The simplest way to get survivors back to work is EXACT 100% RECOVERY PROTOCOLS! And you blithering idiots don't know that! Doesn't anyone in stroke know how to think?
Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work After stroKE: a pragmatic, parallel arm multi-centre, randomised-controlled trial
Abstract
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
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 randomised 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, hospitalised with new stroke
and within 12-weeks of stroke. People not intending to return-to-work
were excluded. Participants were randomised (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 hours per week at 12-months. Primary and safety analyses were
done in the intention-to-treat population.
Results
Between
1st June-2018, and 7th March-2022, 583 participants (mean age 54.1
years [SD 11.0], 69% male) were randomised 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 0.8 to 1.87],p=0.3582). 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).
Conclusions
To
our knowledge, this is the largest trial of a stroke 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 hours per week) rates were higher than in
previous studies (64.2% ESSVR versus 59.4% UC) at 12-months and more
than double that observed in our feasibility trial (26%). Interpretation
of findings was limited by a predominantly mild-moderate sample of
participants and the Covid-19 pandemic. The pandemic impacted the trial,
ESSVR and UC delivery, altering the work environment and employer
behaviour. These changes influenced our primary outcome and the meaning
of work in people’s lives; all pivotal to the context of ESSVR delivery
and its mechanisms of action.
Data access:
Data available on reasonable request.
Registration:
ISRCTN12464275.
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