parallel-arm multicenter, randomized controlled trial |
| Authors: |
Radford, K. A.; Wright-Hughes, A.; Thompson, E.; Clarke, D .J.; Phillips, J.; Holmes, J.; Powers, K.; Trusson, D.; Craven, K.; Watkins, C.; Bowen, A.; McKevitt, C.; Stevens, J.; Murray, J. D.; O’Connor, R. J.; Pyne, S.; Risebro, H.; Cameron, R.; Sach, T. H.; Day, F.; Farrin, A. J.; On behalf of the RETAKE Research group |
| Publisher Information: |
SAGE Publications |
| Publication Year: |
2024 |
| Collection: |
University of Nottingham: Repository@Nottingham |
| Description: |
Background: Return-to-work is a major goal achieved by fewer than 50% stroke survivors. Evidence on how to support return-to-work is lacking. Aims: This study aimed to evaluate the clinical effectiveness of Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) versus UC alone for helping people return-to-work after stroke. Methods: This pragmatic, multicentre, individually randomized controlled trial with embedded economic and process evaluations compared ESSVR with UC in 21 NHS stroke services across England and Wales. Eligible participants were aged ⩾ 18 years, in work at stroke onset, hospitalized with new stroke and within 12 weeks of stroke. People not intending to return-to-work were excluded. Participants were randomized (5:4) to individually tailored ESSVR delivered by stroke specialist occupational therapists for up to 12 months or usual National Health Service rehabilitation. Primary outcome was self-reported return-to-work for ⩾ 2 h per week at 12 months. Primary and safety analyses were done in the intention-to-treat population. Results: Between 1 June 2018, and 7 March 2022, 583 participants (Mage 54.1 years (SD 11.0), 69% male) were randomized to ESSVR (n = 324) or UC (n = 259). Primary outcome data were available for 454 (77.9%) participants. Intention-to-treat analysis showed no evidence of a difference in the proportion of participants returned-to-work at 12 months (165/257 (64.2%) ESSVR vs 117/197 (59.4%) UC; adjusted odds ratio 1.12 (95% CI: 0.75–1.68), p = 0.5678). There was some indication that older participants and those with more post-stroke impairment were more likely to benefit from ESSVR (interaction p = 0.0239 and p = 0.0959, respectively). Conclusion: To our knowledge, this is the largest trial of a stroke vocational rehabilitation (VR) intervention ever conducted. We found no evidence that ESSVR conferred any benefits over UC in improving return-to-work rates 12 months post-stroke. Return-to-work (for at least 2 h per week) ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
https://nottingham-repository.worktribe.com/output/45590912; International Journal of Stroke; Volume 20; Issue 4; Pagination 471-485 |
| DOI: |
10.1177/17474930241306693 |
| Availability: |
https://doi.org/10.1177/17474930241306693; https://nottingham-repository.worktribe.com/file/45590912/1/Radford-et-al-2024-effectiveness-of-early-vocational-rehabilitation-versus-usual-care-to-support-return-to-work-after; https://nottingham-repository.worktribe.com/output/45590912 |
| Rights: |
openAccess ; https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.74AACB34 |
| Database: |
BASE |