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

These tools were built for the South African context, and the authors say applying them elsewhere needs careful thought about local differences that could change whether they are usable or appropriate. Only eleven therapists took part, all from one province, and six of them worked in academia and four in the private sector, with just one in the public sector. The therapists who would actually deliver vocational rehabilitation at grassroots level are barely represented. Nothing here shows the tools change practice or help anyone return to work. The authors state that the efficacy of the whole program, including whether it improves therapists' knowledge and skills and translates into practice, still has to be evaluated. The Return-to-Work Decision Tree contains a level of detail the authors themselves allow may be overwhelming. The Job Match Tool is not considered ready for implementation, got the least feedback of the three, got the fewest revisions, was ranked the lowest priority for revision, and one therapist disagreed that it was clinically useful. Further work on how it distinguishes levels of job demand and on its content around cognitive and social demands of work is recommended. The tools are not meant to make formal determinations of work capacity, only to inform clinical decision making.

The research received no funding, and the authors declared no potential conflicts of interest with respect to the research, authorship, or publication of the article.

Do not read the high levels of agreement as evidence that these tools work. Eleven experienced therapists rated them as useful in a single consensus meeting, and the paper itself says the program's effect on therapists' knowledge and skills, and on their practice, has not yet been evaluated.