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

Spinal Cord Series and Cases volume 9, Article number: 33 (2023) Cite this article

Subjects

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.

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Fig. 1: Overview of how early intervention vocational rehabilitation outcomes are achieved in the context of inpatient SCI rehabilitation.

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Data availability

Data generated and analysed during the study are available from the corresponding author on reasonable request.

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Acknowledgements

The research team would like to acknowledge all study participants who generously gave their time and were willing to share their experiences.

Author information

Authors and Affiliations

  1. Burwood Academy | Hā-i-mano, Christchurch, New Zealand

    Emily Timothy, John Bourke, Rachelle Martin & Jo Nunnerley

  2. John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia

    John Bourke

  3. Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia

    John Bourke

  4. Department of Orthopaedic Surgery and Musculoskeletal Medicine | Te Tari Hāparapara me te Whaiora Ua-kāhiwi, University of Otago, Christchurch, New Zealand

    Jennifer Dunn & Jo Nunnerley

  5. Rehabilitation Teaching and Research Unit | Te Whare Whakamatūtū, University of Otago, Wellington, New Zealand

    Rachelle Martin

Authors
  1. Emily Timothy
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  4. Rachelle Martin
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  5. Jo Nunnerley
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Contributions

All authors were involved in the study design. JD was study principal investigator and provided an overview of interpretation. ET recruited and conducted data collection. ET, JB and RM conducted data analysis. RM advised on methodological considerations. All authors contributed to further edits and iterations of the paper.

Corresponding author

Correspondence to Emily Timothy.

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The authors declare no competing interests.

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Timothy, E., Bourke, J., Dunn, J. et al. United and flexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study. Spinal Cord Ser Cases 9, 33 (2023). https://doi.org/10.1038/s41394-023-00587-1

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