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Development of a Programme Theory for Early Intervention Vocational Rehabilitation: A Realist Literature Review

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Abstract

Purpose Little is currently known about how early intervention vocational rehabilitation (EIVR) works for people with newly acquired neurological conditions such as traumatic brain injury, acquired brain injury and spinal cord injury. This study aims, from a realist framework, to identify relevant literature and develop an initial programme theory to understand how EIVR might work for people experiencing acquired neurological disability. Realist reviews are ideally placed to address the identified knowledge gap as they assist in gaining a deeper understanding of how the intervention works, for whom it works best, and the contexts that promote the activation of desired outcomes. Methods We used a seven-step iterative process to synthesise literature using a realist approach. The steps included: development of initial programme theory, literature search, article selection, extracting and data organising, synthesis of evidence and programme theory refinement. We performed a literature search using the following databases: Cinahl, Embase, EMcare, Medline, PsychInfo and Scopus. Articles were selected if they contributed to the knowledge describing what is EIVR and how it works in newly acquired neurological conditions. Data were extracted and synthesised to develop a programme theory for EIVR. Results Following screening of 448 references, 37 documents were eligible for data extraction. We developed a refined programme theory of EIVR consisting of three contexts (prioritisation of exploring work options, return to work discussed as an option, and workplace support), nine mechanisms (ensuring rehabilitation teams’ culture, fostering hope, exploring options, optimising self-efficacy, maintaining worker identity, staying connected, setting goals, engaging employer, and flexing roles) and three outcomes (confidence in ability to work, psychological adjustment, and engagement in solution focussed options). Conclusions This appears to be the first paper to explore how EIVR works, for whom and in what situations. We have produced a programme theory that may provide an initial understanding of EIVR following acquired neurological conditions.

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References

  1. Hilton G, Unsworth CA, Stuckey R, Murphy GC. The experience of seeking, gaining and maintaining employment after traumatic spinal cord injury and the vocational pathways involved. Work. 2018;59(1):67–84.

    Article  PubMed  Google Scholar 

  2. Dunn DS, Brody C. Defining the good life following acquired physical disability. Rehabil Psychol. 2008;53(4):413–25.

    Article  Google Scholar 

  3. De Angelis T. Boosting productivity and pride. Monitor on Psychology. 47(11). http://www.apa.org/monitor/2016/12/boosting-productivity (2016)

  4. Oppermann JD. Interpreting the meaning individuals ascribe to returning to work after traumatic brain injury:a qualitative approach. Brain Inj. 2004;18(9):941–55.

    Article  PubMed  Google Scholar 

  5. Watson TJ. Sociology work and industry [electronic resource]. London: Routledge; 2008

  6. Giaquinto S, Ring H. Return to work in selected disabilities. Disabil Rehabil. 2007;29(17):1313–6.

    Article  PubMed  Google Scholar 

  7. The Royal Australasian College of Physicians. Australasian Faculty of Occupational and Environmental Medicine Position Statement on Realising the Health Benefits Work. Sydney; 2011.

  8. Waddell G, Burton AK. Is work good for your health and well-being? London, UK: The Stationery Office; 2006.

  9. Yasuda S, Wehman PH, Targett P, Cifu DX, West M. Return to work after spinal cord injury: a review of recent research. NeuroRehabil. 2002;17:177–86.

    Article  Google Scholar 

  10. Waddell G, Burton AK, Kendall AS. Vocational rehabilitation what works, for whom, and when? London; 2008.

  11. Fadyl JK, McPherson KM. Approaches to vocational rehabilitation after traumatic brain injury: a review of the evidence. J Head Trauma Rehabil. 2009;24(3):195–212.

    Article  PubMed  Google Scholar 

  12. Bloom J, Dorsett P, McLennan V. Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries. Spinal Cord Ser Cases. 2017;3(1):1–4.

    Article  Google Scholar 

  13. Cancelliere C, Donovan J, Stochkendahl MJ, Biscardi M, Ammendolia C, Myburgh C, et al. Factors affecting return to work after injury or illness: Best evidence synthesis of systematic reviews. Chiropr Man Therapy. 2016;24(1):1–23.

    Article  Google Scholar 

  14. Hilton G, Unsworth CA, Murphy GC, Browne M, Olver J. Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury. Spinal Cord. 2017;55(8):743–52.

    Article  CAS  PubMed  Google Scholar 

  15. Fadyl JK, McPherson KM. Understanding decisions about work after spinal cord injury. J Occ Rehabil. 2010;20(1):69–80.

