United and ﬂexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study

Spinal Cord Series and Cases, 2023 · DOI: https://doi.org/10.1038/s41394-023-00587-1 · Published: June 27, 2023

Simple Explanation

This study explores how offering vocational rehabilitation early to people with spinal cord injuries (SCI) works best within a hospital setting. It looks at how the rehab team's approach affects patients' feelings about returning to work. The research found that when the rehab team is united and flexible in their approach, patients feel more confident and hopeful about working again. However, if the team is hesitant or unclear, it can increase uncertainty for the patient. Ultimately, early and well-coordinated vocational support can greatly improve a person's outlook and readiness to return to work after a spinal cord injury.

Study Duration

16-week period

Participants

7 people with SCI and 17 clinical staff members

Evidence Level

Qualitative study using realist review

Key Findings

1
A united approach among the rehabilitation team, where work is seen as possible regardless of individual circumstances, enhances work self-efficacy and maintains work identity for people with SCI.
2
A flexible approach, particularly from EIVR staff, allows for individualized conversations and strengthens hope for a working future by addressing the person's needs on any given day.
3
A hesitant approach to work conversations, stemming from uncertainty about recovery or adjustment, can increase uncertainty and diminish confidence in returning to work.

Research Summary

This study used a realist approach to understand how early intervention vocational rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation in a New Zealand Spinal Unit. The research identified three primary contexts influencing EIVR delivery: a united approach, a flexible approach, and a hesitant approach. These contexts resulted in outcomes such as enhanced work self-efficacy, strengthened hope, maintained work identity, and increased uncertainty. The study concludes that unity, flexibility, and clarity between EIVR services and the wider MDT are essential for supporting people with SCI on their journey to employment and that the approach taken by the MDT and EIVR staff can have a negative effect on a person’s outlook for work.

Practical Implications

Team Training

Clinician training is needed to promote a united and flexible approach to early work conversations, addressing hesitancy and embedding EIVR in the rehabilitation team.

Service Design

EIVR service designs should prioritize flexibility, allowing time for informal relationship building and individualized conversations, while maintaining clarity about the EIVR staff role.

Early Intervention Focus

Rehabilitation teams should explore people’s expectations about returning to work early in the process to instill hope and support work readiness, while avoiding a hesitant approach that can increase uncertainty.

Study Limitations

1
Small number of directly observed EIVR sessions due to their impromptu nature.
2
Concerns that a researcher might undermine the informal conversations.
3
Data relies on participant recall of conversations, which may be subject to bias.

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