Using Co-Design To Develop A Hospital-Based Vocational Rehabilitation Intervention For Adults With Acquired Brain Injury

Research Objectives
Although recommendations are for vocational rehabilitation to commence soon after injury, there are acknowledged challenges to commencing this activity during hospitalisation, when clinical goals are more often centred on basic activities (such as self-care and mobility). This study aimed to develop a vocational rehabilitation intervention for people who have suffered brain injury, that is suitable for delivery in an inpatient rehabilitation setting.

Design
Using an action-research design, this study followed a participatory, intervention mapping approach to develop and pilot the intervention.

Setting
Specialist inpatient brain injury rehabilitation unit, Melbourne, Australia.

Participants
Stakeholder participants included n=14 allied health clinicians (including occupational therapists, speech and language therapists, physiotherapists, clinical and neuropsychologists and social workers) who worked in collaboration with researchers (n=2) to co-design the vocational rehabilitation intervention process. An open invitation was extended to clinicians to participate in the intervention mapping process.

Interventions
Not applicable.

Main Outcome Measures
Systematic literature review identified the barriers and enablers to providing work-focussed interventions in the inpatient setting. Qualitative focus groups and document review were used iteratively to identify intervention objectives and outcomes, before intervention strategies were developed and trialed.

Results
Early vocational rehabilitation interventions should be delivered in partnership with the patient, clinicians, family and their social network (inclusive of the workplace). A comprehensive, five phase program was developed: (i) orientation to the worker role, (ii) building awareness of work activities, (iii) improving core work skills, (iv) improving job-specific skills, (v) discharge planning from the program.

Conclusions
Co design offered an excellent opportunity to develop an intervention which supported an interdisciplinary team to embed vocational rehabilitation into usual hospital-based rehabilitation.