    Article  Google Scholar 

  16. Ville I. Biographical work and returning to employment following a spinal cord injury. Sociol Health Illn. 2005;27(3):324–50.

    Article  PubMed  Google Scholar 

  17. British Society of Rehabilitation Medicine. Vocational rehabilitation the way foward: report of a working party. London: BSRM; 2003.

    Google Scholar 

  18. Pawson R, Tilley N. Realistic evaluation. Thousand Oaks: Sage; 1997.

    Google Scholar 

  19. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist synthesis: an introduction. Manchester: ESRC Research Methods Programme, University of Manchester; 2004.

    Google Scholar 

  20. Pawson R, Greenhalgh T, Harvey G, Walsh K. Realist review-a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005; 10(suppl_1): 21–34.

  21. Wong G, Westhorp G, Manzano A, Greenhalgh J, Jagosh J, Greenhalgh T. RAMESES II reporting standards for realist evaluations. BMC Med. 2016;14(1):96.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Dunn JA, Martin RA, Hackney JJ, Nunnerley JL, Snell DL, Bourke JA, et al. Early vocational rehabilitation for people with spinal cord injury; a research protocol using realist synthesis and interviews to understand how and why it works. BMJ Open. 2021;11(5):e048753.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Dalkin SM, Greenhalgh J, Jones D, Cunningham B, Lhussier M. What’s in a mechanism? Development of a key concept in realist evaluation. Implement Sci. 2015;10(1):49.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jagosh J, Pluye P, Wong G, Cargo M, Salsberg J, Bush PL, et al. Critical reflections on realist review: insights from customizing the methodology to the needs of participatory research assessment. Res Syn Meth. 2014;5(2):131–41.

    Article  Google Scholar 

  25. Coole C, Radford K, Grant M, Terry J. Returning to work after stroke: perspectives of employer stakeholders, a qualitative study. J Occup Rehabil. 2013;23(3):406–18.

    Article  PubMed  Google Scholar 

  26. Gard G, Pessah-Rasmussen H, Brogardh C, Nilsson A, Lindgren I. Need for structured healthcare organization and support for return to work after stroke in Sweden: experiences of stroke survivors. J Rehabil Med. 2019;51(10):741–8.

    Article  PubMed  Google Scholar 

  27. Öst Nilsson A, Eriksson G, Johansson U, Hellman T. Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme. Scand J Occup Ther. 2017;24(5):349–56.

    Article  PubMed  Google Scholar 

  28. Cotner B, Njoh E, Trainor J, O’Connor D, Barnett S, Ottomanelli L. Facilitators and barriers to employment among veterans with spinal cord injury receiving 12 months of evidence-based supported employment services. Top Spinal Cord Inj Rehabil. 2015;21(1):20–30.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ramakrishnan K, Murphy G, Middleton J, Cameron I. Early vocational rehabilitation for patients with spinal injury: a qualitative research study of service providers. Int J Ther Rehabil. 2018;25(10):505–15.

    Article  Google Scholar 

  30. Hay-Smith EJ, Dickson B, Nunnerley J, Sinnott KA. “The final piece of the puzzle to fit in”: an interpretative phenomenological analysis of the return to employment in New Zealand after spinal cord injury. Disabil Rehabil. 2013;35(17):1436–46.

    Article  PubMed  Google Scholar 

  31. Marti A, Escorpizo R, Schwegler U, Staubli S, Trezzini B. Employment pathways of individuals with spinal cord injury living in Switzerland: a qualitative study. Work. 2017;58(2):99–110.

    Article  PubMed  Google Scholar 

  32. Libeson L, Downing M, Ross P, Ponsford J. The experience of return to work in individuals with traumatic brain injury. Brain Impair. 2018;19(3):306.

    Google Scholar 

  33. McRae P, Hallab L, Simpson G. Navigating employment pathways and supports following brain injury in Australia: client perspectives. Aust J Rehabil Couns. 2016;22(2):76–92.

    Article  Google Scholar 

  34. Soeker MS, Darries Z. The experiences of women with traumatic brain injury about the barriers and facilitators experienced after vocational rehabilitation in the Western Cape Metropole, South Africa. Work. 2019;64(3):477–86.

    Article  PubMed  Google Scholar 

  35. Rubenson C, Svensson E, Linddahl I, Björklund A. Experiences of returning to work after acquired brain injury. Scand J Occup Ther. 2007;14(4):205–14.

