There is a growing consensus that professional action in occupational rehabilitation should be research-based, and that practice-based knowledge is needed to achieve contextual insight and new theoretical understanding. Few study design examples exist to help inform an evaluation plan and develop research-practice interactions to examine process complexity of targeted occupational rehabilitation programs. This study design article is a proposal on a theory-driven and interactive research methodology for a process evaluation of a pragmatic intervention trial, known as STAiR. The aim of the process evaluation is to examine the delivery and implementation of an inpatient and an outpatient occupational rehabilitation program, and explore active mechanisms pertaining to patient experiences of the return to work (RTW) process. Qualitative and interactive data collection methods will include (a) participant observation of program setting and activities; (b) participatory dialogue conferences with program providers to facilitate initial logic modelling; (d) individual patient interviews at program intake and follow up; and (d) focus groups with rehabilitation teams and external stakeholders. The qualitative data will be supplemented with description of program activities and patient questionnaires. Program logic modelling is suggested to inform a logic analysis of how expected RTW outcomes and delivery of program activities are aligned and how contextual characteristics may clarify differences in achieved RTW outcomes. The proposed process evaluation approach may inform future design discussions and theoretical understanding, and it is expected that the applied knowledge gained through this study may help rehabilitation professionals better navigate potential challenges in clinical evaluation efforts.

The guidelines published by the International Social Security Association, ISSA Guidelines: Return to Work and Reintegration, provide a policy imperative towards early intervention for people with nonoccupational health conditions at risk of exiting the workforce and moving to disability dependency. Socioeconomic and fiscal imperatives have been demonstrated by the Organisation for Economic Co-operation and Development's (OECD) review on sickness, disability and work (OECD, 2010), and by an accumulating evidence base for effectiveness. This study explored how social protection agencies are responding in terms of employment rehabilitation services for employed people with acquired disabilities. Specifically, this study reviewed job retention and return processes for workers with nonoccupational health conditions from the perspective of the ISSA guidelines in four jurisdictions with differing system frameworks. The methods used included a review of relevant literature and web resources and gathering detailed system descriptions from national respondents. Although the jurisdictions differed in the concepts used, service context, the structure of welfare systems and eligibility criteria, there was evidence of an acknowledgement of the needs of employed people with disabilities. This was not, however, consistently reflected in procedures, processes or outcome measurements. While some promising characteristics were identified, there was substantial room for improvement in the job retention and return to work strategies of the relevant agencies in all four jurisdictions. It was concluded that the deployment of the ISSA Guidelines: Return to Work and Reintegration, published in 2013, had yet to make a substantial impact on services and approaches in the domain of nonoccupational health conditions in these jurisdictions.

Aim: The aim of this study was to provide new insight into the factors that affect work participation by those with cognitive deficits following an acquired brain injury. Method: The study had a qualitative exploratory design, with three focus-group interviews used to collect data. The first group comprised workers with experience of cognitive deficits after a traumatic brain injury (TBI), anoxic brain damage and stroke, the second group professionals from specialist levels of social security service and the third professionals from specialised health care services. Transcribed interviews were analysed using a conventional approach to content analysis. Major findings: A broad range of factors affected work participation. Personal factors, the psychosocial adaptation process, injury-related consequences as well as factors in the working environment were found to inhibit work participation. Acceptance of a different level of functioning and a new role in working life was an important but time-consuming process. Significant working-environment barriers were workplace demands, the attitudes of employers and colleagues, complicated information, excessive bureaucracy, too little practice before going back to work and physical barriers. Optimism and being determined were found to be particularly important facilitating personal factors. Important resources provided by the working environment were social support, time-related flexibility, relevant tasks and accommodations.