Return to Work
Who we work with
Service providers:
- Derby Hospitals NHS Foundation Trust
Service users:
- Marita Jenkinson, Malcolm Jarvis
Expert panel:
- A group of local and national experts in Vocational Rehabilitation and stroke have helped us to develop our intervention. This panel consists of stroke service users, vocational rehabilitation service providers from the statutory (Health services, Local Authority and Department for Work and pensions), independent and voluntary sectors, as per our list:
Jennifer Allen - Ready4Work Team Manager - Nottingham City Council
Yashashree Bedekar – Specialist Neuro Vocational Rehabilitation Occupational Therapist - Tower Hamlets -
London
Dr Nicola Brain – Consultant in Rehabilitation Medicine – Royal Derby Hospital
Carol Coole – Specialist Vocational Rehabilitation Occupational Therapy Researcher – University of Nottingham
Leigh Cordery – Occupational Therapist – Support into Work Team – Nottingham
Rosemary Cunningham - Head Speech and Language Therapist (Stroke) - Royal Derby Hospital
Alison Hammond - Professor in Rheumatology Rehabilitation - Salford University
Jain Holmes - Specialist Vocational Rehabilitation Occupational Therapist - Independent Practice - Derbyshire
Matthew Horrocks – IAPTS Practitioner – Nottinghamshire
Malcolm Jarvis - Stroke Survivor
Marita Jenkinson – Stroke Survivor
Gillian Linford – Stroke Specialist Community Speech and Language Therapist – Derbyshire
Zandra Morling – Specialist Neuro Occupational Therapist – Nottingham City Hospital
Diane Pearson - Occupational Therapist - Nottingham City Hospital
Julie Phillips – Senior Occupational Therapist – Nottingham Traumatic Brain Injury Service
Dawn Stephenson – Specialist Neuro Occupational Therapist – Nottingham City Hospital
Jane Terry – Senior Occupational Therapist – Community Stroke Team – Nottingham
Dr Louise Thomson – Research Fellow – Engagement Theme – CLAHRC-NDL
Christa Wright – Specialist Vocational Rehabilitation Occupational Therapist – Independent Practice London
Lou Watkins, Stroke Specialist Occupational Therapist, Royal Derby Hospital
Zoe Zydzienowski – Specialist Neuro Occupational Therapist - Royal Derby Hospital
Other Institutions:
- Dr Beverley French, Ali Gibson and Michael Bowerman from the University of Central Lancashire are working with us to conduct an Evidence Synthesis which attempts to map stroke survivors needs and job demands to different types of vocational rehabilitation service for people with stroke.
We also network with a wide variety of people, professional groups and organisations across the public, independent and voluntary sectors who offer advice support and or help to stroke survivors hoping to return to work.
Progress to date
February 2010
We identified stakeholders (commissioners, providers and service users (stroke survivors, families and employers) in health, social care, the independent and voluntary sector and the Department for Work and Pensions) who give or receive advice or support with returning to work after a stroke in Derbyshire, Nottinghamshire and Lincolnshire.
April 2010
We started to interview key stakeholders in the identified services in Derbyshire to find out how the services were operationally defined (what they did / didn't do and for whom) and organized. In this phase we identified barriers and enablers of work return in existing services and gaps between services.
May 2010
Having identified barriers and sought stakeholders views on the ideal mechanisms of support, we worked closely with these stakeholders and a panel of experts, to develop a stroke specialist Vocational Rehabilitation (VR) intervention intended to bridge service gaps and support stroke survivors in their return to work.
June 2010
The expert panel assisted in the development of a proforma for capturing content of the VR intervention. The intervention can be recorded and content analysed retrospectively on a case by case basis to identify components of successful work return and work retention.
July 2010
We tested the intervention in two case studies and presented these to the expert panel prior to further development and testing in a feasibility trial.
August 2010
Recruitment began for a small randomized controlled trial (RCT) to test the feasibility of measuring the effects and costs of the intervention in around 60 patients (30 controls). Primary (occupational & benefit status) and secondary outcomes (mood, instrumental ADL, quality of life, work impairment, productivity and costs from health & societal perspectives) are recorded at 3, 6 and 12 months.
April 2011
We started a systematic review of the literature of therapeutic interventions and organisational models to facilitate work return in people with stroke.
May 2011
An engagement event was held feedback on the study was given to all stakeholders who attended and there was a forum for discussion and pertinent questions. Karen Stainer (Implementation Fellow) also joined the team. A new Implementation Lead resulted in a change of focus to the scheduled interview plan, providing an opportunity to consider how Vocational Rehabilitation services are commissioned in the NHS.
December 2011
Recruitment of trial participants ended. One paper and 2 posters were accepted presentation at the UK Stroke Forum in December 2011 and were well received.
The employer and stakeholder interviews were also completed.
April 2012
Three month follow-up data collection completed.
July 2012
Six month follow-up data collection completed.
