A third of people hospitalised with serious injuries are still out of work a year later, often with untreated psychological and physical problems. This research programme tests whether a tailored package of vocational rehabilitation—combining occupational therapy and clinical psychology—can help trauma survivors return to work and improve their quality of life. The problem is that existing return-to-work programmes focus on single injuries, but trauma patients often have multiple injuries across different body regions, plus cognitive and psychological difficulties that standard rehabilitation does not address. The NHS currently lacks an evidence-based intervention for this group. The team will run a trial across five major trauma centres, randomising 722 working-age adults to receive either usual care or a case-coordinated rehabilitation package. If successful, the researchers estimate the intervention could help an additional 4,000 to 7,500 trauma survivors across England return to work each year. That would reduce long-term NHS costs, improve patients’ financial and mental wellbeing, and cut the wider societal burden of prolonged unemployment after serious injury.
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Background Trauma of at least moderate severity (Injury Severity Score (ISS) >8) is a major cause of death, disability and NHS resource use. Many survivors experience physical and psychological problems, reduced quality of life (QoL) and difficulty returning to work, with psychological and occupational needs frequently unmet. The detrimental effects of being out of work on patient health, NHS costs and society are well documented. Our recent study found one third of patients with ISS>8 have not returned to work one year later with many suffering significant physical and psychological problems. Systematic reviews demonstrate vocational rehabilitation (VR) improves return-to-work in some conditions. Evidence is lacking for VR amongst trauma survivors who often suffer multiple injuries, affecting several body regions, with psychological and/or cognitive problems impacting on work ability. We have developed VR interventions for traumatic brain injury and stroke. Our proposal adapts these for a much wider range of injuries, potentially enabling wide-scale NHS roll-out. Aim To develop, evaluate and assess implementation of an intervention to enhance return-to-work and improve quality of life (QoL) and wellbeing in people with at least moderate trauma. The programme comprises four work-packages (WPs). Methods WP1 develops theory and intervention through an iterative process including trauma survivor focus groups, key informant interviews and co-production. Outputs include intervention programme theory, logic model, intervention manual, fidelity checklist, data collection tools and training package. (Months 1-12) WP2 is a feasibility study piloting data collection processes and tools and assessing follow-up rates; case-studies evaluating intervention usage and acceptability, outcome measure acceptability and therapist training; assessment of intervention fidelity and contamination and focus groups exploring barriers and facilitators to recruitment and retention. (Months 13-22) WP3 is the definitive trial evaluating clinical and cost effectiveness of the intervention using a pragmatic individually randomised controlled trial, in five major trauma centres, randomising 722 working-age adults with ISS>8. The intervention is a case-coordinated package of individually tailored VR provided by occupational therapists and clinical psychologists plus usual care. The control arm receives treatment as usual. The primary outcome measure is return-to-work (including voluntary work and full-time education) 12 months post-randomisation. Secondary outcomes include QoL, psychological measures, broader employment outcomes, recovery expectations and self-efficacy. A nested economic evaluation assesses cost-effectiveness. (Months 23-67) WP4 is a process and implementation study. Process evaluation nested within WPs 2 and 3 assesses intervention fidelity, factors affecting intervention quality and enablers and barriers to intervention deployment. Qualitative data collected across all WPs will be analysed for implementation-relevant content. This includes ethnographic research and document analysis (WP1), case-studies (WP2), interviews with trauma survivors, service providers, employers and commissioners (WP3). Data synthesis will produce implementation toolkits and workshops to facilitate commissioner and practitioner implementation. (Months 1-70) Impact and Dissemination We anticipate our intervention will result in an additional 4000-7500 trauma survivors achieving a sustainable return-to-work each year across England. Dissemination includes policy makers, commissioners, practitioners, employer and patient organisations via implementation toolkits and workshops, brief evidence summaries, open-access academic and practitioner journal articles, conferences (academic, practitioner, policy maker) and social media.
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