Return to Work after Trauma: Work Package 1
Research type
Research Study
Full title
Multicentre Research Programme to Enhance Return to Work after Trauma: Work Package 1 – Developing an Intervention
IRAS ID
257164
Contact name
Kate Radford
Contact email
Sponsor organisation
Nottingham University Hospitals NHS Trust, Research and Innovation
Duration of Study in the UK
0 years, 11 months, 31 days
Research summary
Research Summary
Trauma of at least moderate severity (Injury Severity Score (ISS) >8) is a major cause of death, disability and NHS resource use. Many survivors experience physical and psychological problems, reduced quality of life (QoL) and difficulty returning to work, with psychological and occupational needs frequently left unmet. The detrimental effects of being out of work on patient health, NHS costs and society are well documented. Our recent study found one third of patients with ISS>8 have not returned to work one year later with many suffering significant physical and psychological problems.Systematic reviews demonstrate vocational rehabilitation (VR) improves return-to-work in some conditions. However, evidence is lacking for intervention supporting return to work amongst trauma survivors who often suffer multiple injuries, affecting several body regions, with psychological and/or cognitive problems impacting on work ability. We have developed VR interventions for traumatic brain injury and stroke. Our proposal adapts these for a much wider range of injuries, potentially enabling wide-scale NHS roll-out.
We aim to develop, evaluate and assess the implementation of an intervention to enhance return-to-work and improve quality of life and wellbeing in people with at least moderate trauma. The study submitted for review is the first of four work packages within a larger programme. This work package will review existing evidence and will collect information through interviews, focus groups and observations within working environments to build knowledge and develop all the documents required to test the new interventions. This includes intervention programme theory, intervention manual, fidelity checklist, data collection tools and training package. We will talk to patients, NHS service providers, carers and commissioners to ensure our vocational rehabilitation programme (called ROWTATE) meets patients’ needs and is feasible as an alternative for care provision.
Summary of Results
Work Package 1 is the first of the 4 work packages. This work package helped understand and develop the key features of the ROWTATE vocational rehabilitation intervention. It helped address four study objectives:Objective 1: Identify and describe the key features that should be part of the ROWTATE intervention.
a) We reviewed existing literature and evidence about what makes return-to-work interventions successful.
b) We interviewed 86 key stakeholders (service providers, trauma survivors, carers) across five major trauma networks to identify issues, needs and challenges faced by people surviving serious injury.
c) We conducted workshops with key trauma stakeholders (n=43) in 5 MTCs to identify what helps and what hinders the delivery of the ROWTATE intervention in each of the 5 local areas.
We used the information from the literature review, interviews and workshops to inform discussions in seven expert group meetings with academics, patients and clinicians. These discussions led to the generation of the guiding principles for the intervention, identification of key intervention features and development of a training package to support intervention delivery.
Objective 2: Understand usual care, local contexts for intervention implementation, including service gaps and unmet need for return-to-work services
We used the interviews with 86 key people (service providers, trauma survivors, carers) to also identify where and how trauma patients’ rehabilitation needs are met. We used the interview and workshop collectively to create a map of existing rehabilitation services across five UK major trauma networks and compared these services against recommended pathways. We identified several issues in current services:
(1) lack of vocational (i.e. return to work)/psychological support particularly for musculoskeletal injuries,
(2) inconsistent service provision in areas located further from major trauma centres
(3) lack of communication between acute and community care,
(4) long waiting lists (≤12 months) for community rehabilitation,
(5) most well-established pathways were focused on patients with brain or spinal cord injuries.The findings from the mapping exercise were published in a journal article (see paper 1 in the reference list).
The findings from the interview and workshop data analysis also informed our understanding of issues that could impact on testing our intervention in the NHS and delivering it in the NHS in the longer term. These included:
(1) inconsistent service provision and the complexity of the major trauma pathway,
(2) the importance of accounting for the ways of working and type of organisations involved in the intervention delivery (both the NHS and patients’ employers),
(3) a lack of employer awareness about the impact of injury on ability to work,
(4) failure to recognise vocational rehabilitation as a priority and
(5) external policies and funding.We used the results to inform two large parts of our study. First, we used the results to check that our intervention can be delivered. Next, we used the results to develop the training that is needed for the therapists to deliver the intervention.
