King's College London

Research portal

RETurn to work after stroKE (RETAKE) Trial: Protocol for a mixed-methods process evaluation using normalisation process theory

Research output: Contribution to journalArticlepeer-review

Kathryn A. Radford, Christopher McKevitt, Sara Clarke, Katie Powers, Julie Phillips, Kristelle Craven, Caroline Watkins, Amanda Farrin, Jain Holmes, Rachel Cripps, Vicki McLellan, Tracey Sach, Richard Brindle, Ivana Holloway, Suzanne Hartley, Audrey Bowen, Rory J. O'Connor, Judith Stevens, Marion Walker, John Murray & 2 more Angela Shone, David Clarke

Original languageEnglish
Article numbere053111
JournalBMJ Open
Issue number3
Published15 Mar 2022

Bibliographical note

Funding Information: Funding This study is funded by the NIHR HTA programme (ref: 15/130/11). The views expressed herein are those of the authors, not necessarily the NIHR, the Department of Health and Social Care or the NHS. Publisher Copyright: © 2022 Authors

King's Authors


Objectives This mixed-method process evaluation underpinned by normalisation process theory aims to measure fidelity to the intervention, understand the social and structural context in which the intervention is delivered and identify barriers and facilitators to intervention implementation. Setting RETurn to work After stroKE (RETAKE) is a multicentre individual patient randomised controlled trial to determine whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care is a clinically and cost-effective therapy to facilitate return to work after stroke, compared with usual care alone. This protocol paper describes the embedded process evaluation. Participants and outcome measures Intervention training for therapists will be observed and use of remote mentor support reviewed through documentary analysis. Fidelity will be assessed through participant questionnaires and analysis of therapy records, examining frequency, duration and content of ESSVR sessions. To understand the influence of social and structural contexts, the process evaluation will explore therapists' attitudes towards evidence-based practice, competency to deliver the intervention and evaluate potential sources of contamination. Longitudinal case studies incorporating non-participant observations will be conducted with a proportion of intervention and usual care participants. Semistructured interviews with stroke survivors, carers, occupational therapists, mentors, service managers and employers will explore their experiences as RETAKE participants. Analysis of qualitative data will draw on thematic and framework approaches. Quantitative data analysis will include regression models and descriptive statistics. Qualitative and quantitative data will be independently analysed by process evaluation and Clinical Trials Research Unit teams, respectively. Linked data, for example, fidelity and describing usual care will be synthesised by comparing and integrating quantitative descriptive data with the qualitative findings. Ethics and dissemination Approval obtained through the East Midlands - Nottingham 2 Research Ethics Committee (Ref: 18/EM/0019) and the National Health ServiceResearch Authority. Dissemination via journal publications, stroke conferences, social media and meetings with national Stroke clinical leads. Trial registration number ISRCTN12464275.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454