1. Introduction
stroke
REGRESSION, STROKE
Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05–0.53, Results of intervention studies typically only report whether an intervention is shown to attain target outcomes, but attention is not often afforded to more nuanced considerations around intervention implementation [Fidelity assessment can be useful not just as an implementation technique to monitor and support healthcare professionals delivering an intervention over the course of the study period [Individual-level attributes are personal characteristics that can be stable, i.e., thought to stay the same over time (e.g., education, openness to change, critical thinking) [Vocational rehabilitation (VR) is an intervention that supports people in returning to or remaining in work [This study sought to explore the relationships between OT attributes, implementation fidelity, and stroke survivor return-to-work outcomes and was conducted using data collected from the RETurn to work After stroKE (RETAKE) trial (ISRCTN: 12464275); a large multi-centre randomised controlled trial (RCT) of a complex, VR intervention to support stroke survivors to return to and stay in work following their stroke.