Early vocational rehabilitation following neurological disability (EVocS study)

Research Framework

Maximising Participation

Overview

Stroke affects over 8000 people each year in NZ, making return to work (RTW) difficult. One method of supporting RTW is vocational rehabilitation. The best model of vocational rehabilitation has not been determined, although there is evidence supporting early intervention for people with a new health condition or disability. In NZ, one vocational service that incorporates a focus on early intervention is the vocational rehabilitation service provided by the NZ Spinal Trust. This novel early intervention model may hold promise for other health conditions or disabilities, in particular stroke, where similar barriers to employment as those associated with spinal cord injury have been identified.

This study aims to:

• Understand how the early intervention vocational rehabilitation programme provided by the NZ Spinal Trust works, and how the context in which it is provided impacts on RTW outcomes among people with SCI.
• Use this theoretical understanding to develop an implementation plan for this programme to be trialled in the stroke population.

Key Outcome: An implementation plan is developed for an early intervention vocational rehabilitation service for people with stroke in New Zealand.

This study is funded by the Health Research Council in collaboration with the Ministry of Social Development.

Method

This study will take place over 2 years (2020 – 2021) and will:

• Gain a better understanding of how early intervention vocational services work for people with SCI by conducting:
  • Literature review of early intervention vocational support literature
  • Interviews with people with SCI who have received early intervention vocational support from the NZ Spinal Trust (at various time points)
  • Survey of people with SCI who have and haven’t returned to work
  • Focus groups with existing and previous NZ Spinal Trust EIVS staff
  • Focus group with both MSD and ACC vocational providers in Auckland and Christchurch to determine how the developing theoretical framework integrates with the current RTW pathway for SCI
• Explore how to transfer the programme to a stroke population by conducting:
  • focus groups with vocational providers currently working with people with stroke in Auckland and Christchurch
  • interviews with people with stroke who have or have not returned to work following their ABI
  • presenting the draft framework to groups of stakeholders based in Auckland and Christchurch in a knowledge translation workshop.

Status of Research

• Research complete
• Knowledge Translation activities ongoing

Publications resulting from this project:

1. Martin RA, Johns JK, Hackney JJ et al. (2022) Early Opportunities to Explore Occupational Identity Change: Qualitative Study of Return-To-Work Experiences After Stroke. J Rehabil Med. 55: jrm00363. DOI: 10.2340/jrm.v54.4825
2. Dunn, J. A., Martin, R.A., Hackney, J. J., Nunnerley, J. L., Snell, D. L., Bourke, J.A., Young, T., Hall, A., Derrett, S. (2022). Developing a conceptual framework for Early Intervention Vocational Rehabilitation for people following spinal cord injury. Journal of Occupational Rehabilitation. 18 July 2022. DOI: 10.1007/s10926-022-10060-9
3. Martin, R. A., Nunnerley, J. L., Young, T., Hall, A., Snell, D. L., Hackney, J. J., Bourke, J. A., Derrett, D. & Dunn, J. A. (2022). Vocational wayfinding following spinal cord injury: In what contexts, how and why does early intervention vocational rehabilitation work? Journal of Vocational Rehabilitation. 1 Jan., 243 – 254.
4. Snell, D. L., Hackney, J. J., Maggo, J., Martin, R. A., Nunnerley, J. L., Bourke, J. A., Hall, A., Derrett, S., & Dunn, J. A. (2021). Early vocational rehabilitation after spinal cord injury: A survey of service users. Journal of Vocational Rehabilitation, Preprint, 1-11. https://doi.org/10.3233/JVR-211166
5. Dunn, J. A., Hackney, J. J., Martin, R. A., Tietjens, D., Young, T., Bourke, J. A., Snell, D. L., Nunnerley, J. L., Hall, A., & Derrett, S. (2021). Development of a Programme Theory for Early Intervention Vocational Rehabilitation: A Realist Literature Review. Journal of Occupational Rehabilitation, 1-14.
6. Dunn, J.A., Martin R.A., Hackney, J., Nunnerley, J.L., Snell, D.L., Bourke, J.A., Hall, A. and Derrett, S. (2021). 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. BMJ Open;11:e048753. doi: 10.1136/bmjopen-2021-048753

7. Martin, R. A., Johns, J. K., Hackney, J. J., Bourke, J. A., Young, T. J., Nunnerley, J. L., Snell, D. L., Derrett, S., & Dunn, J. A. (2023). Early Opportunities to Explore Occupational Identity Change: Qualitative Study of Return-To-Work Experiences After Stroke. Journal of Rehabilitation Medicine, 55, jrm00363. https://medicaljournalssweden.se/jrm/article/view/4825

Conference presentations resulting from this project:

1. Johns J, Martin R, Dunn J et al. ‘What am I, what am I doing?’ A qualitative study about changing occupational identity and return-to-work experiences after stroke. Oral presentation at Stroke Society of Australasia, 31st Annual Scientific Meeting. 31 August – 2 September 2022
2. Martin R, Hackney J, Nunnerley J, Snell D, Derrett S and Dunn J. How realist research approaches support equitable service development for people following stroke: An early intervention vocational service exemplar. Poster presentation at Stroke Society of Australasia, 31st Annual Scientific Meeting. 31 August – 2 September 2022.
3. Dunn J, Martin R, Snell D, et al. Early intervention vocational rehabilitation in neurological injuries study (EVocS). Poster presentation at Stroke Society of Australasia, 31st Annual Scientific Meeting. 31 August – 2 September 2022.
4. Snell, D.L., Boyce, C.D., Martin, R.A., Nunnerley, J.L., Hackney, J.J., Bourke, J.A., Hall, A., Derrett, S.and Dunn. J.A. Return to work pathways following spinal cord injury in New Zealand. Poster presentation at 27th Australian & New Zealand Spinal Cord Society Annual Scientific Meeting (ANZSCoS), 27 – 29 October 2021.
5. Dunn, J., Martin, R., et al. Developing a theoretical framework for early intervention vocational rehabilitation. Oral presentation at 27th Australian & New Zealand Spinal Cord Society Annual Scientific Meeting (ANZSCoS), 27 – 29 October 2021.

Presentation Videos:

(click titles to follow links to videos)

Rachelle Martin and Emily Timothy: Early Conversations about Vocational Aspirations with People with Acquired Neurological Conditions – February 2021

Julianne Johns: “What am I, what am I doing?” A qualitative study about changing occupational identity and return-to-work experiences after stroke. – 9th November 2022

Rachelle Martin: Early vocational support after stroke (EVocS study) – November 2022

Images of the two posters presented at the Australasian Stroke Conference, in September 2022: