Octobre 2019

Need for Structured Healthcare Organization and Support for Return to Work after Stroke in Sweden: Experiences of Stroke Survivors

Purpose To explore stroke survivors' experiences of healthcare-related facilitators and barriers concerning return to work after stroke. Design: A qualitative study. Setting: Outpatient stroke rehabilitation unit at a University Hospital in southern Sweden. Participants A convenience sample of 20 persons admitted to Skåne University Hospital for acute stroke care (median age 52 years), in employment of at least 10 h per week at stroke onset and been referred to stroke rehabilitation within 180 days. Methods The interviews were performed by focus groups, and the data were analysed by content analysis. Results Facilitating factors were a tailored rehabilitation content with relevant treatments, adequate timing and a structured stepwise return-to-work process. A lack of sufficient early healthcare information, rehabilitation planning and coordination were perceived as barriers. An early rehabilitation plan, a contact person, and improved communication between rehabilitation actors were requested, as well as help with work transport, home care, children and psychosocial support for families. Conclusions Tailored rehabilitation content and a structured stepwise return-to-work process facilitated return to work. Insufficient structure within the healthcare system and lack of support in daily life were perceived barriers to return to work, and need to be improved. These aspects should be considered in the return-to-work process after stroke.

Source: Gard G, Rasmussne H, Brogårdh C, Åsalindgren I, Journal of Rehabilitation Medicine, Vol. 51(10), p.741-748, 2019.

Septembre 2019

Interventions to promote work participation after ischaemic stroke: A systematic review

Purpose Only a disappointingly low proportion of patients successfully engage in professional activities after ischaemic stroke. This systematic review maps all contemporary evidence regarding interventions aiming to promote return-to-work in survivors of ischaemic stroke. Methods We performed a search according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and searched five reference databases. Prospective trial registers and grey literature were also assessed, and we executed backwards and forward reference searching. The study protocol was registered in PROSPERO (CRD42017077796). The search yielded 444 records of which 174 were duplicates. Backward and forward reference searching resulted in 808 unique records. Results Eleven articles were retained for full-text analysis and two met the selection criteria. A controlled before-after study showed beneficial effects of intravenous thrombolytic treatment in patients with moderate to severe acute ischaemic stroke. A retrospective study with low methodological quality reported improved vocational outcome of an outpatient rehabilitation program in patients with mild to moderate ischaemic stroke. Conclusions We conclude that there currently is insufficient evidence regarding the effectiveness of interventions to promote return-to-work in patients with ischaemic stroke, though intravenous thrombolytic therapy has shown beneficial effects and there are indications that rehabilitation programs may also be advantageous.

Source: Brouns R, Valenzuela Espinoza A, Goudman L, Moens M; Verlooy J, Clinical Neurology and Neurosurgery, Vol. 185, p. 105458, 2019 Aug.

Need for structured healthcare organization and support for return to work after stroke in Sweden: Experiences of stroke survivors

Purpose To explore stroke survivors' experiences of healthcare-related facilitators and barriers concerning return to work after stroke. Design A qualitative study. Setting Outpatient stroke rehabilitation unit at a University Hospital in southern Sweden. Participants A convenient sample of 20 persons admitted to Skåne University Hospital for acute stroke care (median age 52 years), in employment of at least 10 h per week at stroke onset and having been referred to stroke rehabilitation within 180 days. Methods The interviews were performed by focus groups, and the data were analysed by content analysis. Results Facilitating factors were a tailored rehabilitation content with relevant treatments, adequate timing and a structured stepwise return-to-work process. A lack of sufficient early healthcare information, rehabilitation planning and coordination were perceived as barriers. An early rehabilitation plan, a contact person, and improved communication between rehabilitation actors were requested, as well as help with work transport, home care, children and psychosocial support for families. Conclusion Tailored rehabilitation content and a structured stepwise return-to-work process facilitated return to work. Insufficient structure within the healthcare system and lack of support in daily life were perceived barriers to return to work, and need to be improved. These aspects should be considered in the return-to-work process after stroke.

