Background: Returning to work after traumatic injury can be problematic. We developed a vocational telerehabilitation (VR) intervention for trauma survivors, delivered by trained occupational therapists (OTs) and clinical psychologists (CPs), and explored factors affecting delivery and acceptability in a feasibility study. Methods: Surveys pre- (5 OTs, 2 CPs) and post-training (3 OTs, 1 CP); interviews pre- (5 OTs, 2 CPs) and post-intervention (4 trauma survivors, 4 OTs, 2 CPs). Mean survey scores for 14 theoretical domains identified telerehabilitation barriers (score ≤ 3.5) and facilitators (score ≥ 5). Interviews were transcribed and thematically analysed. Results: Surveys: pre-training, the only barrier was therapists’ intentions to use telerehabilitation (mean = 3.40 ± 0.23), post-training, 13/14 domains were facilitators. Interviews: barriers/facilitators included environmental context/resources (e.g., technology, patient engagement, privacy/disruptions, travel and access); beliefs about capabilities (e.g., building rapport, complex assessments, knowledge/confidence, third-party feedback and communication style); optimism (e.g., impossible assessments, novel working methods, perceived importance and patient/therapist reluctance) and social/professional role/identity (e.g., therapeutic methods). Training and experience of intervention delivery addressed some barriers and increased facilitators. The intervention was acceptable to trauma survivors and therapists. Conclusion: Despite training and experience in intervention delivery, some barriers remained. Providing some face-to-face delivery where necessary may address certain barriers, but strategies are required to address other barriers.

Objectives: Major trauma centres (MTCs) save lives but rehabilitation to support return-to-work (RTW) is lacking. This paper describes development of a vocational rehabilitation intervention (the ROWTATE intervention) to support RTW following traumatic injury. Design: Sequential and iterative person-based approach in four stages— Stage 1: review of evidence about the efficacy and mechanisms of RTW interventions; Stage 2: interviews (n=38) and focus groups (n=25) with trauma survivors and service providers in five UK MTCs to identify the issues, and challenges faced postinjury; Stage 3 : codesign workshops (n=43) with trauma stakeholders in MTCs to conceptually test and identify intervention delivery barriers/enablers; Stage 4: meetings (n=7) with intervention development working group (IDWG) to: (1) generate guiding principles, (2) identify key intervention features (process, components, mechanisms) to address unmet rehabilitation needs; (3) generate a logic model and programme theory to illustrate how the intervention works; and (4) develop a training package to support delivery. Results: Trauma survivors described unmet needs relating to early advice about RTW; psychological support; pain management; hidden disabilities (eg, fatigue); estimating recovery; and community, amputee and musculoskeletal rehabilitation. Mechanisms of effective interventions identified in the review included early intervention, colocation, employer engagement, case coordination and work accommodations. Intervention features identified by IDWG members (n=13) from stages 1 and 2 were use of stepped-care approaches by occupational therapists (OTs) and clinical psychologists (CPs), OT/CP formulation for complex cases, assessment of mental health problems, individually tailored rehabilitation including vocational goal setting, cross-sector coordination/communication, employer engagement, phased RTW, education/advice for family/employers, exploration of work alternatives, ongoing review of physical and mental health needs, work stability monitoring. Conceptual testing ratified the logic model. Geography and long waiting lists were identified as potential delivery barriers. Conclusions: Real-world testing of the intervention is underway in a randomised controlled trial.

