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A service of the National Library of Medicine, National Institutes of Health. < Prev Next > Development and description of Early Stroke Specialist Vocational Rehabilitation delivered in the RETAKE trial Health Technology Assessment, No. 30.31 Kathryn A Radford , Mary I Grant , Jain A Holmes , Julie Phillips , Kathryn Powers , Rachel L Chambers , Kristelle Craven , Brian Bell , Christopher McKevitt , David Clarke , Amanda Farrin , Diane Trusson , Caroline Watkins , Audrey Bowen , Ellen Thompson , and Alexandra Wright-Hughes ; on behalf of the RETAKE Research Group. Author Information and Affiliations Authors Kathryn A Radford , 1,2 ,* Mary I Grant , 1 Jain A Holmes , 1 Julie Phillips , 1 Kathryn Powers , 1 Rachel L Chambers , 3 Kristelle Craven , 1 Brian Bell , 1 Christopher McKevitt , 3 David Clarke , 4 Amanda Farrin , 5 Diane Trusson , 1 Caroline Watkins , 6 Audrey Bowen , 7 Ellen Thompson , 5 and Alexandra Wright-Hughes 5 ; on behalf of the RETAKE Research Group. Affiliations 1 Centre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK 2 Nottingham Biomedical Research Centre, Nottingham, UK 3 School of Population Health and Environmental Sciences, King’s College London, Strand, London, UK 4 Academic Unit of Ageing and Stroke Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK 5 Clinical Trials Research Unit, University of Leeds, Leeds, UK 6 School of Nursing and Midwifery, Faculty of Health and Care, University of Central Lancashire, Preston, UK 7 Division of Psychology & Mental Health, University of Manchester, Manchester, UK * Corresponding author ; Email: [email protected] Southampton (UK): National Institute for Health and Care Research ; 2026 Apr . Copyright and Permissions Copyright © 2026 Radford et al. This work was produced by Radford et al . under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/ . For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited. Search term Abstract Objective: This paper describes the development of an Early Stroke Specialist Vocational Rehabilitation intervention to support return to work following stroke and its delivery in the RETAKE trial. Methods: Iterative three stage, target population approach to intervention development and evaluation informed by the Medical Research Council Framework. Stage 1 (Initial codevelopment): interviews with key stakeholder service providers and users’ and mapping of services supporting return to work after stroke to identify and explore barriers to and unmet needs for support; intervention codevelopment with experts and patient and public involvement (PPI). Stage 2 (Refinement): expert panel codevelopment workshops and systematic review to identify vocational rehabilitation intervention mechanisms of change in supporting return to work after stroke. Stage 3 (Testing): intervention piloting in two case studies, feasibility testing in a randomised controlled trial, acceptability interviews with stroke and employer participants. Further intervention refinement following delivery in the RETAKE randomised controlled trial. Results: Stage 1: service mapping and 25 stakeholder interviews identified service gaps and unmet needs relating to early identification of employed stroke survivors, mild stroke, and hidden disabilities. Access to timely support relied on geographical proximity to a specialist hub and tacit knowledge of complex health, education and employment services and provider roles. Return to work issues reported by stroke survivors informed Early Stroke Specialist Vocational Rehabilitation prototype design objectives. Iterative developments following piloting included fatigue management, involvement of general practitioners, work simulation and liaison with other healthcare services. Interviews with 12 recipient stroke survivors and 6 employers identified additional features including occupational therapist negotiation skills, ability to respond to changing needs over time and patient empowerment to self-re-refer. The review corroborated intervention components and mechanisms and identified additional mechanisms, for example, peer support, supported self-management. Intervention mechanisms identified across the three stages were early intervention, understanding the impact of stroke on the person, their job and work environment, vocational goal setting, implementing workplace accommodations, individual tailoring, work preparation, colocation, case co-ordination, Multidisciplinary Team (MDT) working, employer engagement and education, and responsiveness, which involved monitoring work stability, providing feedback, and responding to changing needs over time and participant self-re-referral. In RETAKE, Early Stroke Specialist Vocational Rehabilitation was successfully delivered to 95.4% of allocated participants with 75.3% compliance. Intervention commenced a median 38 days (interquartile range 23–56, range 6–216) post stroke and continued for ≤ 12 months. Participants had a median seven intervention sessions (interquartile range 4–12, range 0–37), with discharge a median 10.3 months (interquartile range 5.5–12.0, range 0–15.4) post randomisation. Most intervention sessions were delivered via telerehabilitation (51.7%), in participants’ homes (35.9%) or workplaces (6.4%). There was little difference between the number of sessions offered [mean 9.6 (standard deviation 7.46, range 0–39)] and attended [mean 9.0 (standard deviation 7.16), range 0–37]. However, occupational therapist contact with employers only occurred for 109 (36.8%) participants and employer visits occurred for 74 (25.0%). The Early Stroke Specialist Vocational Rehabilitation focus changed between the feasibility and definitive trial, with greater emphasis on current issues, fatigue management and informal psychological support, possibly due to the coronavirus disease discovered in 2019 pandemic. A programme theory and logic model illustrating the refined intervention and a description of Early Stroke Specialist Vocational Rehabilitation delivered in the RETAKE trial is reported. Conclusion: This comprehensive description of Early Stroke Specialist Vocational Rehabilitation will enable occupational therapists to implement Early Stroke Specialist Vocational Rehabilitation in practice and facilitative future evaluation. 