Source: Gard G, Pessah-Rasmussen H, Brogårdh C, Nilsson Å, Lindgren I, Journal of Rehabilitation Medicine, 2019 Aug. 

Return to Employment After Stroke in Young Adults: How Important Is the Speed and Energy Cost of Walking?

Purpose A quarter of individuals who experience a stroke are under the age of 65 years (defined as young adults), and up to 44% will be unable to return to work poststroke, predominantly because of walking difficulties. No research study has comprehensively analyzed walking performance in young adult's poststroke. The primary aim of this study is to investigate how a stroke in young adults affects walking performance (eg, walking speed and metabolic cost) compared with healthy age-matched controls. The secondary aim is to determine the predictive ability of walking performance parameters for return to employment poststroke. Methods Forty-six individuals (18-40 years: n=6, 41-54 years: n=21, 55-65 years: n=19) who have had a stroke and 15 healthy age-matched able-bodied controls were recruited from 6 hospital sites in Wales, United Kingdom. Type, location, cause of stroke, and demographic factors (eg, employment status) were recorded. Temporal and spatial walking parameters were measured using 3-dimensional gait analysis. Metabolic energy expenditure and metabolic cost of walking were captured during 3 minutes of walking at self-selected speed from measurements of oxygen consumption. Results Stroke participants walked slower (P<0.004) and less efficiently (P<0.002) than the controls. Only 23% of stroke participants returned to employment poststroke. Walking speed was the strongest predictor (sensitivity, 0.90; specificity, 0.82) for return to work (P=0.004) with a threshold of 0.93 m/s identified: individuals able to walk faster than 0.93 m/s were significantly more likely to return to work poststroke than those who walked slower than this threshold. Conclusions This study is the first to capture walking performance parameters of young adults who have had a stroke and identifies slower and less efficient walking. Walking speed emerged as the strongest predictor for return to employment. It is recommended that walking speed be used as a simple but sensitive clinical indicator of functional performance to guide rehabilitation and inform readiness for return to work poststroke.

Source: Jarvis HL, Brown SJ, Price M, Butterworth C, Groenevelt R, Jackson K, Walker L, Rees N, Clayton A, Reeves ND, Stroke, 2019 Sep.

Juillet et Août 2019

Predictors of return to work after stroke: a prospective, observational cohort study with 6 months follow-up

Purpose To determine, in Brazil, the proportion of individuals who return to a paid work after stroke, and the factors which predict this. Methods A prospective observational cohort study was carried out for six months. Participants were recruited early after stroke from four public hospitals. The outcome of interest was return to work, and the following predictors were investigated: age, sex, education, marital status, contribution to household income, type of work, independence, and depression. Logistic regression was used to identify multivariate predictors of return to work. Results Of the 117 included participants, 52 (44%) had returned to work by 6 months. Contribution to household income (OR 2.4; 95% CI 1.0 to 5.9), being a white-collar worker (OR 4.0; 95% CI 1.8 to 8.6) and being independent in daily activities at 3 months (OR 10.6; 95% CI 2.9 to 38.3), in combination, positively predicted return to work. Conclusions Less than 50% of stroke survivors returned to work six months after stroke. Among predictors, only the level of dependence in daily activities is a modifiable factor. Interventions aimed at reducing disability after stroke might increase rates of return to work. Implications for rehabilitation In Brazil, less than 50% of stroke survivors returned to work six months after stroke. Clinicians may collect information regarding household income, type of work and dependence in daily activities to estimate chances of returning to work, in developing countries. Being independent at 3 months was the strongest predictor of return to work; therefore, interventions aimed at reducing disability after stroke may increase rates of return to work.

Source: Nascimento LR, Scianni AA, Ada L, Fantauzzi MO, Hirochi TL, Teixeira-Salmela LF, Disability and Rehabilitation, p.1-5, 2019 Jul.

