Mixed methods non-randomised single-arm feasibility study assessing delivery of a remote vocational rehabilitation intervention for patients with serious injury: the ROWTATE study

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 a) tele-rehabilitation qualitative literature review, b) qualitative interviews pre and post intervention with therapists and patients, c) a team objective structured clinical examination to assess competency, d) 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 e) single arm intervention delivery feasibility study. Setting: The study was conducted in two United Kingdom Major Trauma Centres. The intervention and training were adapted for remote delivery due to the COVID-19 pandemic. Participants: Therapists: 7 occupational therapists (OTs) and clinical psychologists (CPs) were trained, and 6 participated in competency assessment. 7 OTs and CPs participated in pre-intervention interviews and surveys; 6 completed post-intervention interviews and 4 completed post-training surveys. Patients: 10 patients were enrolled in the single-arm feasibility study and 4 of these participated in post-intervention 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 that had returned to work or education for at least 80% of pre-injury hours Intervention: The ROWTATE vocational rehabilitation intervention was delivered remotely by trained OTs and CPs. Training included competency assessments, mentoring, and adaptation for tele-rehabilitation. 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 pre-training 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-face delivery where necessary was important. Conclusion: 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.