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

IF 0.7 Q4 CLINICAL NEUROLOGY

Spinal Cord Series and Cases Pub Date : 2023-07-13 DOI:10.1038/s41394-023-00587-1

Emily Timothy, John Bourke, Jennifer Dunn, Rachelle Martin, Jo Nunnerley

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Abstract

Study design: Qualitative study using realist review.

Objectives: To conceptualise how Early Intervention Vocational Rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation.

Setting: New Zealand Spinal Unit.

Methods: People with newly acquired SCI and members of their rehabilitation team were observed in a range of rehabilitation sessions, team meetings and therapeutic interactions. Participants were also interviewed to explore how EIVR functioned alongside the multidisciplinary team (MDT). Interviews and observations were transcribed, coded and analysed using realist methods.

Results: We identified three primary contexts which influenced how EIVR was delivered within the MDT: (1) a united approach, (2) a flexible approach, and (3) a hesitant approach. These contexts generated four work-related outcomes for people with SCI; enhanced work self-efficacy, strengthened hope for work, maintained work identity, and the less desirable outcome of increased uncertainty about work.

Conclusions: To optimise work outcomes for people after SCI, it is important to consider how EIVR is delivered and integrated within the wider MDT. Such an understanding can also inform the establishment of new EIVR services in different settings. Results suggest that unity, flexibility and clarity between EIVR services and the wider MDT are essential foundations for supporting people with SCI on their journey to employment.

Sponsorship: This research was funded by Health Research Council NZ grant in partnership with Canterbury District Health Board.

Abstract Image

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团结和灵活：脊柱科早期职业康复的合作方法。一项现实主义研究。

研究设计：采用现实主义审查方法进行定性研究：对脊髓损伤（SCI）康复过程中，早期干预职业康复（EIVR）如何在住院多学科背景下发挥作用进行概念化：环境：新西兰脊柱科：方法：观察新近获得 SCI 的患者及其康复团队成员在一系列康复治疗、团队会议和治疗互动中的表现。还对参与者进行了访谈，以探讨EIVR如何与多学科团队（MDT）一起发挥作用。采用现实主义方法对访谈和观察结果进行了转录、编码和分析：我们确定了影响多学科小组如何开展 EIVR 的三种主要环境：(1) 团结的方法，(2) 灵活的方法，以及 (3) 犹豫不决的方法。这些环境为 SCI 患者带来了四种与工作相关的结果：提高了工作自我效能感、增强了对工作的希望、保持了工作认同感，以及工作不确定性增加这一不太理想的结果：为了优化 SCI 患者的工作成果，必须考虑如何在更广泛的 MDT 中提供和整合 EIVR。这种认识也可以为在不同环境中建立新的EIVR服务提供参考。研究结果表明，EIVR服务和更广泛的MDT之间的统一性、灵活性和明确性是支持 SCI患者就业的重要基础：本研究由新西兰卫生研究委员会（Health Research Council NZ）与坎特伯雷区卫生局（Canterbury District Health Board）合作资助。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spinal Cord Series and Cases Medicine-Neurology (clinical)

CiteScore

2.20

自引率

8.30%

发文量