Août 2020

The ReWork-Stroke rehabilitation programme described by use of the TIDieR checklist

Purpose About half of those that have had stroke in working age return to work (RTW). Few rehabilitation programmes exist focussing RTW after stroke. Aim To produce a clear replicable description of the ReWork-Stroke rehabilitation programme targeting RTW for people of working age who have had stroke. Methods The Template for Intervention Description and Replication 12 item checklist was used to describe the ReWork-Stroke programme developed 2013-2014. This paper presents the development, rationale and processes in the programme to enable replication and provide evidence for implementation. Results Occupational therapists (OTs) skilled in stroke rehabilitation contribute knowledge about consequences of stroke and coordinate stakeholders involved. The ReWork-Stroke is person-centred, includes individual plans and generic components, consists of a preparation and a work trial phase. During the preparation phase, resources and hindrances for RTW are mapped and a plan for work trial is elaborated. During the work trial phase, the intervention is located at the workplace. The OT conducts recurrent follow-ups and collaborates with employers/co-workers. Conclusions A person-centred programme has advantages in its flexibility to meet different needs between people and by this thorough description of ReWork-Stroke, others can replicate the programme and its fidelity and evidence can be strengthened.

Source: Johansson U, Hellman T, Öst Nilsson A, Eriksson G, Scandinavian journal of occupational therapy, p.1-9, 2020 Jul.

Juin 2020

Exploring post acute rehabilitation service use and outcomes for working age stroke survivors (≤65 years) in Australia, UK and South East Asia: data from the international AVERT trial

Purpose Information about younger people of working age (≤65 years), their post stroke outcomes and rehabilitation pathways can highlight areas for further research and service change. This paper describes: (1) baseline demographics; (2) post acute rehabilitation pathways; and (3) 12-month outcomes; disability, mobility, depression, quality of life, informal care and return to work of working age people across three geographic regions (Australasia (AUS), South East (SE) Asia and UK). Design This post hoc descriptive exploration of data from the large international very early rehabilitation trial (A Very Early Rehabilitation Trial (AVERT)) examined the four common post acute rehabilitation pathways (inpatient rehabilitation, home with community rehabilitation, inpatient rehabilitation then community rehabilitation and home with no rehabilitation) experienced by participants in the 3 months post stroke and describes their 12-month outcomes. Setting Hospital stroke units in AUS, UK and SE Asia. Participants Patients who had an acute stroke recruited within 24 hours who were ≤65 years. Results 668 participants were ≤65 years; 99% lived independently, and 88% no disability (modified Rankin Score (mRS)=0) prior to stroke. We had complete data for 12-month outcomes for n=631 (94%). The proportion receiving inpatient rehabilitation was higher in AUS than other regions (AUS 52%; UK 25%; SE Asia 23%), whereas the UK had higher community rehabilitation (UK 65%; AUS 61%; SE Asia 39%). At 12 months, 70% had no or little disability (mRS 0-2), 44% were depressed, 28% rated quality of life as poor or worse than death. For those working prior to stroke (n=228), only 57% had returned to work. A noteworthy number of working age survivors received no rehabilitation services within 3 months post stroke. Conclusions There was considerable variation in rehabilitation pathways and post acute service use across the three regions. At 12 months, there were high rates of depression, poor quality of life and low rates of return to work.

Source: Walters R, Collier JM, Braighi Carvalho L, Langhorne P, Katijjahbe MA, Tan D, Moodie M, Bernhardt J, BMJ open, Vol. 10 (6), pp. e035850, 2020 Jun.

Intention to Return to Work after Stroke Following Rehabilitation in Ontario

Purpose Returning to work is important for many people following stroke. An estimate of the prevalence of people intending to return to work post-stroke would be helpful in planning services supporting work reintegration. This study examined the prevalence of intention to return to work after discharge among stroke rehabilitation inpatients. Methods We performed secondary analysis of National Rehabilitation Reporting System data for all stroke rehabilitation inpatients across Ontario (2012–2017). Intention to return to work was examined by gender, age, and level of disability. Results Among 25,691 stroke rehabilitation inpatients, 4,668 (18.2%) were employed pre-stroke and 2,039 (43.7%) of them intended to return to work. Intention to return to work was somewhat higher among younger and middle-aged stroke survivors and those with mild disability. Conclusions Providers and planners should be aware that almost half of previously employed stroke-rehabilitation inpatients may be seeking services to assist with return to work.

Source: Duong PK, Egan MY, Meyer MJ, Morrison TL, Canadian Journal of Occupational Therapy, Vol. 87(3), p.221-226, 2020 Jun.

Avril 2020

Being a co-worker or a manager of a colleague returning to work after stroke: A challenge facilitated by cooperation and flexibility

Purpose The process of return to work is complex. Knowledge is scarce regarding the experiences from co-workers and employers about this process. Aim: To explore and describe how co-workers and managers experience the return to work process involving a colleague with stroke who is participating in a person-centred rehabilitation programme focusing on return to work including a work trial. Methods Seven co-workers and four managers were interviewed during the work trial of a colleague with stroke. Results Being a co-worker or manager was related to various challenging experiences; the emotional challenge of being a supportive co-worker or manager, the challenging experience of having too much responsibility, and the challenge of being supportive despite a lack of knowledge. Conclusions The participants placed value on having support from the coordinator for handling different challenges, but despite this they experienced difficulties in being a valuable support. The limited time of work trial and occasional lack of support from the employer were aggravating aspects. Significance: This study highlights the importance of establishing a commitment between the employer and all involved actors in the initial phase in order to create the best possibilities for a fruitful return to work process, including work trial.