Impact of Upper Limb Function and Employment Status on Return to Work of Blue-Collar Workers after Stroke

Purpose Return to work (RTW) after stroke is the ultimate goal of the working population to achieve economic independence and well-being. Previous studies have reported lower RTW rates of blue-collar workers versus white-collar workers. Thus, investigating predictive factors for RTW of blue-collar workers is meaningful to improve RTW after stroke. Here, we investigate the physical, cognitive, and social factors associated with the RTW of blue-collar workers after stroke. Methods Poststroke rehabilitation data for 71 patients aged 15-64 years who had been active blue-collar workers at stroke onset were analyzed from a single-center observational cohort database. Baseline characteristics, social background factors, and quantitative assessments of the upper limb, lower limb, and cognitive functions at discharge were analyzed to identify any association with RTW. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value of continuous valuables with significant associations. Results Functional upper limb represented by an increasing Simple Test for Evaluating hand Function (STEF) score was independently associated with RTW of blue-collar workers by multivariable logistic regression analysis (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01-1.14; p = .017). Correlation with self-employment status was also significant compared to that with employee status (OR, 185; 95% CI, 1.05-32400; p = .048). The cutoff value of the 100-point scale STEF to discriminate between RTW and non-RTW was 82. Conclusions Functional upper limb and self-employment status were independent predictors for the RTW of blue-collar workers after stroke.

Source: Fukuda S, Ueba Y, Fukuda H, Kangawa T, Nakashima Y, Hashimoto Y, Ueba T, Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association, Vol. 28 (8), p. 2187-2192, 2019 Aug.

Very early cognitive screening and return to work after stroke

Purpose Stroke is a common cause of long-term disability worldwide, and an increasing number of persons affected by stroke are of working age. In addition to physical impairments, a majority of patients reportedly suffer cognitive impairments after stroke. Reduced cognitive function may hinder poststroke return to work (RTW); however, most studies of this relationship have assessed cognitive function months after the stroke. Objectives The current study aims to investigate the degree of post-stroke RTW, and whether very early cognitive function screening can predict RTW after a stroke. Methods This study included 145 persons treated for stroke at 18-63 years of age at a large university hospital in Sweden between 2011 and 2016. Data were retrieved from the GOTVED database. Within 36-48 h after hospital admission, cognitive function was screened using the Montreal Cognitive Assessment (MoCA). Full and partial RTW were assessed based on the Swedish Social Insurance Agency's register. Logistic regression was performed to analyze the potential predictors of RTW at 6 months and 18 months. Results Neither global cognitive function nor executive function at 36-48 h after stroke predicted any degree of RTW at 6 or 18 months. Male sex, lower stroke severity, and not being on sick leave prior to stroke were significant predictors of RTW. Conclusions Screening for cognitive impairments at 36-48-h post stroke is apparently too early for predicting RTW, and thus cannot be the sole basis for discharge planning after stroke. Additional research is needed to further analyze cognitive function early after stroke and RTW.

Source: Westerlind E, Abzhandadze T, Rafsten L, Persson HC, Sunnerhagen KS, Topics In Stroke Rehabilitation, p. 1-6, 2019 Aug.

Mai 2019

Operational Definitions and Estimates of Return to Work Poststroke: A Systematic Review and Meta-Analysis

Purpose and methods To examine operational definitions of return to work (RTW) poststroke and provide more precise estimates of RTW through meta-analysis. A systematic search was conducted using MEDLINE, CINAHL, PsycINFO, and SCOPUS (2005 to March 26, 2018). The search strategy involved expansion of medical subjective headings using terms related to stroke and work. The reference lists of review articles and included studies were checked for additional relevant studies. Studies were included if they (1) quantitatively analyzed RTW outcomes or factors associated with RTW; (2) reported RTW outcomes for participants employed prior to stroke; and (3) were written in English or French. Results Two reviewers independently screened titles and abstracts. Of 7265 articles initially identified, 55 studies were included. Data were extracted and study quality was assessed by 1 reviewer and verified by a second reviewer. Explicit and implicit operational definitions of RTW were determined and categorized. Ranges of RTW estimates were presented for study and participant characteristics. Pooled summary estimates were calculated for comparable studies by follow-up time poststroke: 55.7% at 1 year (95% confidence interval [95% CI], 51.3%-60.0%) and 67.4% at 2 years (95% CI, 60.4%-74.4%). Similar summary estimates were noted when only population-based studies were considered: 56.7% at 1 year (95% CI, 48.3%-65.1%) and 66.7% at 2 years (95% CI, 60.2%-73.2%). Conclusions Operational definitions varied across studies and were often not explicitly reported. To promote comparability of RTW outcomes in future studies, we recommend working toward a universal operational definition and consistent follow-up times. The more precise estimates calculated in this review could be used as benchmarks for health care and social service providers.

