Effectiveness of early vocational rehabilitation versus usual care to support RETurn to work after stroKE: A pragmatic, parallel-arm multicenter, randomized controlled trial

International Journal of Stroke, 2025 · DOI: 10.1177/17474930241306693 · Published: April 1, 2025

Occupational Health Neurorehabilitation Rehabilitation

Simple Explanation

This study investigated whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care is more effective than usual care alone in helping stroke survivors return to work. The study found no evidence that ESSVR conferred any benefits over UC in improving return-to-work rates 12 months post-stroke. Return-to-work rates were higher than in previous studies, but the interpretation of findings was limited by a predominantly mild–moderate sample of participants and the COVID-19 pandemic.

Study Duration

Between 1 June 2018, and 7 March 2022

Participants

583 participants (Mage 54.1 years (SD 11.0), 69% male)

Evidence Level

Randomized controlled trial

Key Findings

1
ESSVR did not show a significant benefit over usual care in improving return-to-work rates at 12 months post-stroke.
2
Older participants and those with more post-stroke impairment were more likely to benefit from ESSVR.
3
The COVID-19 pandemic impacted the trial, ESSVR and UC delivery, altering the work environment and employer behavior.

Research Summary

The RETAKE trial evaluated the effectiveness of ESSVR plus usual care versus usual care alone for helping people return-to-work after stroke. The study found no evidence that ESSVR conferred any benefits over UC in improving return-to-work rates 12 months post-stroke. The COVID-19 pandemic impacted the trial, ESSVR and UC delivery, altering the work environment and employer behavior and potentially influencing the primary outcome.

Practical Implications

Targeted Intervention

ESSVR should be targeted, potentially at older patients and those with greater post-stroke impairment.

Further Research

Further research is needed to confirm the benefits of ESSVR in specific subgroups.

Adaptable Strategies

Strategies for vocational rehabilitation need to be adaptable to changing work environments and external factors like pandemics.

Study Limitations

1
The study was conducted during the COVID-19 pandemic, which changed the healthcare and employment contexts.
2
There was high loss-to-follow-up, particularly for secondary outcomes.
3
The sample was predominantly mild-to-moderate severity, limiting generalizability to more severe stroke survivors.

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