Background: Returning to work after stroke has physical, psychological and financial benefits for stroke survivors. However, global evidence estimates return-to-work rates 1 year post stroke at < 50%. Although its importance is acknowledged by policy-makers and healthcare providers, vocational rehabilitation is not always part of National Health Service usual care post stroke. Currently, there is limited evidence of the effectiveness of return-to-work support interventions. RETurn to work After stroKE was a multicentre individually randomised controlled pragmatic trial, with embedded process and health economic evaluations. RETurn to work After stroKE aimed to establish whether Early Stroke Specialist Vocational Rehabilitation plus usual care improves the likelihood of return to work at 12 months post stroke compared to usual care alone. As part of an embedded process evaluation, longitudinal case studies enabled exploration of participants’ experiences of support to return to work in the trial. Objectives: This article aims to understand participants’ experiences of being supported to return to work and explores the social and structural factors which support, or act as barriers to, implementation of the Early Stroke Specialist Vocational Rehabilitation intervention. Method: A longitudinal case-study approach was used to compare experiences of post-stroke return-to-work support received over 12 months by 15 participants who received the Early Stroke Specialist Vocational Rehabilitation intervention plus usual care, and 11 participants who received usual care only. Data were gathered at three time points using follow-up questionnaires, health records, intervention delivery records and semistructured interviews with participants and seven nominated informal carers. Interviews were also conducted with 1 employer and 11 occupational therapists delivering the intervention. Setting: Sixteen National Health Service sites across England and Wales. Findings: In the intervention arm, stroke survivors, carers and employers reported benefits from information and support from the treating occupational therapist to facilitate acceptance of, and adaptation to, post-stroke abilities. Participants also valued occupational therapists’ provision of sustained and tailored vocational rehabilitation, co-ordinating their care and advocating for them in return-to-work discussions with their employers. Those unable to return to their previous employment were supported to consider alternative options. In contrast, participants who received usual care only reported feeling abandoned when community rehabilitation support ended, typically after 2–8 weeks. Usual care largely focused on restoring physical function, leaving these participants struggling to find return-to-work information, advice and support. Longitudinal case studies enabled psychosocial and environmental factors impacting on participants’ return-to-work experiences to be considered. Limitations: Recruitment to the process evaluation was impacted by the COVID-19 pandemic. It proved difficult to recruit employers for interview, and fewer women participated in the case studies (21 men, 5 women). Direct observation of intervention delivery could not be carried out as planned due to pandemic restrictions on access to clinical areas. Conclusions: These case studies highlighted self-reported differences between recipients of the Early Stroke Specialist Vocational Rehabilitation intervention plus usual care and participants allocated to usual care only. Aspects perceived as important in underpinning the differences in support included the length of Early Stroke Specialist Vocational Rehabilitation intervention, occupational therapist advocacy, employer liaison and ongoing workplace monitoring. Provision of these core components as part of post-stroke services may support and help to sustain return to work, with associated benefits for stroke survivors and wider society. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/130/11.

To implement a job retention vocational rehabilitation (VR) intervention (MSVR) for people with multiple sclerosis (MS) and their employers in the UK National Health Service (NHS). Multicentre, single-arm feasibility study with post-intervention interviews. MSVR was delivered by an occupational therapist (OT). Feasibility was assessed by recruitment rates, compliance, and practicality of delivery. Acceptability was assessed with post-intervention interviews. A survey assessed change in eight vocational outcomes (e.g., vocational goals, work instability) immediately post-intervention and at 3-month follow-up. Recruitment and training an OT was challenging. Twenty participants with MS, three employers, and three healthcare professionals were recruited. All participants but one completed the intervention. Factors affecting intervention adherence included annual leave and family responsibilities.MSVR was associated with improved vocational goal attainment post-intervention (t(18) = 7.41, p = <0.001) and at follow-up (t(17) = 6.01, p = <0.001). There was no change to the remaining outcomes. Interviews identified six themes: intervention impact, accessibility of support, the OT's role, readiness for support, workplace supportiveness, and barriers to NHS delivery. Challenges with recruitment, identifying newly diagnosed MS participants, and understanding the OT's training needs to deliver the intervention were identified. The intervention demonstrated acceptability, but participants wanted it to continue for longer to address further needs.

