Early vocational rehabilitation compared with usual care for stroke survivors: an individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations
Stroke
This study will involve 760 stroke survivors (420 ESSVR plus usual care, 340 usual care alone), who are employed at stroke onset, and their carers (if applicable). Two occupational therapists from 20 UK hospitals will receive training in the Early Stroke Specialist Vocational Rehabilitation (ESSVR). ESSVR seeks to lessen the impact of stroke by assessing the patient’s role as a worker and finding acceptable strategies to overcome problems. ESSVR is individually tailored to participants’ needs, starting within eight weeks of stroke, with dose and intensity as needed. The Early Stroke Specialist Vocational Rehabilitation (ESSVR) model (intervention) will be compared to a usual care (control) group: Intervention group: ESSVR will be delivered by a stroke specialist occupational therapist (OT) who is trained to assess the impact of the stroke on the participant and their job; coordinate appropriate support from NHS, employer and other stakeholders; negotiate workplace adjustments, monitor return to work and explore alternatives where current work is not feasible or cannot be sustained. It will be tailored to individual needs. Usual care (UC) group: Usual NHS rehabilitation provided by usual care team. This may involve outpatient/community physio-, speech- or occupational- therapy, psychology, medical follow-up. The intervention will commence within 2 weeks of randomisation and last for as long as is needed up to 12 months post-randomisation. Participants will be followed up by postal/online questionnaire at 3, 6 and 12 months post-randomisation. The success of ESSVR will primarily be measured by the number of stroke survivors who are in employment (paid or unpaid) for a minimum of 2 hours at 12 months post-randomisation. Secondary outcomes will also include changes in mood, physical function, community integration, quality of life, work self-efficacy, post-stroke confidence, the number of NHS services needed for participants, changes in the numbers and types of neg
1. Age ≥18 years 2. Admitted to hospital with new stroke (all severities) 3. In work at stroke onset (including self-employed, paid or unpaid) 4. Willing and have capacity to provide informed consent to participate in the study 5. Have sufficient proficiency in English to contribute to the data collection required for research
Not intending to work