Katie Powers - RETAKE embedded study

RetakeThe REturn To work After stroKE (RETAKE) study is a four year study aimed at determining whether early stroke specific vocational rehabilitation (ESSVR), in addition to the usual NHS rehabilitation, is more effective and more cost effective at returning stroke survivors to work, and keeping them there for at least 12 months, than the NHS intervention alone.

The aim of this doctoral study, which is embedded in the wider RETAKE trial, is to understand the effect that patient and therapist characteristics have on how the trial works in practice, looking at both the impact on individual stroke survivors and examining the effect on the outcomes of the trial overall.
The study will look at stroke survivor characteristics such as stroke severity, age, socioeconomic status, motivation, pre-stroke experience of coping and perceived ‘readiness’ for rehabilitation. Occupational therapist characteristics to be examined will include, for example, experience, beliefs about the use of research evidence in practice, and skills in engaging patients in a therapeutic relationship. Information about relevant characteristics will be collected by using a range of different research methods, including questionnaires, interviews, data from therapy records and therapist competency assessments.

The findings from this research will contribute to the stroke rehabilitation literature by indicating which factors influence engagement in and the outcomes of rehabilitation targeted at a return to work. This will be used not only to inform clinical practice, allowing better design of therapeutic interventions and improving specialist therapist training, but will also help to improve future research trial design.

Questions to be explored in the research:

Individual Therapists:
1. Do the occupational therapists’ attitudes toward evidence-based practice (EBP) affect their ability to deliver the intervention as was intended in the research design?
2. Does competency affect the occupational therapist’s ability to deliver the trial intervention as was intended in the research design? [Including competency in negotiating with the employer organisation as well as occupational therapy competency?]
3. To what extent does the patients' perception of the therapist contribute to a successful or unsuccessful relationship with the therapist?
4. What has motivated the trial occupational therapists to take part in a complex rehabilitation trial?
5. How does the response of the participant’s employer affect the ability of the therapist to deliver the trial intervention as was intended in the research design?

Individual Stroke Survivor Attributes

1. Do stroke survivors need to be actively engaged in the intervention for a positive outcome?
2. What motivates stroke survivors to participate in rehabilitation? How does this affect the stroke survivor’s success? (In development) [think about liminality, emotional and biographical disruption, and hope, here?]
3. Does the stroke survivor’s ‘readiness’ for rehabilitation have an impact on the outcome overall?
4. Does the stroke survivor’s beliefs about their own capabilities have an impact on the outcome?

Therapeutic Alliance
1. To what extent does the quality of the therapeutic relationship affect the stroke survivor’s outcome?