Vocational rehabilitation following traumatic brain injury: what is the evidence for clinical practice?

Traumatic brain injury (TBI) typically affects young adults with potentially many years of working life ahead of them. For people who were in work prior to their injury, return to work (RTW) is a common goal. However, a systematic review of RTW rates for people with TBI who were in work prior to their injury found that approximately 41% were in work at one and two years post TBI [1]. Since TBI is a leading cause of morbidity worldwide in young adults [2], this discrepancy between what people with TBI want and what they achieve is important. The question is does the research evidence inform clinicians how to help a person with TBI return to work

A scoping review of the needs of children and young people with acquired brain injuries and their families

Understanding the needs of children and young people (CYP) with acquired brain injuries (ABI) isessential in delivering pathways of care and providing effective rehabilitation.Aim: To identify relevant literature and key themes relating to the nature and extent of needs (met,unmet or unrecognized) of CYP with ABI and their families.Method: Scoping review. Sixteen electronic bibliographic databases were searched using terms relating tochildren, brain injury and need. Papers were screened against eligibility criteria by two independentreviewers. No date limits were applied. Data were extracted by the lead author regarding the needs ofCYP with ABI and their families and thematic analysis conducted to identify the key themes. Methodologicalquality was not assessed.Results: A total of 28 articles were identified including three systematic reviews, one scoping review,two practice recommendation articles, and 22 original research studies. Participants included CYP withABI, parents, siblings, and professionals. Four key themes were identified; CYP-related impairment needs,support needs, return to school and long-term aftercare.Conclusion: CYP with ABI and their families report extensive needs, many of which are often unmet orunrecognized by those supporting the CYP. Needs transcend the health, social care, and education domains

Return to work after stroke: recording, measuring, and describing occupational therapy intervention

Introduction: Existing research on vocational rehabilitation following stroke has been criticised for not describing intervention in sufficient detail for replication or clinical implementation. The purpose of this study was to test the feasibility of recording and measuring the content of an early stroke-specific vocational rehabilitation intervention delivered to participants in a feasibility randomized controlled trial, using a proforma previously developed for a study of vocational rehabilitation following traumatic brain injury. Method: The proforma was adapted for use in stroke with input from an expert panel and was used to record intervention content, in 10-minute units, following each intervention session. Findings: Twenty-five people, working or in education at the time of stroke, participated in the study. Two thirds of the therapists' time was spent in face-to-face contact (43%) and liaison with the patient and others (20%). Intervention mainly focused on work preparation (21%) and the return to work process (24%). The remaining time was consumed by administration (19%) and travel (18%). Conclusion: The proforma was quick and easy to use and captured the main focus of intervention. This study suggests that it can be used to record stroke-specific vocational rehabilitation intervention content and has potential for wider use in research and clinical practice

What is 'Early intervention' for work related difficulties for people with multiple sclerosis?: a case study report

Background: Employment matters and at diagnosis most people with multiple sclerosis are in full time work or education. 75% of people with multiple sclerosis report the condition has impacted on this employment or career opportunities. Early intervention to support people in work is advocated for in the literature. This paper starts the journey of exploring what is meant by early. Methods: A randomized control trial was undertaken offering either occupational therapy led early intervention or usual care to people diagnosed with multiple sclerosis within one year. Two cases were purposively selected from the treatment group and used to illustrate the importance as well as the nature of early intervention. Results: Both participants received occupational therapy led support which included fatigue management, advice about legal rights, support accessing services such as Access to Work, and support with disclosure in the workplace. Conclusions: Neither of the participants had reported any work problems at the point of referral. However the clinical intervention led to the identification of small concerns and worries. The education and support offered to these two participants alleviated these worries. Early support and education to enable people with multiple sclerosis to manage their condition in the work place can have a positive impact. This may equip them better for the journey ahead

Interventions to reduce dependency in bathing in community dwelling older adults: a systematic review

Background The onset of bathing disability for older adults has been found to be an indicator and potential precursor of further disability. Thus interventions targeting bathing may prevent or delay further disability and the use of health and social care services. The aim of this systematic review was to identify interventions targeted at reducing dependency in bathing for community dwelling older adults, and determine their content and effectiveness in maintaining or improving function and quality of life. Methods We conducted a systematic search of electronic databases including: The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; AMED; CINAHL; PsycINFO and OTSeeker. The search took place on 18 October 2016. We included randomised controlled trials, nonrandomised controlled trials, and controlled before and after studies that evaluated an intervention designed to reduce dependency in bathing. Articles were screened for inclusion by two independent reviewers; risk of bias was assessed using quality assessment tools; and data extracted using pre-prepared forms. Disagreements were resolved by discussion and inclusion of a third reviewer. Results The search process identified one study for inclusion in the review. This study evaluated a bathing intervention delivered by an occupational therapist following discharge from hospital. Overall, the findings suggest modest improvements in functional ability in favour of the intervention group although the results should be interpreted with caution. Conclusion Despite evidence suggesting the importance of addressing bathing difficulties as a means of possible prevention of disability in the ageing process, there is a dearth of evaluative or interventional research studies. Further robust research is warranted, including studies of randomised and controlled design