Source: Duong P, Sauvé-Schenk K, Egan MY, Meyer MJ, Morrison T, Archives of Physical Medicine & Rehabilitation, Vol.100 (6), p.1140-1152, 2019 Jun.

Avril 2019

Return to work after mild-to-moderate stroke: Work satisfaction and predictive factors

PurposeA large proportion of stroke patients are unable to return to work (RTW), although figures vary greatly. MethodsA total of 121 mild-to-moderate stroke patients, who had a paid job at the time of their stroke were included (a) to quantify RTW and work satisfaction one-year post-stroke (using the Utrecht Scale for Evaluation of Rehabilitation-Participation) and (b) to determine factors predicting RTW post-stroke, based on stroke-related, personal and neuropsychological variables. ResultsHalf of the patients were not in work (28%) or were working less (22%) than pre-stroke. Ninety percent of those in fulltime employment post-stroke were satisfied with their occupational situation, against 36% of the unemployed participants. In regards to factors predicting RTW, global cognitive functioning (r=.19, Montreal Cognitive Assessment) and depressive symptoms (r=−0.16, Hospital Anxiety and Depression Scale) at two months post-stroke onset were associated with return to work within one year. Only global cognitive functioning was an independent predictor of RTW (11.3% variance, p=.013). ConclusionsAlthough the explained variance was not that high, neuropsychological factors probably play a pivotal role in returning to work and should be taken into account during rehabilitation after mild and moderate stroke.

Source: van der Kemp J, Kruithof WJ, Nijboer TCW, van Bennekom CAM, van Heugten C, Visser-Meily JMA, Neuropsychological Rehabilitation, Vol 29 (4), p. 638-653, 2019 May.

Factors, trends, and long-term outcomes for stroke patients returning to work: The South London Stroke Register

PurposeThere is limited information on factors, trends, and outcomes in return to work at different time-points post-stroke; this study aims to identify these in a multi-ethnic urban population. MethodsPatterns of return to work were identified in individuals in paid work prior to first-ever stroke in the population-based South London Stroke Register (SLSR) between 1995 and 2014. Multivariable logistic regression examined associations between patient characteristics and return to work at 1 year (1 y), 5 years (5 y) and 10 years (10 y) post-stroke. ResultsAmong 5609 patients, 940 (17%) were working prior to their stroke, of whom 177 (19%) were working 3 months post-stroke, declining to 172 (18%) at 1 y, 113 (12%) at 5 y, and 27 (3%) at 10 y. Factors associated with return to work within 1 y, after logistic regression, included functional independence (BI ≥ 19; p < 0.01) and shorter length of stay (p < 0.05). Younger age (p < 0.01) was associated with return to work at 5 y and 10 y post-stroke. Non-manual occupation (p < 0.05) was associated with return to work at 10 y post-stroke. Return to work within 1 y increased the likelihood of working at 5 y (OR: 13.68; 95% CI 5.03-37.24) and 10 y (9.07; 2.07-39.8). Of those who were independent at follow-up (BI ≥ 19), 48% were working at 1 y, 42% at 5 y, and 28% at 10 y. Lower rates of anxiety and depression and higher self-rated health were associated with return to work at 1 y (p < 0.01). ConclusionsAlthough functionally independent stroke survivors are more likely to return to work long-term, a large proportion do not return to work despite functional independence. Return to work post-stroke is associated with improved long-term psychological outcomes and quality of life.

