Professor of Rehabilitation Research University of Nottingham
Objectives
Background:
Moderately severe or major trauma (injury severity score (ISS) >8) frequently results in physical and psychological problems that limit sustainable return to work (RTW). Vocational Rehabilitation (VR) can improve RTW, but its effectiveness in UK major trauma centre (MTC) populations is uncertain.
Aim:
To determine whether VR plus psychological support is more clinically and cost-effective than usual NHS rehabilitation (UC) at supporting RTW and wellbeing 12-months after injury.
Design Multicentre RCT across 8 UK MTCs compared Occupational-Therapy-led VR and psychological support plus UC against UC alone. Eligible participants were aged ≥16, ISS >8, within 12-weeks of injury and in paid/unpaid work/full-time education pre-injury. Recruitment ran Nov 2021-Mar 2024, with 1:1 individual randomisation. Follow-up at 3, 6 and 12-months via post/online questionnaires, SMS and telephone. Individually-tailored VR was delivered up to 12-months, including assessment of injury impact, NHS and employer/stakeholder coordination, job-accommodation negotiation, RTW monitoring and psychological therapy where indicated.
PRIMARY OUTCOME: RTW to ≥80% pre-injury hours at 12-months.
SECONDARY OUTCOMES: Depression, Anxiety, Distress, Work Ability, Financial Stress, Purpose in Life, additional work measures.
ECONOMIC EVALUATION: Within trial cost-effectiveness (NHS and PSS perspective, HRQoL).
PROCESS EVALUATION: Mixed-methods assessment of implementation and fidelity (reported elsewhere).
Results 710 participants were randomised. RTW status was determined for 80%; 63% returned 12-month questionnaires. Intervention uptake was 91%, with 29% receiving psychological input. At 12-months, VR was not more effective than UC for RTW to ≥80% hours (58% vs 64%; OR 0.72, 95%CI 0.50-1.04). VR was not superior on secondary outcomes except distress at 3-months. Some outcomes favoured UC, including RTW to ≥80% hours at 3-months, and total working hours at 3 and 12-months. HRQoL was improved in VR, equating to ~11 additional days in perfect health/year.
Conclusion This large RCT found no overall evidence that VR improved RTW or most other outcomes compared with usual care.
