Working after brain injury

Plain English Summary

Background and study aims
As traumatic brain injury (TBI) mostly occurs in young men at the start of their working lives, inability to return to work can have a long-term effect on the person, their family and the wider economy. However, not everybody admitted to an NHS hospital with a TBI has access to support to assist them in returning to work. In some parts of the UK people get specialist support known as vocational rehabilitation (VR), which involves finding ways to 'match' the TBI person's abilities and limitations to the demands of the job and work environment. The VR process involves assessing the person, the job and the workplace and interacting with and educating employers about the nature of the injury, legal responsibilities and any changes that may need to be put in place. It also involves using rehabilitation strategies to prepare a person for work (e.g., improving stamina and concentration, and compensating for problems such as memory aids and negotiating a phased return). It may also involve re-training and negotiating work placements for those unable to return to their previous job. In our initial small study we compared the work outcomes of people who had access to early specialist VR support (ESTVR) to people who didn't have access because of where they lived, and found that people who received ESTVR were more likely to return to work, returned sooner and remained in work 12 months later, and that it only cost health services on average £75 per person more to deliver. However, as this was a small study we can't be certain that the outcomes were due to the ESTVR or whether they were chance findings, therefore a larger study is needed. We also have no way of knowing whether this sort of specialist support can be delivered in other centres and what impact it might have on work outcomes. We don't know how best to measure these outcomes or what effect ESTVR might have on a person's mood, functional ability or quality of life or how best to measure these effects. Therefore we propose a study to find out whether early (starting within 8 weeks of injury) TBI specialist vocational rehabilitation (ESTVR) can be delivered in three new centres and whether its effects on work outcomes (return to work and work retention), benefit status, health, wellbeing and quality of life can be measured and costs captured at different points in time. We would also like to know whether it is acceptable to service users (patients and employers) and staff.
This study will provide all the necessary information to design and conduct a larger study that will tell us whether ESTVR is effective or not.

Who can participate?
Adults (aged 16 and above) living in the London, Preston and Leeds health communities and admitted for 48 hours or more with new TBI and who were in work, intending to work or in full-time education (paid or unpaid) before their injury.

What does the study involve?
Participants will be randomly allocated to receive either the ESTVR intervention or treatment as usual (TAU). The ESTVR intervention group will receive early specialist vocational rehabilitation targeted at preventing job loss delivered by an occupational therapist, supported by a TBI case manager, in addition to usual NHS care. The intervention is structured around individual needs and involves up to 10 individual sessions. TAU is usual NHS care, which may involve efforts to return people to work but does not typically include components of the ESTVR model. Participants will be followed up at 3, 6 and 12 months.

What are the possible benefits and risks of participating?
The intervention may pose a risk of distress caused by raising participants' awareness that their level of functioning may be significantly reduced, in comparison to their abilities and functioning before brain injury. As this is a feasibility study the side effects of the intervention are as yet unknown. We hope to identify these as part of this study to inform the design of future studies. In our single-centre study in Nottingham, this approach resulted in more people in work and fewer living entirely off state benefits at 12 months post injury. Those who received the intervention (participants and their families) were also financially better off. However, as this is only a feasibility study we will not be able to determine whether similar outcomes identified for people who receive the ESTVR intervention in this study are due to the support received or not.

Where is the study run from?
The study is run from the University of Nottingham with study coordination support from the Lancashire Clinical Trials Unit and input from the Nottingham Clinical Trials Unit. There are three participating centres in Preston (Lancashire Teaching Hospitals), London (Barts Health NHS Trust) and Leeds Teaching Hospitals, UK.

When is the study starting and how long is it expected to run for?
The study began in March 2013 and will run until the end of February 2016. Recruitment to the study started in December 2013 and will continue until August 2014.

Who is funding the study?
National Institute for Health Research (UK).

Who is the main contact?
Dr Kate Radford
Kate.radford@nottingham.ac.uk

Study website

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• England
• United Kingdom

Study participating centre

Sponsor information

University of Nottingham (UK)
University/education

c/o Mr Paul Cartledge
Head of Research Grants and Contracts, Research and Graduate Services
Kings Meadow Campus
Lenton lane
Nottingham
NG7 2NR
England
United Kingdom

Phone	+44 (0)115 846 8837
Email	sponsor@nottingham.ac.uk
Website	http://www.nottingham.ac.uk/
"ROR"	https://ror.org/01ee9ar58

Funders

Funder type

Government

Results and Publications

Study outputs

Editorial Notes

01/08/2022: The following changes have been made:
1. Publication reference added.
2. The final enrolment number has been added from the main results reference.
06/06/2018: Publication reference added.