Source: Sen A, Bisquera A, Wang Y, McKevitt CJ, Rudd AG, Wolfe CD, Bhalla A, International Journal of Stroke: Official Journal of The International Stroke Society, 2019 Mar.

Mars 2019

Workrelated predictors for return to work after stroke

Purpose Disability due to stroke imposes a large burden on individuals, and on society, in terms of impaired work ability and sick leave. The reported return to work (RTW) rate after stroke varies globally and is influenced by a range of different aspects. The aim of this study was to investigate the influence of work‐related factors on time to RTW after stroke, and possible differences between the sexes. Methods Data from 204 persons with first‐time stroke in the years 2009‐2010 in Gothenburg, Sweden, who were of working age and had worked prior to their stroke, were analysed. Disease‐related characteristics were retrieved from medical records, and work‐related‐ and socio‐economic data were collected up to 6 years post‐stroke from Statistics Sweden and the Swedish Social Insurance Agency. Cox regression was used to analyse predictors for time to RTW. Results We identified qualified occupation and large organizational size as work‐related predictors for shorter time to RTW after stroke. Being male predicted a faster and higher frequency of RTW. Qualified occupation predicted shorter time to RTW in men but not in women. For women, the only predictor for RTW was physical dependency at discharge. Conclusions Type of work and organizational size are work‐related factors of importance for RTW after stroke. Work‐related factors were important for RTW in men, but not in women. Reasons for differences between men and women in work‐related factors that influence RTW need to be further investigated to better understand how to support women in the RTW process.

Source: Palstam A, Westerlind E, Persson HC, Sunnerhagen KS, Acta Neurologica Scandinavica, Vol. 139 (4), p.382-388, 2019 Apr.

Février 2019

Return to Work Among Stroke Survivors

Purpose Despite improvements in the treatment of stroke, many individuals still face cognitive, emotional, and physical impairments. Stroke is a leading cause of serious long-term disability and subsequent failure to return to work (RTW). The purpose of this literature review was to synthesize and discuss the literature relevant to factors affecting RTW for stroke survivors, summarize the identified gaps, and discuss steps occupational health nurses can take to facilitate RTW among stroke survivors. Methods A literature search was conducted using the keywords: "stroke," "cerebrovascular disease," "return to work," and "employment". Results After excluding articles based on inclusion/exclusion criteria, 19 quantitative research articles were reviewed. Consistent themes found in the literature affecting RTW following stroke included physical, social, and cognitive factors. One of the most consistent predictors of RTW found was stroke severity. Individuals who experienced a mild to moderate stroke, those of Caucasian ethnicity, and higher socioeconomic levels were more likely to RTW. Conclusions Findings suggest the importance of future studies to examine factors among African American stroke survivors that predict RTW and the role of occupational health nurses.

Source: Ashley KD, Lee LT, Heaton K, Workplace Health & Safety, Vol.  67 (2), p.87-94, 2019 Feb.

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.

Source: Öst NA, Eriksson G, Asaba E, Johansson U, Hellman T, Scandinavian Journal of Occupational Therapy, p. 1-10, 2019 Jan.

Return to work after mild-to-moderate stroke: work satisfaction and predictive factors

Purpose A large proportion of stroke patients are unable to return to work (RTW), although figures vary greatly. Methods A total of 121 mild-to-moderate stroke patients, who had a paid job at the time of their stroke were included (a) to quantify RTW and work satisfaction one-year post-stroke (using the Utrecht Scale for Evaluation of Rehabilitation-Participation) and (b) to determine factors predicting RTW post-stroke, based on stroke-related, personal and neuropsychological variables. Results Half of the patients were not in work (28%) or were working less (22%) than pre-stroke. Ninety percent of those in fulltime employment post-stroke were satisfied with their occupational situation, against 36% of the unemployed participants. In regards to factors predicting RTW, global cognitive functioning (r = .19, Montreal Cognitive Assessment) and depressive symptoms (r = −.16, Hospital Anxiety and Depression Scale) at two months post-stroke onset were associated with return to work within one year. Only global cognitive functioning was an independent predictor of RTW (11.3% variance, p = .013). Conclusions Although the explained variance was not that high, neuropsychological factors probably play a pivotal role in returning to work and should be taken into account during rehabilitation after mild and moderate stroke.

