Utilizing nominal group technique to achieve consensus on a clinical decision-making tool for vocational rehabilitation at a grassroots level in South Africa

Abstract

BACKGROUND : Barriers to the delivery of vocational rehabilitation have been reported as a lack of knowledge, skills and confidence in occupational therapists who deliver these services. A program aimed at overcoming these barriers was developed to provide training in the delivery of vocational rehabilitation services. The program includes three decision-making tools to facilitate not only knowledge translation but also practice changes. The tools are (1) Return-to-Work Decision Tree, (2) Performance-based Assessment Tool, (3) Job Match Tool. OBJECTIVE : The objective of the research was to obtain consensus on the acceptability and utility of the developed tools to facilitate clinical reasoning in the delivery of vocational rehabilitation services. METHODS : A nominal group technique was used to obtain consensus on the developed tools. During a second phase, participants were sent revised versions of the tools and asked to comment on the tools’ clinical utility using a four-point Likert scale. RESULTS : The Return-to-Work Decision Tree and the Performance-based Assessment Tool received a 100% agreement in terms of clinical utility with the Job Match Tool receiving a 90% agreement for clinical utility. Participants made valuable recommendations such as adding a user manual and a training workshop to facilitate implementation of the tools. CONCLUSION : The three tools developed to support clinical reasoning and decision making during the vocational rehabilitation process were reported to be acceptable by the expert participants. Further development of the Job Match Tool is recommended.