Reflections of a rehabilitation professional: research – some introductory thoughts

I have been very fortunate in my career to work with the Medical Research Council at Northwick Park Hospital in my early years as a consultant and latterly with Brunel University London.

The first question is – What is Research? Simply it just means trying to answer a question. The issues arise relate to the complexity of the solution to the question. The problems arise when one needs to employ someone else to do the work which you could do if you had time – which most professional folk don’t have, or because it is necessary for a researcher to be ‘blind’ as to the nature of any intervention. For example, if one wanted to compare the results of an injection for pain relief, then the desired test of the effectiveness of the injection needs to be done by a researcher who does not know whether the individual receiving the injection had the real new treatment or a dummy injection.

It follows that most questions that are asked need considerable resources and are big questions e.g. does rehabilitation help individuals who have had a stroke? and therefore need lots of money. It also means that considerable intellectual resources may be required e.g. statistical – and this usually means that the work needs to be assisted by a dedicated university or research team.

All my initial research experience resulted in my having a dedicated back pain clinic which was needed if one was to ask questions about hospital-based experience of the management of back pain. This resulted in research groups coming to me and forming collaborations enabling them to ask questions from my ‘patients’ and also for me to ask my own questions which the research groups could help me to answer. I will now refer to all my/your customers as disadvantaged individuals (DIs) to avoid terminological problems!

However, vocational rehabilitation professionals (VRPs) may have very simple questions to ask – like ‘how many of the DIs using our service get back to work’ or ‘what is the best way to get employers to assist their employees – talking to managers or to human resources – or to both’?

The starting off point for all VRPs is to understand one’s client group so one can:-

• Read the literature about any particular group of DIs
• Define the nature of the problems identified by your DIs and thus whether your ‘sample’ of DIs is the same or different from everyone else’s.

The first step is always to do a retrospective review of the DIs that you have seen over a certain period, or to decide to review e.g. the last 20 case notes (or charts). You may be doing this anyway as part of your reflective practice? I personally have always used an excel spreadsheet but there are probably more modern approaches. All those being reviewed need to be given a number so that all your data is analysed on anonymous sheets and in order to clearly define the nature of one’s DIs, the following data might be considered a minimal dataset:-

• Postcode (first 3/4 digits only)
• Age
• Gender
• Nature of the disadvantages (flag system might help here – see table [1]
  • medical e.g. spinal cord injury and all comorbidities
  • psychosocial status
  • non-medical e.g. poverty, living alone etc.
  • unhelpful employer

As a VRP, you may have very particular interests that you wish to document e.g.

• any objective assessments you have performed
• Difficulties associated with return to work (RTW) identified by the
  • DI
  • Employer
• Nature of specific VR interventions performed e.g. worksite visit and meeting with employer’s representative, phased (graded) RTW, home working etc
• Unexpected problems that arose and how you overcame them etc.

Even with a small number of DIs, this data should give you some insight into the nature of your practice and whether it is similar or different to other VR practices and more specifically whether the problems you have identified have clearly defined solutions or whether some are unique and thus worthy of reporting.

Having done your retrospective review, the next step is to ask some questions prospectively and I will comment on this in my next reflection.

I am happy to discuss any of the issues raised in these reflections with colleagues who can email me at ‘andrew.frank1@btinternet.com’ and head the email VRA – professional reflections.

Andrew Frank

Trustee and Past-Chair, VRA.

Table

The flag system of obstacles in RTW

Red – severity of impairment (a)

Yellow – psychosocial obstacles (b)

Orange – those with pre-existing psychological impairments (b)

Blue – perceived obstacles in the workplace – changeable (c)

Black – unalterable obstacles – e.g. national agreements (c)

Chequered – social obstacles (c)

a        Biological

b       Psychological

c        Social

a-c     Components of the ‘bio-psycho-social’ model

from Frank Vocational Rehabilitation: Supporting Ill or Disabled Individuals in (to) Work: A UK Perspective

Reference

1. Kendall, N. and A. Burton, Tackling musculoskeletal problems: a guide for clinic and workplace – identifying obstacles using the psychosocial flags framework. First ed. Vol. 1. 2009, London: TSO.