Can stroke specific vocational rehabilitation (SSVR) be delivered and measured?: feasibility RCT and economic analysis

Background: A quarter of UK strokes occur in working age people. Fewer than half resume work. Rehabilitation frequently fails to address work needs and evidence for post-stroke vocational rehabilitation is lacking. This pilot trial tested the feasibility of delivering SSVR and measuring its effects and costs compared to usual care (UC). Method: Previously employed stroke survivors (SS) aged ≥16 recruited from a stroke unit were randomised to receive SSVR or UC. Exclusion criteria: refusing consent; not intending to work, medical preclusion. Primary outcomes: occupational and benefit status. Mood, function, participation, quality of life and resource use were measured using standardized and bespoke postal questionnaires at 3, 6 and 12 months. Service use was cross-referenced in 10% of participants and costs calculated. Results: 46/126 patients screened (36 men, mean 56 (SD 12.7, 18-78 years) were recruited in 15 months; 40 declined. Most (29) had NIHSS scores ≤ 15, were in professional roles (65%), self-employed (21.7%) at onset. 32 available at 12-month follow-up, with poorer response (61%) among UC. Intervention successfully deployed in 22/23 cases. 39% returned to work at 12 months - twice as many in SSVR. More depression and productivity loss in UC, especially at 6 mths. Cross-referencing for 5 participants involved 51 phone calls, 23 letters/emails. Self-reported and actual service use data were discrepant. SS underestimated GP& consultant and overestimated therapy input. Discussion: SSVR can be delivered and its effects and costs measured. More reliable methods of capturing service use, income and benefit data and clearer definitions of work are needed. Conclusion: Findings inform the definitive trial.