{
  "abstract": "Objectives This study aimed to evaluate the feasibility of delivering a vocational rehabilitation intervention (Return to Work After Trauma—ROWTATE), remotely to individuals recovering from traumatic injuries. The primary objectives were to assess therapists’ training and competence, adapt the intervention and training for remote delivery and assess the feasibility and fidelity of remote delivery to inform a definitive randomised controlled trial.Design A mixed-methods feasibility study incorporating (1) telerehabilitation qualitative literature review, (2) qualitative interviews preintervention and postintervention with therapists and patients, (3) a team objective structured clinical examination to assess competency, (4) usefulness of training, attitudes towards (15-item Evidence-Based Practice Attitude Scale) and confidence in (4-item Evidence Based Practice Confidence Scale) evidence-based practice, intervention delivery confidence (8-bespoke questions) and intervention behaviour determinants (51-items Theoretical Domains Framework) and (5) single-arm intervention delivery feasibility study.Setting The study was conducted in two UK Major Trauma Centres. The intervention and training were adapted for remote delivery due to the COVID-19 pandemic.Participants Therapists: Seven occupational therapists (OTs) and clinical psychologists (CPs) were trained, and six participated in competency assessment. Seven OTs and CPs participated in preintervention interviews and surveys; six completed post-intervention interviews and four completed post-training surveys. Patients: 10 patients were enrolled in the single-arm feasibility study and 4 of these participated in postintervention qualitative interviews. Inclusion criteria included therapists involved in vocational rehabilitation delivery and patients admitted to major trauma centres. Exclusion criteria included participation in other vocational rehabilitation trials or those who had returned to work or education for at least 80% of preinjury hours. Intervention: The ROWTATE vocational rehabilitation intervention was delivered remotely by trained OTs and CPs. Training included competency assessments, mentoring and adaptation for telerehabilitation. The intervention was delivered over multiple sessions, with content tailored to individual patient needs.Results Therapists found the training useful, reported positive attitudes (Evidence-Based Practice Attitude Scale mean=2.9 (SD 0.9)) and high levels of confidence in delivering evidence-based practice (range 75%–100%) and the ROWTATE intervention (range 80%–100%). Intervention barriers identified pretraining became facilitators post-training. Half the therapists needed additional support post-training through mentoring or additional training. The intervention and training were successfully adapted for remote delivery. High levels of fidelity (intervention components delivered: OTs=84.5%, CPs=92.9%) and session attendance rates were found (median: OT=97%, CP=100%). Virtually all sessions were delivered remotely (OT=98%, CP=100%). The intervention was acceptable to patients and therapists; both considered face-to-face delivery where necessary was important.Conclusions The ROWTATE intervention was delivered remotely with high fidelity and attendance and was acceptable to patients and therapists. Definitive trial key changes include modifying therapist training, competency assessment, face-to-face intervention delivery where necessary and addressing lower fidelity intervention components.Trial registration number ISRCTN74668529.",
  "authors": [
    {
      "affiliations": [
        "Department of Psychology, Nottingham Trent University, Nottingham, UK",
        "Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK"
      ],
      "name": "Blerina Kellezi"
    },
    {
      "affiliations": [
        "Centre for Rehabilitation & Ageing Research, University of Nottingham, Nottingham, UK"
      ],
      "name": "Jain Holmes"
    },
    {
      "affiliations": [
        "Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK"
      ],
      "name": "Jade Kettlewell"
    },
    {
      "affiliations": [
        "Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK"
      ],
      "name": "Rebecca Lindley"
    },
    {
      "affiliations": [
        "Centre for Rehabilitation and Ageing, University of Nottingham, Nottingham, UK",
        "NIHR Nottingham Biomedical Research Centre, Nottingham, UK"
      ],
      "name": "Kate Radford"
    },
    {
      "affiliations": [
        "Institute of Mental Health, University of Nottingham School of Medicine, Nottingham, UK"
      ],
      "name": "Priya Patel"
    },
    {
      "affiliations": [
        "Department of Psychology, Nottingham Trent University, Nottingham, UK"
      ],
      "name": "Kay Bridger"
    },
    {
      "affiliations": [
        "Neuroscience, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia"
      ],
      "name": "Natasha A Lannin"
    },
    {
      "affiliations": [
        "Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK"
      ],
      "name": "Isobel Andrews"
    },
    {
      "affiliations": [
        "Department of Major Trauma, East Midlands Major Trauma Centre, Queen’s Medical Centre, Nottingham, UK"
      ],
      "name": "Lauren Blackburn"
    },
    {
      "affiliations": [
        "Department of Major Trauma, East Midlands Major Trauma Centre, Queen’s Medical Centre, Nottingham, UK"
      ],
      "name": "Adam Brooks"
    },
    {
      "affiliations": [
        "SINTEF, Trondheim, Norway"
      ],
      "name": "Roshan das Nair"
    },
    {
      "affiliations": [
        "Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK"
      ],
      "name": "Steve Fallon"
    },
    {
      "affiliations": [
        "Clinical Trials Research Unit, University of Leeds, Leeds, UK"
      ],
      "name": "Amanda Farrin"
    },
    {
      "affiliations": [
        "Queen Mary University of London, London, UK"
      ],
      "name": "K Hoffman"
    },
    {
      "affiliations": [
        "Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK"
      ],
      "name": "Trevor Jones"
    },
    {
      "affiliations": [
        "Institute of Mental Health, University of Nottingham School of Medicine, Nottingham, UK"
      ],
      "name": "Richard Morriss"
    },
    {
      "affiliations": [
        "Centre for Health Innovation, Leadership & Learning, University of Nottingham, Nottingham University Business School, Nottingham, UK"
      ],
      "name": "Stephen Timmons"
    },
    {
      "affiliations": [
        "Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK"
      ],
      "name": "Denise Kendrick"
    }
  ],
  "title": "Mixed-methods non-randomised single-arm feasibility study assessing delivery of a remote vocational rehabilitation intervention for patients with serious injury: the ROWTATE study",
  "uid": "febea0f6-f97c-5ea6-b6d8-ac41110ee98d"
}