Social cognition and executive functioning predictors of supervisors’ appraisal of interpersonal behaviour in the workplace following acquired brain injury

BACKGROUND: Social cognition and executive functioning difficulties following acquired brain injury have been linked to negative employment outcomes, such as demotion and loss of vocational roles. These are very counter-intuitive and challenging difficulties for other employees and work supervisors who have little or no brain injury knowledge, whose perceptions of play a key role in their responses to these difficulties and the final outcome of such problems for vocational status. OBJECTIVES: This study aimed to study the relationship between social cognition and executive functioning difficulties and the perceptions of work supervisors’ appraisal of survivor interpersonal behaviour and social skills in the workplace. METHOD: The performance of 73 survivors of acquired brain injury (47% TBI, 38% CVA, 15% other ABI type; 73% male; mean age 45.44 years, range 19-64 years; mean time since injury 6.36 years, range 10.5-31.33 years), currently in a vocational rehabilitation placement) on neuropsychological tests of executive functioning and social cognition was measured. Informant ratings on the Social Skills Factor subscale from the Work Personality Profile (WPP, Bolton&Roessler, 1986) were used as the primary outcome measure, a vocational functioning questionnaire assessing social and presentational aspects of workplace behaviour. The raters were non-clinical workplace informants acting in a supervisory role (supervisory placement providers and job coaches). RESULTS: Correlational analysis identified significant associations between the WPP and survivor goal-orientated planning and implementation, mentalising ability, recognition of positive and negative emotions, and recognition of simple sarcasm (all significant at p < 0.05). These correlates were entered into a stepwise multiple regression. The combination final of survivor mentalising ability and executive functioning explained 32%of the variance in the WPP ratings (F (2, 52) = 12.15, p < 0.001). CONCLUSION: Certain limitations of the study withstanding, the current findings add to previous literature in highlighting the relevance of survivor executive functioning and social cognition difficulties for the perceptions and appraisal of work colleagues, consistent with other studies that have identified negative vocational outcomes associated with such neuropsychological difficulties. The implications for vocational rehabilitation are discussed

How does mentoring occupational therapists improve intervention fidelity in a randomised controlled trial? A realist evaluation

Background: Integrating complex interventions within healthcare settings can be challenging. Mentoring can be embedded within a randomised controlled trial (RCT) to upskill and support those delivering the intervention. This study aimed to understand, from a realist perspective, how mentoring worked to support implementation fidelity for occupational therapists (OTs) delivering a vocational rehabilitation (VR) intervention within the context of an RCT. Methods: A realist evaluation using secondary data (emails, mentoring record forms, interviews) collected as part of an RCT. Three researchers coded the data following content analysis, focused on refining or refuting an initial programme theory by exploring the interactions between context, mechanisms, and outcomes. The research team met to further refine the programme theories. Results: Data from 584 emails, 184 mentoring record forms, and 25 interviews were analysed following a realist approach. We developed a programme theory consisting of two contexts (trial set-up, ongoing mentoring), nine mechanisms (collective understanding, monitoring, timely support, positive reinforcement, reflective practice, support data completeness, facilitation strategy, shared learning experience, management of research and clinical duties), and three outcomes (improved confidence, improved fidelity, reduced contamination). Conclusions: Offering mentoring support to OTs delivering a VR intervention as part of an RCT improves intervention fidelity and reduces the risk of contamination. It improves OTs’ understanding of the differences between their clinical and research roles and increases their confidence and competence in trial paperwork completion and identification of potential contamination issues

Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT

Background Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI. Objective To assess the feasibility of a definitive, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, specialist VR plus usual care (UC) compared with UC alone on work retention 12 months post TBI. Design A multicentre, feasibility, parallel-group RCT with a feasibility economic evaluation and an embedded mixed-methods process evaluation. Randomisation was by remote computer-generated allocation. Setting Three NHS major trauma centres (MTCs) in England. Participants Adults with TBI admitted for > 48 hours and working or studying prior to injury. Interventions Early specialist TBI VR delivered by occupational therapists (OTs) in the community using a case co-ordination model. Main outcome measures Self-reported RTW 12 months post randomisation, mood, functional ability, participation, work self-efficacy, quality of life and work ability. Feasibility outcomes included recruitment and retention rates. Follow-up was by postal questionnaires in two centres and face to face in one centre. Those collecting data were blind to treatment allocation. Results Out of 102 target participants, 78 were recruited (39 randomised to each arm), representing 39% of those eligible and 5% of those screened. Approximately 2.2 patients were recruited per site per month. Of those, 56% had mild injuries, 18% had moderate injuries and 26% had severe injuries. A total of 32 out of 45 nominated carers were recruited. A total of 52 out of 78 (67%) TBI participants responded at 12 months (UC, n = 23; intervention, n = 29), completing 90% of the work questions; 21 out of 23 (91%) UC respondents and 20 out of 29 (69%) intervention participants returned to work at 12 months. Two participants disengaged from the intervention. Face-to-face follow-up was no more effective than postal follow-up. RTW was most strongly related to social participation and work self-efficacy. It is feasible to assess the cost-effectiveness of VR. Intervention was delivered as intended and valued by participants. Factors likely to affect a definitive trial include deploying experienced OTs, no clear TBI definition or TBI registers, and repatriation of more severe TBI from MTCs, affecting recruitment of those most likely to benefit/least likely to drop out. Limitations Target recruitment was not reached, but mechanisms to achieve this in future studies were identified. Retention was lower than expected, particularly in UC, potentially biasing estimates of the 12-month RTW rate. Conclusions This study met most feasibility objectives. The intervention was delivered with high fidelity. When objectives were not met, strategies to ensure feasibility of a full trial were identified. Future work should test two-stage recruitment and include resources to recruit from ‘spokes’. A broader measure covering work ability, self-efficacy and participation may be a more sensitive outcome. Trial registration Current Controlled Trials ISRCTN38581822. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 33. See the NIHR Journals Library website for further project information

Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors

Background: Little guidance exists regarding how best to upskill and support those delivering complex healthcareinterventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupationaltherapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimedto explore mentors’ roles in supporting OTs with intervention delivery and fidelity, and to describe factors affectingthe mentoring process and intervention delivery.Methods: Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoringrecords and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to interventiondelivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions ofintervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring werecalculated per trial site. Qualitative data were analysed thematically.Results: Forty-one OTs across 16 sites were mentored between March 2018 and April 2020. Most mentoring wasprovided by phone or Microsoft Teams (range: 88.6–100%), with the remainder via email and SMS (Short MessageService) text messages. Mentors suggested strategies to enhance trial recruitment, improved OTs’ understanding ofandadherence to trial processes, intervention delivery and fidelity, and facilitated independent problem-solving.Barriers to mentoring included OT non-attendance at mentoring sessions and mentors struggling to balancementoring with clinical roles. Facilitators included support from the trial team and mentors having protected timefor mentoring.Conclusions: Mentoring supported mentee OTs in various ways, but it remains unclear to what extent the OTSwould have been able to deliver the intervention without mentoring support, or how this might have impactedfidelity. Successful implementation of mentoring alongside new complex interventions may increase the likelihoodof intervention effectiveness being observed and sustained in real-life contexts. Further research is needed toinvestigate how mentors could be selected, upskilled, funded and mentoring provided to maximise impact. Theclinical- and cost-effectiveness of mentoring as an implementation strategy and its impact on fidelity also requirestesting in a future trial

Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT

BACKGROUND: Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI.OBJECTIVE: To assess the feasibility of a definitive, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, specialist VR plus usual care (UC) compared with UC alone on work retention 12 months post TBI.DESIGN: A multicentre, feasibility, parallel-group RCT with a feasibility economic evaluation and an embedded mixed-methods process evaluation. Randomisation was by remote computer-generated allocation.SETTING: Three NHS major trauma centres (MTCs) in England.PARTICIPANTS: Adults with TBI admitted for &gt; 48 hours and working or studying prior to injury.INTERVENTIONS: Early specialist TBI VR delivered by occupational therapists (OTs) in the community using a case co-ordination model.MAIN OUTCOME MEASURES: Self-reported RTW 12 months post randomisation, mood, functional ability, participation, work self-efficacy, quality of life and work ability. Feasibility outcomes included recruitment and retention rates. Follow-up was by postal questionnaires in two centres and face to face in one centre. Those collecting data were blind to treatment allocation.RESULTS: Out of 102 target participants, 78 were recruited (39 randomised to each arm), representing 39% of those eligible and 5% of those screened. Approximately 2.2 patients were recruited per site per month. Of those, 56% had mild injuries, 18% had moderate injuries and 26% had severe injuries. A total of 32 out of 45 nominated carers were recruited. A total of 52 out of 78 (67%) TBI participants responded at 12 months (UC, n = 23; intervention, n = 29), completing 90% of the work questions; 21 out of 23 (91%) UC respondents and 20 out of 29 (69%) intervention participants returned to work at 12 months. Two participants disengaged from the intervention. Face-to-face follow-up was no more effective than postal follow-up. RTW was most strongly related to social participation and work self-efficacy. It is feasible to assess the cost-effectiveness of VR. Intervention was delivered as intended and valued by participants. Factors likely to affect a definitive trial include deploying experienced OTs, no clear TBI definition or TBI registers, and repatriation of more severe TBI from MTCs, affecting recruitment of those most likely to benefit/least likely to drop out.LIMITATIONS: Target recruitment was not reached, but mechanisms to achieve this in future studies were identified. Retention was lower than expected, particularly in UC, potentially biasing estimates of the 12-month RTW rate.CONCLUSIONS: This study met most feasibility objectives. The intervention was delivered with high fidelity. When objectives were not met, strategies to ensure feasibility of a full trial were identified. Future work should test two-stage recruitment and include resources to recruit from 'spokes'. A broader measure covering work ability, self-efficacy and participation may be a more sensitive outcome.TRIAL REGISTRATION: Current Controlled Trials ISRCTN38581822.FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.</p

Waterlogging in Australian agricultural landscapes: a review of plant responses and crop models

This review summarises reported observations of the effects of waterlogging on agricultural production in Australia and briefly discusses potential remediation strategies. Inconsistencies are demonstrated in the current indicators used for assessment of waterlogging potential across agricultural landscapes as well as in parameters measured in waterlogging studies. It is suggested that predictions of waterlogging potential for landscapes should be based on a minimum dataset that includes pedological, topographical, and climate data for the defined area, as well as observations of plant morphological appearance and visible surface water. The review also summarises the effects of low oxygen concentration in soil on rhizosphere processes, and discusses evidence for direct effects on plant physiology of reductions in soil oxygen caused by waterlogging. Finally, the review describes current crop growth, water use, and yield simulation models used in Australia (SWAGMAN, DRAINMOD, and APSIM) that incorporate waterlogging stress. It is suggested that there is scope for modifications to these models based on recent improved understanding of plant physiological responses to waterlogging and on further research. The review concludes that improvements in modelling waterlogging outcomes to assist growth and yield predictions should ultimately enhance management capacity for growers.Ruth E. Shaw, Wayne S. Meyer, Ann McNeill, and Stephen D. Tyerma