Source: Öst N, Eriksson A, Asaba G, Johansson E, Hellman U, Scandinavian Journal of Occupational Therapy, Vol. 27 (3), p. 213-222, 2020 Apr.

How primary care can help survivors of transient ischaemic attack and stroke return to work: focus groups with stakeholders from a UK community

Purpose Evidence about how primary care can best enable survivors of transient ischaemic attack (TIA)/stroke return to work is limited. This study explored the role of primary care in supporting survivors of transient ischaemic attack (TIA)/stroke return to work with stakeholders from a local UK community. Design A qualitative study using framework analysis. Methods Four focus groups were carried out in Cambridgeshire, UK, between September and November 2015. The 18 participants included survivors of TIA/stroke, carers, an employer representative, GPs, occupational therapists (OTs), and clinical commissioners. Results There was a mismatch between patient and carer needs and what is provided by primary care. This included: lack of GP awareness of invisible impairments; uncertainty how primary care could help in time-limited consultations; and complexity of return-to-work issues. Primary care physicians were not aware of relevant services they could refer patients to, such as OT support. In addition, there was an overall lack of coordination between different stakeholders in the return-to-work process. Linking with other services was considered important but challenging because of ongoing changes in service structure and the commissioning model. Suggestions for improvement include: a central contact in primary care for signposting to available services; a rehabilitation assessment integrated with the electronic record; and a patient-held shared-care plan at discharge from stroke wards. Conclusions Improving the role for primary care in helping survivors of TIA/stroke return to work is challenging. However, primary care could play a central role in initiating/coordinating vocational rehabilitation. Through focus group discussions with stakeholders from a local community, patients, carers, and clinical commissioners were able to put forward concrete proposals to address the barriers identified.

Source: Balasooriya-Smeekens C, Bateman A, Mant J, De Simoni A, British Journal of General Practice, Vol. 70(693), e294-e302, 2020 Apr.

Février 2020

Intention to Return to Work after Stroke Following Rehabilitation in Ontario

Purpose Returning to work is important for many people following stroke. An estimate of the prevalence of people intending to return to work post-stroke would be helpful in planning services supporting work reintegration. This study examined the prevalence of intention to return to work after discharge among stroke rehabilitation inpatients. Methods We performed secondary analysis of National Rehabilitation Reporting System data for all stroke rehabilitation inpatients across Ontario (2012-2017). Intention to return to work was examined by gender, age, and level of disability.Results Among 25,691 stroke rehabilitation inpatients, 4,668 (18.2%) were employed pre-stroke and 2,039 (43.7%) of them intended to return to work. Intention to return to work was somewhat higher among younger and middle-aged stroke survivors and those with mild disability.Conclusions Providers and planners should be aware that almost half of previously employed stroke-rehabilitation inpatients may be seeking services to assist with return to work.

Source: Duong PK, Egan MY, Meyer MJ, Morrison TL, Canadian Journal of Occupational Therapy, 2020 Feb.

Janvier 2020

Return to work after stroke: A Swedish nationwide registrybased study

Purpose A substantial proportion of individuals with stroke are of working age. After stroke, it is important to return to work (RTW), both for the individual's satisfaction with life and economically for society. The current comprehensive, long‐term study aimed at investigating in what time period the RTW continues after stroke and what factors could predict RTW. Methods All individuals registered in the registry Riksstroke with stroke in Sweden at ages 18‐58 years during 2011 were eligible for participation. RTW was based on sickness absence data from the Social Insurance Agency covering 1 year prestroke to 5 years post‐stroke. Time to RTW was analyzed with Kaplan‐Meier curves. Potential predictors of RTW were analyzed with Cox regression and logistic regression. Results For RTW analyses, 1695 participants were included. Almost 50% RTW within 3 months, 70% within 1 year, and 80% within 2 years post‐stroke. However, the RTW continued for several years, with a total of 85% RTW. Predictors of favorable time to RTW were male sex, ischemic stroke, and long university education compared with primary school education. Predictors of unfavorable times to RTW were higher stroke severity, defined by the level of consciousness, and older ages. Participants with self‐expectations of RTW 1 year post‐stroke had higher odds of RTW within 5 years. Conclusions: The RTW continues for a longer time after stroke than previously known. Both self‐expectations and demographical, socioeconomic, stroke‐related factors were important predictors of RTW. This knowledge could assist healthcare professionals to individualize the rehabilitation post‐stroke.

Source: Westerlind E, Persson HC, Eriksson M, Norrving B, Sunnerhagen KS, Acta Neurologica Scandinavica, Vol. 141 (1), p.56-64, 2020 Jan.