Validation of the stroke drivers screening assessment for patients with an acquired neurological disability

The Stroke Drivers Screening Assessment (SDSA) is a collection of three cognitive tests found predictive of driving in stroke patients. Whilst two of the test (Square Matrices and Road Sign Recognition) were good predictors of on-road performance, it remained unknown whether the SDSA could predict fitness to drive for people with other acquired neurological disabilities. The on-road test, considered the 'gold standard' of driving ability, was the criterion against which SDSA performance was compared. Since the SDSA's validity depends on the reliability of the driving instructor's decision, it seemed important to check that this was consistent with instructors elsewhere. Therefore this study had three aims:- i)To examine the content and concurrent validity of the SDSA sub test. ii)To determine whether the SDSA, either alone or in conjunction with other cognitive tests, could predict fitness to drive for patients with acquired neurological disabilities other than stroke. iii) to check the inter-rater reliability of the gold standard of driving ability (used in studies to validate the SDSA)

Describing return to work after stroke : a feasibility trial of 12-month outcomes

Objective: Stroke is the greatest cause of disability in adults. A quarter of strokes in the UK affect people of working age, yet under half of them return to work after stroke. There has been little investigation into what constitutes “return to work” following stroke. The aim of this study is to describe the work metrics of stroke survivor participants in a feasibility randomized controlled trial of an early stroke specific vocational rehabilitation intervention. Methods: Retrospective analysis of trial data. Metrics on work status, working hours, workplace accommodations and costs were extracted from trial out - comes gathered by postal questionnaire at 3, 6, and 12 months’ post-randomization for 46 stroke participants in a feasibility randomized controlled trial. Participants were randomized to receive vocational rehabilitation (intervention) or usual care (control). Results: Two-thirds ( n = 29; 63%) of participants re - turned to work at some point in the 12 months following stroke. Participants took a mean of 90 days to return to work. Most returned to the same role with an existing employer. Only one-third of participants who were employed full-time at stroke onset were working full-time at 12 months post-stroke. Most participants experienced a reduction in pre-stroke earnings. Workplace accommodations were more common among intervention group participants. More intervention participants than control participants reported satisfaction with work at both 6 and 12 months post-randomization. Conclusion: This study illustrates the heterogeneous nature of return to work and the dramatic impact of stroke on work status, working hours and income. Longitudinal research should explore the socioeconomic legacy of stroke and include clear definitions of work and accurate measures of working hours and income from all sources

Occupational therapy can flourish in the 21st century — a case for professional engagement with health economics

The view that the profession of occupational therapy will flourish in the 21st century was expressed before the banking system and financial market collapse in 2008. The profession now competes for scarce resources as austerity measures take effect. A summit meeting at the College of Occupational Therapists, in May 2013, discussed how to improve the profession's understanding and use of health economics. At this meeting, short-, medium-, and longer-term approaches were discussed, with the aim of improving the quality and quantity of publications on economic evaluations in occupational therapy. Despite an increasing number of publications on health economics across professions, occupational therapy lags behind. This focus is now vital for the profession

Psychosocial consequences of diagnosing nonspecific low-back pain radiologically: a qualitative study

BackgroundChronic low back pain (CLBP) is a complex biopsychosocial problem with financial implications for society. Most LBP is categorized as nonspecific CLBP (NS-CLBP); magnetic resonance imaging (MRI) is increasingly used in the investigation of LBP but has a high false-positive rate for NS-CLBP.PurposeTo explore the psychosocial factors associated with diagnosing NS-CLBP by MRI in Saudi Arabia.MethodsUsing a qualitative design, 11 patients with CLBP without a clear medical diagnosis who had received an MRI scan were interviewed using a semi-structured technique, and transcripts were analyzed using framework analysis.ResultsFour themes of relevance to the psychosocial consequences of using MRI to diagnose CLBP were identified: 1) impact on social participation after MRI diagnosis; 2) psychological impact of MRI diagnosis; 3) conflicting advice; and 4) patient education. Although some patients expressed a sense of relief following the identification of an objective explanation of their symptoms by MRI, a number of negative consequences were also identified. In particular, fear-avoidance behavior and anxiety were apparent.ConclusionThe use of MRI scanning in the diagnosis of LBP may lead to psychosocial factors influencing participation in physical and social daily activities