Background: Aphasia, an acquired language disorder that affects the ability to understand and produce language, significantly impairs effective communication. Large language models (LLMs) such as ChatGPT may help by generating fluent and coherent text, offering new ways to support communication for people with aphasia. Objective: This study aims to coproduce a communication support system using LLMs and evaluate its usefulness and acceptability among people with mild-to-moderate expressive aphasia. Methods: We used the Double Diamond approach across 3 phases. Phase 1: a stroke-survivor patient and public involvement (PPI) group (n=4) and the research team used MoSCoW prioritization (Must Have, Should Have, Could Have, Will Not Have) to rank ideas and co-design a software solution (Revolutionizing Speech Enhancement in Aphasia Using Knowledgeable-AI [R-SPEAK]) to augment verbal communication. Phase 2: 8 LLMs were evaluated on interpreting aphasic utterances from AphasiaBank transcripts. Outputs were compared, and the best responses, selected by team consensus, formed ground truth. The model producing the highest-quality responses was used in the prototype. Four people with aphasia and one carer (n=5) evaluated the prototype in semistructured interviews, and a health care professional (HCP) focus group (n=6) evaluated the concept and prototype. Topic guides were informed by the technology acceptance model (TAM), and thematic analysis themes were mapped onto its constructs. People with aphasia (n=4) rated prototype usability using the System Usability Scale (SUS). Phase 3: to improve processing speed, 12 lightweight LLMs (0.5-4 billion parameters) were evaluated on interpreting real aphasic speech using an LLM-as-a-judge framework to assess answer relevancy, faithfulness, and completeness. Results: In Phase 1, PPI groups (people living with aphasia, carers, and HCPs) identified essential system features and contextual data requirements across 2 co-ideation sessions using MoSCoW prioritization. In Phase 2, Mixtral 8x7B, the best-performing LLM for interpreting aphasic utterances, was used for the prototype. People living with aphasia rated R-SPEAK as good (SUS score: mean 75, SD 9.19). Themes mapped across three TAM constructs. (1) Attitude toward using it: people living with aphasia had high hopes, while clinicians were more cautious about its benefits. (2) Perceived ease of use: participants found it easy, though potentially harder for those with other poststroke impairments or more severe aphasia, with training possibly needed. (3) Perceived usefulness: R-SPEAK could be useful in many scenarios and improve independence. Recommendations included improved accuracy, speed, and tailored interface modifications. Phase 3 showed Qwen2.5:3B performed strongest overall, with high faithfulness and sub-second latency, while models under 1.5 billion parameters showed pronounced hallucination, indicating a lower bound on model capacity for reliable clinical speech interpretation. Conclusions: Our co-designed AI-supported R-SPEAK prototype was considered acceptable to patients. Next steps involve refining and developing a smartphone app for feasibility testing in a larger cohort of people with mild-to-moderate aphasia.

Background: Patient and public involvement and engagement (PPIE) has many benefits for the design, delivery and dissemination of health research, but this can be difficult to achieve. Systematic reporting and evaluation of PPIE in multi‐year, multisite and complex clinical trials is very limited. Methodology: This evaluation presents a multi‐perspective description and evaluation of patient and public involvement within a large‐scale, multisite, longitudinal research programme focused on developing and evaluating a vocational rehabilitation and clinical psychology intervention for individuals recovering from traumatic injury. Conducted as part of the NIHR‐funded ROWTATE research programme (2019–2026), the evaluation explores the scope, impact, and lived experiences of PPIE group members across all phases of the study, from development of the intervention, feasibility study and trial design to intervention delivery, data collection, analysis and dissemination. Employing multiple methods, including open‐ended surveys with PPIE group members and researchers, a ‘You Said, We Did’ activity log, and minute taking, the study identifies key patterns related to PPIE group members' motivations, contributions, personal impact and barriers and facilitators to engagement. Results: Findings highlight the significant value of PPIE in enhancing study relevance, improving data collection and communication strategies, informing rehabilitation, clinical psychology and health economics components, and shaping intervention delivery. PPIE group members reported a strong sense of purpose and intellectual engagement, despite challenges including communication gaps and role clarity. Researchers valued PPIE contribution to the research, and the positive and enriching experience of working with PPIE group members. Both groups reflected on the barriers and facilitators to PPIE. Conclusion: The evaluation highlights the importance of inclusive, well‐supported, and transparent PPIE practices and contributes novel insights into the PPIE role in under‐researched domains such as clinical psychology and health economics. Patient or Public Contribution: Traumatic injury survivors were involved in all processes of this evaluation. This includes research design, funding acquisition, data collection, data analysis and interpretation and the write‐up of this manuscript. Five traumatic injury survivors are co‐authors of this manuscript.