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. Plain language summary This paper describes the development of an intervention aimed at helping people to return to work after experiencing stroke and its and delivery in the RETurn to work After stroKE trial. This is important because working has financial, physical and mental benefits. We began by asking stroke survivors, and service providers in health, education and employment services and employers about what return-to-work support was currently available. This helped us to identify gaps in provision. We also looked at previous research to find out what works when supporting someone to return to work after stroke. Using this information, we developed an early stroke specialist vocational rehabilitation intervention to help employed stroke survivors return to work. Early Stroke Specialist Vocational Rehabilitation began shortly after stroke and continued for up to 1 year. Specially trained occupational therapists with expertise in stroke and vocational (work-related) rehabilitation helped stroke survivors, their families and employers to understand the impact of stroke and adapt to post-stroke abilities. Occupational therapists provided work-based activities and discussed arrangements with employers to help stroke survivors to return to work. For example, graded return, reduced hours, or altered duties. Occupational therapists continued to monitor stroke survivors after their return to work. Early Stroke Specialist Vocational Rehabilitation was initially tested on two stroke survivors, then revised before testing it on 46 more. We interviewed 13 recipient stroke survivors and 6 employers to identify additional features including occupational therapist negotiation skills, and empowering patients to self-refer. Previous studies suggested we include peer support and supported self-management too. A large trial compared Early Stroke Specialist Vocational Rehabilitation with usual care in 583 stroke survivors. Stroke survivors, occupational Therapists and employers all valued Early Stroke Specialist Vocational Rehabilitation, especially the advice which was tailored to individual needs, employer engagement, and continuity of support (including emotional support) for up to 12 months. The intervention delivered to stroke survivors in the trial is described here. This description of how Early Stroke Specialist Vocational Rehabilitation was developed and delivered will enable occupational therapists to use it. Contents Expand All Collapse All Background Aims Objectives Methods Data analysis Results Stakeholder mapping and interview study Expert panel Case studies Feasibility and acceptability testing Systematic review Definitive evaluation and description of the intervention delivered in the RETAKE trial Why What RETAKE intervention delivery summary Who How Where When and how much Modifications Tailoring How well Discussion ESSVR components The model behind ESSVR Early Stroke Specialist Vocational Rehabilitation scope Implementation fidelity in the RETAKE trial Patient and public involvement Equality, diversity and inclusion Strengths and limitations Conclusion Additional information List of supplementary materials List of abbreviations References Appendix 1. Systematic review search strategy Appendix 2. Author-identified important components for supporting after stroke mapped to mechanisms Appendix 3. Quality assessment of included papers Appendix 4. Barriers to return to work identified in interviews with stroke survivors and service providers (phase 1) Appendix 5. Case study participant data and Interview feedback Appendix 6. Themes emerging from the feasibility trial stroke and employer participant interviews Appendix 7. Mechanisms of interventions Appendix 8. RETAKE intervention summaries Appendix 9. Summary of ESSVR training package components Expand All Collapse All About the Series Health Technology Assessment ISSN (Electronic): 2046-4924 Disclaimer: This report contains transcripts of interviews conducted in the course of the research, or similar, and contains language that may offend some readers. Article history The contractual start date for this research was in July 2017. This article began editorial review in April 2024 and was accepted for publication in July 2025. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The Health Technology Assessment editors and publisher have tried to ensure the accuracy of the authors’ article and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this article. Last reviewed: April 2024; Accepted: July 2025. Copyright © 2026 Radford et al . This work was produced by Radford et al . under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/ . For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited. Bookshelf ID: NBK621568 DOI: 10.3310/GJKR0715 < Prev Next > Share Views PubReader Print View Cite this Page Radford KA, Grant MI, Holmes JA, et al. Development and description of Early Stroke Specialist Vocational Rehabilitation delivered in the RETAKE trial. Southampton (UK): National Institute for Health and Care Research; 2026 Apr. (Health Technology Assessment, No. 30.31.) doi: 10.3310/GJKR0715 PDF version of this title (1.6M) Other titles in this collection Health Technology Assessment Related information NLM Catalog Related NLM Catalog Entries Similar articles in PubMed Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. [Health Technol Assess. 2020] Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. 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