Purpose Little is currently known about how early intervention vocational rehabilitation (EIVR) works for people with newly acquired neurological conditions such as traumatic brain injury, acquired brain injury and spinal cord injury. This study aims, from a realist framework, to identify relevant literature and develop an initial programme theory to understand how EIVR might work for people experiencing acquired neurological disability. Realist reviews are ideally placed to address the identified knowledge gap as they assist in gaining a deeper understanding of how the intervention works, for whom it works best, and the contexts that promote the activation of desired outcomes. Methods We used a seven-step iterative process to synthesise literature using a realist approach. The steps included: development of initial programme theory, literature search, article selection, extracting and data organising, synthesis of evidence and programme theory refinement. We performed a literature search using the following databases: Cinahl, Embase, EMcare, Medline, PsychInfo and Scopus. Articles were selected if they contributed to the knowledge describing what is EIVR and how it works in newly acquired neurological conditions. Data were extracted and synthesised to develop a programme theory for EIVR. Results Following screening of 448 references, 37 documents were eligible for data extraction. We developed a refined programme theory of EIVR consisting of three contexts (prioritisation of exploring work options, return to work discussed as an option, and workplace support), nine mechanisms (ensuring rehabilitation teams’ culture, fostering hope, exploring options, optimising self-efficacy, maintaining worker identity, staying connected, setting goals, engaging employer, and flexing roles) and three outcomes (confidence in ability to work, psychological adjustment, and engagement in solution focussed options). Conclusions This appears to be the first paper to explore how EIVR works, for whom and in what situations. We have produced a programme theory that may provide an initial understanding of EIVR following acquired neurological conditions.

目的目前对于早期干预职业康复 (EIVR) 如何对患有新获得性神经系统疾病（如创伤性脑损伤、获得性脑损伤和脊髓损伤）的人的作用知之甚少。本研究旨在从现实主义框架中识别相关文献并开发初始程序理论，以了解 EIVR 如何对患有获得性神经功能障碍的人起作用。现实主义评论非常适合解决已确定的知识差距，因为它们有助于更深入地了解干预措施的工作原理、对谁最有效，以及促进激活预期结果的背景。方法我们使用了一个七步迭代过程来使用现实主义方法综合文献。这些步骤包括：开发初始程序理论、文献检索、文章选择、提取和数据组织、证据综合和程序理论改进。我们使用以下数据库进行了文献检索：Cinahl、Embase、EMcare、Medline、PsychInfo 和 Scopus。如果文章有助于描述什么是 EIVR 以及它如何在新获得的神经系统疾病中发挥作用的知识，则被选中。数据被提取和综合以开发EIVR的程序理论。结果在筛选了 448 份参考文献后，有 37 份文件符合数据提取条件。我们开发了一套完善的 EIVR 计划理论，包括三个背景（探索工作选项的优先级、作为选项讨论的重返工作岗位和工作场所支持）、九个机制（确保康复团队的文化、培养希望、探索选项、优化自我效率、保持员工身份、保持联系、设定目标、吸引雇主和灵活角色）和三个结果（对工作能力的信心、心理调整和参与以解决方案为重点的选项）。结论这似乎是第一篇探讨 EIVR 如何工作、为谁以及在什么情况下工作的论文。我们已经提出了一个程序理论，可以提供对获得性神经系统疾病后 EIVR 的初步理解。