Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work after stroKE: A pragmatic, parallel-arm multicenter, randomized controlled trial

作者：Kate Radford, Alexandra Wright‐Hughes, Ellen Thompson, David M. Clarke, Julie Phillips, J. Holmes, Katie Powers, Diane Trusson, Kristelle Craven, Caroline Watkins, Audrey Bowen, Christopher McKevitt, Judith Stevens, John Murray, Rory J O’Connor, Sarah Pyne, Helen Risebro, Rory Cameron, Tracey Sach, Florence Day, Amanda Farrin · 发表于：International Journal of Stroke · 年份：2024 · DOI：10.1177/17474930241306693 · 被引用次数：12 · 研究领域：Stroke Rehabilitation and Recovery、Occupational Therapy Practice and Research、Balance, Gait, and Falls Prevention

BACKGROUND: Return-to-work is a major goal achieved by fewer than 50% stroke survivors. Evidence on how to support return-to-work is lacking. AIMS: This study aimed to evaluate the clinical effectiveness of Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) versus UC alone for helping people return-to-work after stroke. METHODS: This pragmatic, multicentre, individually randomized controlled trial with embedded economic and process evaluations compared ESSVR with UC in 21 NHS stroke services across England and Wales. Eligible participants were aged ⩾ 18 years, in work at stroke onset, hospitalized with new stroke and within 12 weeks of stroke. People not intending to return-to-work were excluded. Participants were randomized (5:4) to individually tailored ESSVR delivered by stroke specialist occupational therapists for up to 12 months or usual National Health Service rehabilitation. Primary outcome was self-reported return-to-work for ⩾ 2 h per week at 12 months. Primary and safety analyses were done in the intention-to-treat population. RESULTS: 54.1 years (SD 11.0), 69% male) were randomized to ESSVR (n = 324) or UC (n = 259). Primary outcome data were available for 454 (77.9%) participants. Intention-to-treat analysis showed no evidence of a difference in the proportion of participants returned-to-work at 12 months (165/257 (64.2%) ESSVR vs 117/197 (59.4%) UC; adjusted odds ratio 1.12 (95% CI: 0.75-1.68), p = 0.56...