Barriers and facilitators associated with return to work after stroke: a qualitative meta-synthesis

Purpose To enhance the employment outcomes of individuals who experience a stroke, it is essential to understand the factors that determine successful return to work. The aim of this systematic review was to examine barriers to and facilitators of return to work after stroke from the perspective of people with stroke through the process of a qualitative meta-synthesis. Methods A systematic literature search was conducted. Studies that employed qualitative methods to explore the experiences of individuals with stroke around return to work after stroke were included. The methodological quality of the studies was assessed by two independent reviewers. Overarching themes, concepts and interpretations were extracted from each individual study, compared and meta-synthesized. Results Fifteen studies were included and the overall methodological quality of the studies was good. Four broad themes emerged as factors associated with return to work after stroke. These included (i) the nature of the effects of stroke, (ii) the preparatory environment, (iii) personal coping strategies and internal challenges and (iv) the meaning of work. Conclusions Return to work after stroke is a complex process which can be facilitated or impeded by organizational, social or personal factors, as well as accessibility to appropriate services. Implications for Rehabilitation Following a period of dedicated inpatient rehabilitation, there is a need to integrate community-support services to optimize return to work among stroke survivors. A dedicated community stroke support liaison officer may help to facilitate the transition between the hospital and the community and workplace environment. Education provided by healthcare professionals is necessary in the community and the workplace to ensure that family, friends and employers are aware of the impairments, activity limitations and participation restrictions of the stroke survivor.

Source: Brannigan C, Galvin R, Walsh ME, Loughnane C, Morrissey EJ, Macey C, Delargy M, Horgan NF, Disability & Rehabilitation, Vol. 39 (3), 211-222, 2017 Feb.


Return to Work after a Stroke in Working Age Persons: A Six-Year Follow Up

Purpose Stroke is one of the most common and resource intensive diseases for society. Stroke in the working age population is increasing in different parts of the world. An incomplete return to work (RTW) after sick leave post stroke entails negative consequences for the affected person and an economical burden for society. The aim of this study was to explore the RTW rate and factors associated with RTW in a six-year follow up post stroke. Methods Data from 174 persons 63 years or younger, with first ever stroke in 2009–2010 in Gothenburg were analyzed. Baseline characteristics were collected through medical records and the Swedish Health Insurance Office provided information on sick leave up to 6 years post stroke. Time-to-event was presented and cox regression as well as logistic regression were used to analyze risk factors for no-RTW. Results The RTW rate was 74.7%, at the end of follow up. Participants continued to RTW until just over 3 years post stroke. Dependency at discharge (in the modified Rankin Scale) and sick leave prior to the stroke were significant risk factors for no-RTW after 1 year with odds ratio 4.595 and 3.585, respectively. The same factors were significant in time-to-event within six years post stroke with hazard ratio 2.651 and 1.929, respectively. Conclusions RTW after a stroke is incomplete, however RTW is possible over a longer period of time than previously thought. More severe disability at discharge from hospital and sick leave prior to the stroke were shown to be risk factors for no-RTW. This knowledge can contribute to more individualized vocational rehabilitation.

Source: Westerlind E, Persson HC, Sunnerhagen KS, PLoS ONE, Vol. 12 (1), 1-14, 2017 Jan.


Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme

Purpose In Sweden, less than 50% of those getting stroke in working age return to work (RTW). Effective rehabilitation programmes need to be developed and therapeutic aspects understood. Aim To explore and describe how persons with stroke experience their RTW process while participating in a person-centred rehabilitation programme focusing on RTW. Methods Seven persons with mild or moderate stroke were interviewed twice during the intervention in the vocational training phase using semi-structured interviews. Data were analysed using grounded theory. Results Having a coordinator by their side gave support and guidance during the RTW process. Knowledge of stroke, strategies and a straightforward communication created a structure for the RTW process. Expressing one's own wishes increased opportunities to influence and decide which path to follow in order to reach the goal. Conclusions Straightforward, open and recurring communication facilitated the possibility to adapt to the situation. These aspects increased insight and awareness which facilitated the RTW process.The findings indicate that a precondition for a fruitful RTW process was that suitable platforms at work were created in which the actors involved could cooperate. This knowledge might also be valuable in the RTW process for people with other diagnosis.

