{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T18:18:10Z","timestamp":1793902690443,"version":"4.8.0"},"reference-count":58,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T00:00:00Z","timestamp":1735603200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T00:00:00Z","timestamp":1735603200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Institute for Health Research Health Technology Assessment","award":["15\/130\/11"],"award-info":[{"award-number":["15\/130\/11"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Return-to-work is a major goal achieved by fewer than 50% stroke survivors. Evidence on how to support return-to-work is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>This study aimed to evaluate the clinical effectiveness of Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) versus UC alone for helping people return-to-work after stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This pragmatic, multicentre, individually randomized controlled trial with embedded economic and process evaluations compared ESSVR with UC in 21 NHS stroke services across England and Wales. Eligible participants were aged\u2009\u2a7e\u200918\u2009years, in work at stroke onset, hospitalized with new stroke and within 12\u2009weeks of stroke. People not intending to return-to-work were excluded. Participants were randomized (5:4) to individually tailored ESSVR delivered by stroke specialist occupational therapists for up to 12\u2009months or usual National Health Service rehabilitation. Primary outcome was self-reported return-to-work for\u2009\u2a7e\u20092\u2009h per week at 12\u2009months. Primary and safety analyses were done in the intention-to-treat population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Between 1 June 2018, and 7 March 2022, 583 participants (M\n                      <jats:sub>age<\/jats:sub>\n                      54.1\u2009years (SD 11.0), 69% male) were randomized to ESSVR (n\u2009=\u2009324) or UC (n\u2009=\u2009259). Primary outcome data were available for 454 (77.9%) participants. Intention-to-treat analysis showed no evidence of a difference in the proportion of participants returned-to-work at 12\u2009months (165\/257 (64.2%) ESSVR vs 117\/197 (59.4%) UC; adjusted odds ratio 1.12 (95% CI: 0.75\u20131.68), p\u2009=\u20090.5678). There was some indication that older participants and those with more post-stroke impairment were more likely to benefit from ESSVR (interaction p\u2009=\u20090.0239 and p\u2009=\u20090.0959, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>To our knowledge, this is the largest trial of a stroke vocational rehabilitation (VR) intervention ever conducted. We found no evidence that ESSVR conferred any benefits over UC in improving return-to-work rates 12\u2009months post-stroke. Return-to-work (for at least 2\u2009h per week) rates were higher than in previous studies (64.2% ESSVR vs 59.4% UC) at 12\u2009months and more than double that observed in our feasibility trial (26%). Interpretation of findings was limited by a predominantly mild\u2013moderate sample of participants and the COVID-19 pandemic. The pandemic impacted the trial, ESSVR and UC delivery, altering the work environment and employer behavior. These changes influenced our primary outcome and the meaning of work in people\u2019s lives; all pivotal to the context of ESSVR delivery and its mechanisms of action.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data access:<\/jats:title>\n                    <jats:p>Data available on reasonable request.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>ISRCTN12464275.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930241306693","type":"journal-article","created":{"date-parts":[[2024,11,30]],"date-time":"2024-11-30T02:01:47Z","timestamp":1732932107000},"page":"471-485","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work after stroKE: A pragmatic, parallel-arm multicenter, randomized controlled trial"],"prefix":"10.1177","volume":"20","author":[{"given":"KA","family":"Radford","sequence":"first","affiliation":[{"name":"Centre for Rehabilitation and Ageing Research, School of Medicine, Medical School Queen\u2019s Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8839-6756","authenticated-orcid":false,"given":"A","family":"Wright-Hughes","sequence":"additional","affiliation":[{"name":"Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Thompson","sequence":"additional","affiliation":[{"name":"Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DJ","family":"Clarke","sequence":"additional","affiliation":[{"name":"Academic Unit for Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Phillips","sequence":"additional","affiliation":[{"name":"Centre for Rehabilitation and Ageing Research, School of Medicine, Medical School Queen\u2019s Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Holmes","sequence":"additional","affiliation":[{"name":"Centre for Rehabilitation and Ageing Research, School of Medicine, Medical School Queen\u2019s Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7276-7073","authenticated-orcid":false,"given":"K","family":"Powers","sequence":"additional","affiliation":[{"name":"Centre for Rehabilitation and Ageing Research, School of Medicine, Medical School Queen\u2019s Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Trusson","sequence":"additional","affiliation":[{"name":"Centre for Rehabilitation and Ageing Research, School of Medicine, Medical School Queen\u2019s Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Craven","sequence":"additional","affiliation":[{"name":"Centre for Rehabilitation and Ageing Research, School of Medicine, Medical School Queen\u2019s Medical Centre, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9403-3772","authenticated-orcid":false,"given":"C","family":"Watkins","sequence":"additional","affiliation":[{"name":"Applied Health Research hub and School of Nursing and Midwifery, University of Central Lancashire, Preston, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Bowen","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Psychology, Geoffrey Jefferson Brain Research Centre, Division of Psychology &amp; 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