Early vocational intervention for people after stroke: A randomised pilot trial

The Early Vocational Rehabilitation Program is an early, individually tailored intervention that aims to improve the ability of people to return to work after stroke. It assesses the participants’ role as a worker alongside their stroke-related impairments to develop acceptable strategies to overcome problems and co-ordinate appropriate support from health care professionals, employers and community services. The intervention is provided over a 12 week period and although total number of sessions will depend on the participant's needs, it will be no less than weekly (minimum of 12 sessions); consistent with usual occupational therapy session lengths will be 1 hour in length. There will be a maximum of five sessions per week for 12 weeks. The intervention content comprises of key components that are delivered across four phases: 1. orientation to the participants' worker role; 2. building awareness, skills and, strategies through the use of video feedback, assessment and grading of core work activities; 3. work preparation (work hardening), that will include the simulation of pre-injury work tasks (such as developing quotes or constructing furniture); and 4. Support (to liaise with employer / to complete a work trial / to find a job / to negotiate return to work). Each stage will be tailored to each participant. Tailoring to meet each participant's unique work goal will occur, elements for tailoring will include the content of each therapy session, who is involved in the rehabilitation, how much support is provided post-discharge, and whether the employer / workplace is involved or not - this will occur to ensure the unique work-goals set by each participant can be met. Tailoring will occur according to participants’ needs and preferences, for example, whether the participant consents to employer liaison and workplace visits or whether the participant accepts advice only about employer liaison. The intervention is delivered by an experienced occupational therapist with at least 5 years experience. The intervention is delivered face to face, provided individually to each participant. Employer liaison (which is a potential support element) may be via telephone. The intervention will commence during the participant's hospitalisation (rehabilitation hospital), but will additionally occur in the participant's home and potentially the workplace (if permission is provided). Adherence to the protocol will be monitored by auditing clinical notes completed at the conclusion of therapy sessions.