An extended 12 month follow up was agreed enabling us to understand more about the stroke survivor's journey back to work. This will complete in December 2012.
During the next six months of the project the team will be working hard to complete the 12 month follow-ups and analyse, write up and disseminate the findings.
In the months between March and September 2013, a series of feedback events and workshops will take place sharing the findings with interested stakeholders.
August 2012
In July we said goodbye to Karen and a new Implementation Theme researcher, Amanda Crompton, will pick up the threads and continue to support the team in making sense of the interview data and extracting the important messages for clinical services.
RETURN TO WORK AFTER STROKE STUDY – NOW CLOSED
The purpose of this study was fourfold;
i) To map existing services in Derbyshire, Nottinghamshire and Lincolnshire that help stroke survivors intending to return to work and to explore the gaps in these services with key stakeholders. Then using this knowledge
ii) To develop a stroke-specific vocational rehabilitation intervention intended to bridge existing gaps in supporting the stroke survivor in a return to work and
iii) To test the feasibility of delivering and measuring its effects and cost effectiveness compared to usual NHS rehabilitation in a feasibility randomised controlled trial in Derbyshire.
iv) Following intervention, a number of stroke participants and employers were interviewed about it’s usefulness and acceptability. Commissioners in Derbyshire and Nottinghamshire were also interviewed about the future commissioning and implementation of stroke specific vocational rehabilitation.
Final outcomes
• The study demonstrated that it is feasible to deliver stroke-specific vocational rehabilitation and measure it’s effects and cost effectiveness (Radford et al., in press).
• Results are published in Disability and Rehabilitation (Sinclair E, Radford K, Grant M, Terry J (2013) Developing stroke-specific vocational rehabilitation: a soft systems analysis of current provision. [Online] Disability and Rehabilitation. May 2013. Available at: DOI:10.3109/09638288.2013.793410, the Journal of Occupational Rehabilitation (Coole C, Radford K, Grant M, Terry J (2012) Returning to work after stroke: perspectives of employer stakeholders, a qualitative study. Journal of Occupational Rehabilitation. Published online on December 5th, 2012, DOI 10.1007/s10926-012-9401-1) and the Journal of Health Services Research and Policy (Radford KA, Crompton A, Stainer K, Commissioning Vocational Rehabilitation after Stroke: can the Cinderella Services get to the Ball? A Qualitative ÌÇÐÄÔ´´, Journal of Health Services Research and Policy, 18(Suppl. 1) 30–38)
• Presentations were made at the UK Stroke Forum, the College of Occupational Therapists Annual Conference, NIMAST and the Society for Research in Rehabilitation
• Two additional papers have been submitted for publication and are under review and a further three are in preparation.
Other outcomes
• A 0.6 vocational rehabilitation occupational therapy post was commissioned for 12 months by Nottingham CityCare Partnership which is currently being evaluated by Dr Radford at the ÌÇÐÄÔ´´
• A PhD is being prepared for submission
Contact Dr Kate Radford, Associate Professor in Rehabilitation Research (Long Term Conditions)
Telephone: 0115 823 0226 email: kate.radford@nottingham.ac.uk
How we are disseminating our information?
In May 2011, we held an engagement event at The Royal Derby Hospital. The event aimed to raise the profile of the project and allowed us to present, discuss and validate some of the early findings with stakeholders from across the three counties. To find out more, see our overview of the event.
Return to Work after Stroke Event, May 10th 2011
The Return to Work after Stroke project team in partnership with colleagues from Engagement, hosted an event on May 10th at Royal Derby Hospital, presenting early findings from the mapping, interview and observational study to a wide group of stakeholders including service users, providers and commissioners from health, social care, education and the DWP from across Nottinghamshire, Derbyshire and Lincolnshire.
In addition to an opportunity to feedback and verify results, a lively and topical 'Question Time' allowed contentious issues around the organisation and delivery of vocational rehabilitation services for stroke survivors to be aired. An expert panel including commissioners, GPs, researchers, service providers in health, the DWP, social care and service users, provided frank responses to some difficult questions including Who should benefit? Who should provide this support? Is work a health problem? and What is the employers role? which were useful in challenging barriers to return to work within existing service provision and in the context of the current political and financial climate.
Commissioners who participated in this event have expressed an interest in continuing to work with the project team. Tabled discussions were used to seek delegates' views, exchange knowledge and discuss future research ideas and opportunities for further collaboration.
The valuable dialogue and 'Question Time' responses have been captured and a summary report will shortly be available. For a copy please contact Research Assistant, Emma Sinclair. To remain in touch with the project become a CLAHRC associate.
See also our comprehensive list of papers and presentations.
How are we building capacity in the NHS?
Our Diffusion Fellow Jane Terry provides a link between the research team and the front line clinicians, to ensure there is an exchange of information in both directions. Jane is an Occupational therapist in the Nottingham Community Stroke Team.