Source: Öst Nilsson A, Eriksson G, Johansson U, Hellman T, Scandinavian Journal of Occupational Therapy, 1-8, 2016 Nov.


Return to Work 2-5 Years After Stroke: A Cross-Sectional Study in a Hospital-Based Population

Purpose To describe factors associated with RTW in patients 2-5 years after stroke. Methods Cross sectional study, including patients 2-5 years after hospitalization for a first-ever stroke, who were <65 years and had been gainfully employed before stroke. Patients completed a set of questionnaires on working status and educational level, physical functioning (Frenchay Activities Index, FAI), mental functioning (Hospital Anxiety and Depression Scale, HADS), Coping Orientations to Problems Experienced, (COPE easy) and quality of life (Short-Form(SF)-36 and EQ(Euroqol)-5D). Caregivers completed the Caregiver Strain Index (CSI). Baseline stroke characteristics were gathered retrospectively. Baseline characteristics and current health status were compared between patients who did and did not RTW by means of logistic regression analysis with odds ratios (OR) and 95 % confidence intervals (CI), adjusted for age and gender. Results Forty-six patients were included, mean age of 47.7 years (SD 9.7), mean time since stroke of 36 months (SD 11.4); 18 (39 %) had RTW. After adjusting for age and gender a shorter length of hospitalization was associated with RTW (OR 0.87; CI 0.77-0.99). Of the current health status, a lower HADS depression score (0.76; 0.63-0.92), a less avoidant coping style (1.99; 0.80-5.00), better scores on the FAI (1.13; 1.03-1.25), the mental component summary score of the SF36 (1.07; 1.01-1.13), the EQ5D (349; 3.33-36687) and the CSI (0.68; 0.50-0.92) were associated with the chance of RTW. Conclusions A minority of working patients RTW after stroke; a shorter duration of the initial hospitalization was associated with a favorable work outcome. The significant association between work status and activities, mental aspects and quality of life underlines the need to develop effective interventions supporting RTW.

Source: Arwert HJ, Schults M, Meesters JJ, Wolterbeek R, Boiten J, Vliet Vlieland T, Journal of Occupational Rehabilitation, 2016 Jul.

Socioeconomic factors' effect on return to work after first stroke

Purpose The objective of this nationwide study was to analyze how functional status and socioeconomic status affect return to work (RTW) among younger patients with first-time stroke in a Sweden.Methods This register-based cohort study included employed patients aged 25-55 with first-time stroke between 2008 and 2011 and primary outcome was RTW within 1 year after stroke. Data regarding functional status and employment status were retrieved from the Swedish Stroke Register, Riksstroke, and socioeconomic data (income, education, and country of birth) from Statistics Sweden. Results We included 2539 patients who had answered the question on RTW, and 1880 (74.0%) had RTW within 12 months. Patients with low income (69.9% in lowest income group vs 79.9% in highest group, P<.001), patients born in countries outside the Nordic countries (Sweden 75.5%, Nordic countries 74.3%, European countries 61.7%, other countries 57.3%, P<.001), and the youngest patients (25-34, 63.1%; 35-44, 75.9%; 45-55, 74.3%; P=.008) were less likely to RTW. Pain, low mood, and answering the questionnaire with help were more common in low socioeconomic groups, and when adjusting for these variables, together with age and sex, income and country of birth were no longer independent predictors for RTW. Conclusions Patients with low socioeconomic status less often RTW 1 year after stroke.Impaired functional status after stroke is more common in patients with lower socioeconomic status and mediates socioeconomic differences in RTW. Improvement of functional status should be targeted to facilitate RTW among stroke patients with low socioeconomic status.

Source: Glader EL, Jonsson B, Norrving B, Eriksson M, Acta Neurologica Scandinavica, 2016 Jul.