    Article  PubMed  Google Scholar 

  36. Ramakrishnan K, Johnston D, Garth B, Murphy G, Middleton J, Cameron I. Early access to vocational rehabilitation for inpatients with spinal cord injury: a qualitative study of patients’ perceptions. Top Spinal Cord Inj Rehabil. 2016;22(3):183–91.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Medin J, Barajas J, Ekberg K. Stroke patients’ experiences of return to work. Disabil Rehabil. 2006;28(17):1051–60.

    Article  PubMed  Google Scholar 

  38. Glintborg C, Thomsen AS, Hansen TGB. Beyond broken bodies and brains: a mixed methods study of mental health and life transitions after brain injury. Brain Impair. 2018;19(3):215–27.

    Article  Google Scholar 

  39. Fadyl JK, Payne D. Socially constructed ‘value’and vocational experiences following neurological injury. Disab Rehabil. 2016;38(22):2165–77.

    Article  Google Scholar 

  40. Aas RW, Haveraaen LA, Brouwers EPM, Skarpaas LS. Who among patients with acquired brain injury returned to work after occupational rehabilitation? The rapid-return-to-work-cohort-study. Disabil Rehabil. 2018;40(21):2561–70.

    Article  PubMed  Google Scholar 

  41. Van Velzen JM, Van Bennekom CAM, Van Dormolen M, Sluiter JK, Frings-Dresen MHW. Evaluation of the implementation of the protocol of an early vocational rehabilitation intervention for people with acquired brain injury. Disabil Rehabil. 2016;38(1):62–70.

    Article  PubMed  Google Scholar 

  42. Middleton JW, Johnston D, Murphy G, Ramakrishnan K, Savage N, Harper R, et al. Early access to vocational rehabilitation for spinal cord injury inpatients. J Rehabil Med. 2015;47(7):626–31.

    Article  PubMed  Google Scholar 

  43. Bai Z, Song D, Deng H, Li-Tsang CW. Predictors for return to work after physical injury in China: a one-year review. Work. 2018;60(2):319–27.

    Article  PubMed  Google Scholar 

  44. Power PW, Hershenson DB. Work adjustment and readjustment of persons with mid-career onset traumatic brain injury. Brain Inj. 2003;17(12):1021–34.

    Article  PubMed  Google Scholar 

  45. Kendall E. Predicting vocational adjustment following traumatic brain injury: a test of a psychosocial theory. J Vocat Rehabil. 2003;19(1):31–45.

    Google Scholar 

  46. Hilton G. The experience of achieving a successful employment outcome following traumatic spinal cord injury: Pathways and processes. Melbourne: Victorian Spinal Cord Service, Austin Hospital, Spinal Research Institute. 2014.

  47. Dorsett P, McLennan V. Exploring the “status quo” in vocational rehabilitation and employment outcomes following spinal cord injury. J Vocat Rehabil. 2019;50(2):131–9.

    Article  Google Scholar 

  48. Lundqvist A, Samuelsson K. Return to work after acquired brain injury: a patient perspective. Brain Inj. 2012;26(13/14):1574–85.

    Article  PubMed  Google Scholar 

  49. Johnston D, Ramakrishnan K, Garth B, Murphy G, Middleton JW, Cameron ID. Early access to vocational rehabilitation for inpatients with spinal cord injury: a qualitative study of staff perceptions. J Rehabil Med. 2016;48(9):776–80.

    Article  PubMed  Google Scholar 

  50. Dibb B, Ellis-Hill C, Donovan-Hall M, Burridge J, Rushton D. Exploring positive adjustment in people with spinal cord injury. J Health Psych. 2014;19(8):1043–54.

    Article  Google Scholar 

  51. Blake J, Brooks J, Greenbaum H, Chan F. Attachment and employment outcomes for people with spinal cord injury: the intermediary role of hope. Rehabil Couns Bull. 2017;60(2):77–87.

    Article  Google Scholar 

  52. Schönherr MC, Groothoff JW, Mulder GA, Schoppen T, Eisma WH. Vocational reintegration following spinal cord injury: expectations, participation and interventions. Spinal Cord. 2004;42(3):177–84.

    Article  PubMed  Google Scholar 

  53. Grant M, Radford K, Sinclair E, Walker M. Return to work after stroke: recording, measuring, and describing occupational therapy intervention. Br J Occup Ther. 2014;77(9):457–65.

    Article  Google Scholar 

  54. Radford K, Sutton C, Sach T, Holmes J, Watkins C, Forshaw D, et al. Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT. Health Techn Assess. 2018;22(33):1–124.

    Article  Google Scholar 

  55. Bloom J, McLennan V, Dorsett P. Occupational bonding after spinal cord injury: a review and narrative synthesis. J Vocat Rehabil. 2019;50(1):109–20.

