Long Term Conditions

FRESH - Facilitating Return to work through Early Specialist Health-based interventions

png-logoThe FRESH study is a feasibility randomised control trial with a nested qualitative process evaluation involving 102 working age people with traumatic brain injury.

It has been designed to determine whether it is possible to develop a treatment manual, training package and mentoring model based on a model of Early Specialist Traumatic Brain Injury Vocational Rehabilitation (ESTVR) developed in Nottingham and test whether ESTVR can be delivered and its effects and cost effectiveness measured in a feasibility randomised control trial in three NHS trauma centres (Preston, London and Leeds).

The study is being led by Kate Radford from the Division of Rehabilitation and Ageing at the University of Nottingham and the trial is being coordinated from the Lancashire Clinical Trials Unit.



Trevor Jones, talks about what it means to be a service user representative on the FRESH project



Key Facts

1. What are you testing?

We are testing the feasibility of delivering and measuring Early Traumatic Brain Injury Specialist Vocational Rehabilitation (ESTVR).

ESTVR is a process that begins within eight weeks of injury and involves finding ways to ‘match’ the traumatic brain injured person’s abilities and limitations to the demands of the job and work environment.  


2. What is ESTVR?

ESTVR is an occupational therapy intervention that seeks to lessen the impact of Traumatic Brain Injury (TBI) by assessing the patient’s role as a worker and finding acceptable strategies to overcome problems e.g. new disabilities which might have a direct impact on work activities.


3. What does ESTVR involve?

The occupational therapist (OT) provides pre-work training to prepare the person for work by establishing structured routines with gradually increasing activity levels; opportunity to practice work skills e.g. computer use to increase concentration; liaises with employers/ tutors and disability employment advisors to advise about the effects of TBI and plan and monitor graded work return; conducts worksite visits and job evaluations; identifies the need for workplace or job adaptations and serve as the link between health and Department for Work and Pensions (DWP) services to access additional support.

OT TBI Case managers co-ordinate the overall TBI care package, provide support, education and advice to patients, family and others e.g. NHS staff, social services, Headway and solicitors, remaining in contact with patients and families whilst there are achievable rehabilitation goals. 

Intervention is structured around individual needs and involves up to 10 individual sessions.

We will employ a randomised design where consenting participants will be allocated to receive either the ESTVR Intervention in addition to usual NHS rehabilitation or usual NHS rehabilitation.


4. How many trial participants do you need?

102 Adults (aged 16 and above) living in the London, Preston and Leeds health communities and admitted to hospital for 48 hours or more with new TBI and who were in or intending to work (paid or unpaid) or in full time education prior to their injury.

In addition to the trial we will be interviewing people who have survived a traumatic brain injury, their employers and health care professionals about rehabilitation outcomes. If you are interested in taking part please contact the study team.


5. How long will the study last?

The study began in March 2013 and will run until the end of February 2016. Recruitment to the trial commenced in December 2013 and will continue until September 2014.





More information

If you would like more information, please contact the study team on 0115 8230226 or email kate.radford@nottingham.ac.uk.  




This is an independent trial that is being funded by the National Institute for Health Research Health Technology Assessment programme. The views expressed on this website are those of the author(s) and not necessarily those of the NIHR.



Long Term Conditions Research Group

School of Medicine
Division of Rehabilitation and Ageing
telephone: +44 (0)115 823 0226