Exploring the association between therapist attributes, implementation fidelity and return-to work outcomes in the Return to Work after Stroke (RETAKE) trial

Abstract

Background: Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualizing intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early, stroke-specialist vocational rehabilitation intervention (ESSVR) and stroke survivor return-to-work (RTW) outcomes. Method(s): Thirty-nine OTs were surveyed about their previous experience and knowledge and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Result(s): Fidelity scores ranged from 30.8% to 100% (mean: 78.8%, SD: 19.2%). OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, P < .05). High fidelity was significantly associated with positive stroke survivor RTW outcomes (OR = 1.06, 95% CI = 1.01-1.1, P = .01). Conclusion(s): Findings of this small study suggest mentoring to ensure intervention fidelity may positively influence individual participant outcomes in RTW after stroke. Upskilling OTs to deliver complex interventions, like ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.