    Article  Google Scholar 

  56. O’Keefe S, Stanley M, Adam K, Lannin NA. A systematic scoping review of work interventions for hospitalised adults with an acquired neurological impairment. J Occup Rehabil. 2019;29(3):569–84.

    Article  PubMed  Google Scholar 

  57. Sinclair E, Radford K, Grant M, Terry J. Developing stroke-specific vocational rehabilitation: a soft systems analysis of current service provision. Disabil Rehabil. 2014;36(5):409–17.

    Article  PubMed  Google Scholar 

  58. Hilton G, Unsworth C, Murphy G. The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature. Disabil Rehabil. 2018;40(15):1745–53.

    Article  PubMed  Google Scholar 

  59. van Velzen JM, van Bennekom CAM, van Dormolen M, Sluiter JK, Frings-Dresen MHW. Factors influencing return to work experienced by people with acquired brain injury: a qualitative research study. Disabil Rehabil. 2011;33(23–24):2237–46.

    Article  PubMed  Google Scholar 

  60. Snyder C, Irving LM, Anderson JR. Hope and health. Handbook of social and clinical psychology: the health perspective. Oxford: Pergamon Press; 1991. p. 285–305.

    Google Scholar 

  61. Snyder CR. Hope theory: rainbows in the mind. Psychol Inq. 2002;13(4):249–75.

    Article  Google Scholar 

  62. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191.

    Article  CAS  PubMed  Google Scholar 

  63. Akhtar M. What is self-efficacy? Bandura’s 4 sources of efficacy beliefs. London: Positive Psychology UK; 2008.

    Google Scholar 

  64. Lidal IB, Huynh TK, Biering-Sørensen F. Return to work following spinal cord injury: a review. Disabil Rehabil. 2007;29(17):1341–75.

    Article  PubMed  Google Scholar 

  65. Ottomanelli L, Lind L. Review of critical factors related to employment after spinal cord injury: implications for research and vocational services. J Spinal Cord Med. 2009;32(5):503–31.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Chevalier Z, Kennedy P, Sherlock O. Spinal cord injury, coping and psychological adjustment: a literature review. Spinal Cord. 2009;47(11):778–82.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Matthew Law, Toi Aria: Design for Public Good, Massey University, Wellington for assistance with graphic design.

Funding

This project was funded by the Health Research Council of New Zealand (HRC 19/134).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand

    Jennifer A. Dunn, Deborah L. Snell & Joanne L. Nunnerley

  2. Burwood Academy Trust, Christchurch, New Zealand

    Jonathan J. Hackney, Rachelle A. Martin, Timothy Young, John A. Bourke & Joanne L. Nunnerley

  3. Department of Medicine, University of Otago Wellington, Wellington, New Zealand

    Rachelle A. Martin

  4. Wellington Medical and Health Sciences Library, University of Otago, Wellington, Wellington, New Zealand

    Donna Tietjens

  5. Menzies Health Institute, Griffith University, Brisbane, QLD, Australia

    John A. Bourke

  6. Preventive and Social Medicine, University of Otago, Dunedin, New Zealand

    John A. Bourke & Sarah Derrett

  7. New Zealand Spinal Trust, Christchurch, New Zealand

    Andrew Hall

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  1. Jennifer A. Dunn
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  2. Jonathan J. Hackney
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Contributions

JD, JN, RM, DS, SD conceptualised the study. DT performed the literature searches of the published literature. JB performed the searches of the grey literature. JD and JH screened and critically assessed the articles and grey literature and extracted the data from the included studies. TY assisted in obtaining the literature and extracting data from the studies. JD, JH and RM synthesised the data using realist review methods and developed the theoretical framework. JD drafted the paper and all authors critically reviewed the paper before approving publication.

Corresponding author

Correspondence to Jennifer A. Dunn.

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Conflict of interest

Jennifer Dunn, Jonathan Hackney, Rachelle Martin, Donna Tietjens, Tim Young, John Bourke, Deborah Snell, Joanne Nunnerley, and Sarah Derrett declare they have no conflict of interest. Andrew Hall is employed by the New Zealand Spinal Trust and is National Manager of the Vocational Rehabilitation Service.

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Dunn, J.A., Hackney, J.J., Martin, R.A. et al. Development of a Programme Theory for Early Intervention Vocational Rehabilitation: A Realist Literature Review. J Occup Rehabil 31, 730–743 (2021). https://doi.org/10.1007/s10926-021-10000-z

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