General Medicine · Medical Literature
Implementation barriers and facilitators to a vocational rehabilitation intervention after traumatic injury (ROWTATE) in the UK: qualitative interviews with key stakeholders
Abstract
Objectives To explore barriers and facilitators to implementing the ROWTATE vocational rehabilitation intervention and identify lessons for future service delivery. Design Qualitative interview implementation study embedded within the development and evaluation of a complex health intervention, guided by the UK Medical Research Council framework. Setting National Health Service (NHS) major trauma services in England. The ROWTATE intervention included early vocational assessment lasting up to 12 months, case management, employer engagement and coordinated multidisciplinary support between occupational therapists and clinical psychologists. The intervention was delivered via hybrid models following COVID-19 adaptations. Participants Purposively sampled stakeholders including patients, therapists, mentors, employers, carers, commissioners and primary care practitioners. Methods 80 semistructured interviews were conducted remotely between March 2023 and June 2025 using topic guides informed by the Consolidated Framework for Implementation Research and the Theoretical Framework of Acceptability. Data were analysed using framework coding followed by reflexive thematic analysis to generate cross-cutting themes and implementation-focused recommendations. Results Implementation was shaped by six cross-cutting themes that acted as both barriers and facilitators depending on context. Stakeholders highlighted the importance of addressing diverse patient needs and outcomes through early, personalised support and case management. Remote delivery improved accessibility and flexibility but was most effective when combined with face-to-face contact to strengthen relationships and contextual understanding. Multidisciplinary occupational therapy and clinical psychology collaboration enabled holistic care, though required structured processes to overcome communication challenges. Mentoring provided essential professional development and mitigated isolation in remote roles, while e
Clinical relevance
Traumatic injury disproportionately affects working-age adults — over 367,000 were hospitalised in England in 2020/21 alone — yet structured vocational rehabilitation (VR) remains absent from most NHS major trauma pathways. The ROWTATE implementation study addresses a critical evidence gap by identifying the real-world barriers and facilitators to embedding an early, multidisciplinary VR intervention (occupational therapy plus clinical psychology) within NHS major trauma services. Clinicians working in trauma, rehabilitation medicine, and occupational therapy should attend to these findings now, as the parallel ROWTATE RCT (n=722, ISS >8) is underway and service commissioners will need actionable implementation guidance once trial results are published.
Key findings
NOTE: This abstract is a qualitative implementation study guided by the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Framework of Acceptability; it reports thematic findings rather than quantitative effect sizes, confidence intervals, p-values, or NNT/NNH. Specific numerical data were not available in the provided abstract or retrievable full text. Findings as reported are: 1. Six cross-cutting thematic domains were identified that functioned as either barriers or facilitators depending on context, covering patient diversity, care personalisation, delivery modality, multidisciplinary collaboration, mentoring, and service system factors. 2. Early, personalised vocational assessment and case management — sustained up to 12 months post-injury — was highlighted by stakeholders as essential to addressing heterogeneous patient needs and outcomes. 3. Remote (telerehabilitation) delivery improved accessibility and scheduling flexibility, but was reported to be most effective only when combined with face-to-face contact to maintain therapeutic relationships and contextual understanding. 4. Multidisciplinary OT–clinical psychology collaboration was perceived as enabling holistic, biopsychosocial care; however, structured communication processes were required to overcome interprofessional coordination challenges. 5. Mentoring of therapists was identified as a key facilitator of professional development and mitigation of professional isolation inherent in remote working roles. 6. Data were drawn from 80 purposively sampled stakeholders (patients, therapists, mentors, employers, carers, commissioners, and primary care practitioners), interviewed remotely between March 2023 and June 2025, providing broad implementation perspective across the NHS major trauma pathway.
Practice implications
Major trauma services planning to implement structured VR should initiate vocational assessment early (within the acute/subacute phase) and sustain case management for up to 12 months, using an OT-led case coordinator model with integrated clinical psychology input for psychological screening and treatment of trauma-related mental health comorbidities (anxiety, depression, PTSD). Hybrid delivery combining remote telerehabilitation — for accessibility and flexibility — with scheduled face-to-face contact should be the default model, particularly to sustain therapeutic alliance and enable contextual workplace assessment; purely remote delivery is insufficient for complex cases. Commissioners and clinical leads should ensure structured interprofessional communication pathways, formal mentoring provision for VR therapists, and active employer engagement protocols are embedded in any service model, as these were identified as implementation-critical components that require deliberate organisational infrastructure rather than assumed to occur organically.