Objective 3: Develop the intervention and produce training package (manual, training), produce the guidelines for mentoring the therapists and the content of the treatment provided to the patients
Evidence from objective 1 and objective 2 analysis, was part of the group discussions with the seven expert members (academics, patients and clinicians). These discussions helped generate guiding principles for the intervention, identify key intervention features and develop a training package to support intervention delivery.
In addition, we adapted a mentoring protocol as well as a fidelity checklist (used to understand the content of the intervention delivered) from the RETAKE return to work after stroke trial (HTA 15/130/11) which is being conducted by Professor Radford, one of the ROWTATE Chief Investigators. Both the mentoring protocol and fidelity checklist are used to understand how the intervention is being delivered and if there are any issues that need to be dealt with.
Objective 4: Identify trial outcomes important to trauma survivors, and finalize the data collection tools that will be used to measure the effects of the intervention in the next Work Package of the ROWTATE study.
We conducted semi-structured interviews and focus groups with 17 trauma patients to explore their views on which outcomes are the most important to patients for recovery and successful and sustainable return to work. They suggested we need to consider the following:
(1) physical and psychological recovery,
(2) purposeful life engagement,
(3) managing expectations of recovery and
(4) managing the trauma patients and employers’’ expectations about return to work.The findings from the interviews were published in a journal article (see paper 2 in the reference list).
We conducted a discussion group with 6 trauma patients on what outcomes should be priorities in relation to return to work. The eight most important outcomes were (1) sense of purpose and life satisfaction, (2) understanding the impact of injury, (3) assessment of readiness to return to work, (4) using SMART goals, (5) facilitated reintegration to work, (6) assessing capacity to return to work, (7) collaboration between key stakeholders and (8) improved employer and employee knowledge. The findings from the group discussion were published in a journal article (see paper 3 in the reference list).
We then conducted a discussion group with 6 trauma patients about what the costs of injuries to individuals, families and health services are. We also asked them about the best way we can collect this information. Their answers helped us better understand the costs and ways we can measure these costs in our study.
We used the information from the group discussions and interviews to understand if the intervention is capturing key outcomes that are important to patients and if and we can measure them. The results helped us finalise the outcomes we are measuring in the feasibility study, which is part of Work Package 2.
Published papers:
1. Kettlewell J, Timmons S, Bridger K, Kendrick D, Kellezi B, Holmes J, Patel P, Radford K. A study of mapping usual care and unmet need for vocational rehabilitation and psychological support following major trauma in five health districts in the UK. Clinical Rehabilitation. 2021;35(5):750-764. doi:10.1177/0269215520971777
2. Bridger K, Kellezi B, Kendrick D, Radford K, Timmons S, Rennoldson M, Jones T, Kettlewell J, on behalf of the ROWTATE Team. Patient Perspectives on Key Outcomes for Vocational Rehabilitation Interventions Following Traumatic Injury. Int. J. Environ. Res. Public Health 2021, 18, 2035. https://eur03.safelinks.protection.outlook.com/?url=http%3A%2F%2Furl6570.hra.nhs.uk%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbWg-2F9tK-2FvIbqzTuN-2BF8dNv6z3-2BQJ0CsVxdijfvPNfv2TjJAy_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YLQUWPuSVRjO0BlA8yyGDGjoM4F97OhB3x-2B6Xx07HZagdjV44FmgWCblXZGhi1e-2FKOwHYbD-2FxqfRFSEH-2BHkopFOhssr-2BR-2FgntaKXDIrtS5DcS8Pwd7UV12-2FTj2nRu9XH6C1QVkbbX7YYoaV6pUzqVPqdvHkpQnVbcAHmHZOFS94rg-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7C0d810fc6c52a43b1505708da2e8b3a94%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637873472760435693%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=d%2FElxQvZYbc2LMoE0bIXrXpO%2BYSUxRexoCkjO18l1aE%3D&reserved=0
3. Bridger K, Kellezi B, Kendrick D, Kettlewell J, Holmes J, Timmons S, Andrews I, Fallon S, Radford K. Patients views on which return to work outcomes should be prioritised: A nominal group technique focus group. British Journal of Occupational Therapy.
REC name
East Midlands - Leicester South Research Ethics Committee
REC reference
19/EM/0114
Date of REC Opinion
7 Jun 2019
REC opinion
Further Information Favourable Opinion