Abstract
Purpose Little is currently known about how early intervention vocational rehabilitation (EIVR) works for people with newly acquired neurological conditions such as traumatic brain injury, acquired brain injury and spinal cord injury. This study aims, from a realist framework, to identify relevant literature and develop an initial programme theory to understand how EIVR might work for people experiencing acquired neurological disability. Realist reviews are ideally placed to address the identified knowledge gap as they assist in gaining a deeper understanding of how the intervention works, for whom it works best, and the contexts that promote the activation of desired outcomes. Methods We used a seven-step iterative process to synthesise literature using a realist approach. The steps included: development of initial programme theory, literature search, article selection, extracting and data organising, synthesis of evidence and programme theory refinement. We performed a literature search using the following databases: Cinahl, Embase, EMcare, Medline, PsychInfo and Scopus. Articles were selected if they contributed to the knowledge describing what is EIVR and how it works in newly acquired neurological conditions. Data were extracted and synthesised to develop a programme theory for EIVR. Results Following screening of 448 references, 37 documents were eligible for data extraction. We developed a refined programme theory of EIVR consisting of three contexts (prioritisation of exploring work options, return to work discussed as an option, and workplace support), nine mechanisms (ensuring rehabilitation teams’ culture, fostering hope, exploring options, optimising self-efficacy, maintaining worker identity, staying connected, setting goals, engaging employer, and flexing roles) and three outcomes (confidence in ability to work, psychological adjustment, and engagement in solution focussed options). Conclusions This appears to be the first paper to explore how EIVR works, for whom and in what situations. We have produced a programme theory that may provide an initial understanding of EIVR following acquired neurological conditions.
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Matthew Law, Toi Aria: Design for Public Good, Massey University, Wellington for assistance with graphic design.
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This project was funded by the Health Research Council of New Zealand (HRC 19/134).
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JD, JN, RM, DS, SD conceptualised the study. DT performed the literature searches of the published literature. JB performed the searches of the grey literature. JD and JH screened and critically assessed the articles and grey literature and extracted the data from the included studies. TY assisted in obtaining the literature and extracting data from the studies. JD, JH and RM synthesised the data using realist review methods and developed the theoretical framework. JD drafted the paper and all authors critically reviewed the paper before approving publication.
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Jennifer Dunn, Jonathan Hackney, Rachelle Martin, Donna Tietjens, Tim Young, John Bourke, Deborah Snell, Joanne Nunnerley, and Sarah Derrett declare they have no conflict of interest. Andrew Hall is employed by the New Zealand Spinal Trust and is National Manager of the Vocational Rehabilitation Service.
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Dunn, J.A., Hackney, J.J., Martin, R.A. et al. Development of a Programme Theory for Early Intervention Vocational Rehabilitation: A Realist Literature Review. J Occup Rehabil 31, 730–743 (2021). https://doi.org/10.1007/s10926-021-10000-z
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DOI: https://doi.org/10.1007/s10926-021-10000-z