Source: van der Kemp J, Kruithof WJ, Nijboer TCW, van Bennekom CAM, van Heugten C, Visser-Meily JMA, Neuropsychological Rehabilitation, Vol. 29 (4), p.638-653, 2019 May.

Janvier 2019

Return to work after stroke – Feasibility of 6-year follow-up

Purpose Little is known about long-term work sustainability of stroke survivors. A feasibility trial of early stroke specialist vocational rehabilitation had 32/46 (69.5%) participants available for follow-up at 12 months post stroke. Of these, 19/32 (59.4%) were in work. This study aims to determine the feasibility of longer-term follow-up and explore work status 6 years post stroke. Methods Forty-eight participants fitting criteria for the feasibility trial were sent postal questionnaires measuring employment, income, mood, functional ability and quality of life, and were invited for interview to explore working 6 years after stroke. Ethical approval was obtained. Results Of the 48 participants, five (10.4%) had died; 19/43 (44.2%) responded. Fourteen were men; mean age 62 (24–78) years. Fourteen (74%) reported working (paid work n = 10, voluntary work n = 3, full-time education n = 1). Five had retired. Most (11/13) remained with preinjury employers. Half (8/15, 53%) reported decreased income since stroke. Compared to one year, median functional ability was marginally higher (extended activities of daily living 63 (IQR 8, range 32–66) to 60 (IQR 9, range 17–66)), but health-related quality of life was lower (EuroQuol Visual Analogue Scale mean 77.4 [SD 11] to 70.7 [SD14]). Six interviewees felt returning to work was the correct decision but struggled with invisible impairments. Conclusions This study suggests that long-term follow-up is feasible and that those who made a good recovery were more likely to respond. Work remains important to stroke survivors 6 years post stroke.

Source: Phillips J, Gaffney K, Phillips M, Radford K, British Journal of Occupational Therapy, Vol. 82(1), p. 27-37, 2019 Jan.

Return to Work Among Stroke Survivors

Purpose Despite improvements in the treatment of stroke, many individuals still face cognitive, emotional, and physical impairments. Stroke is a leading cause of serious long-term disability and subsequent failure to return to work (RTW). The purpose of this literature review was to synthesize and discuss the literature relevant to factors affecting RTW for stroke survivors, summarize the identified gaps, and discuss steps occupational health nurses can take to facilitate RTW among stroke survivors. Methods A literature search was conducted using the keywords: "stroke," "cerebrovascular disease," "return to work," and "employment." After excluding articles based on inclusion/exclusion criteria, 19 quantitative research articles were reviewed. Results Consistent themes found in the literature affecting RTW following stroke included physical, social, and cognitive factors. One of the most consistent predictors of RTW found was stroke severity. Individuals who experienced a mild to moderate stroke, those of Caucasian ethnicity, and higher socioeconomic levels were more likely to RTW. Conclusions Findings suggest the importance of future studies to examine factors among African American stroke survivors that predict RTW and the role of occupational health nurses.

Source: Ashley KD, Lee LT, Heaton K, Workplace Health & Safety, 2019 Jan.

Work-related predictors for return to work after stroke

Purpose Disability due to stroke imposes a large burden on individuals, and on society, in terms of impaired work ability and sick leave. The reported return to work (RTW) rate after stroke varies globally and is influenced by a range of different aspects. The aim of this study was to investigate the influence of work-related factors on time to RTW after stroke, and possible differences between the sexes. Methods Data from 204 persons with first-time stroke in the years 2009-2010 in Gothenburg, Sweden, who were of working age and had worked prior to their stroke, were analysed. Disease related characteristics were retrieved from medical records, work-related- and socioeconomic data were collected up to 6 years post stroke from Statistics Sweden and the Swedish Social Insurance Agency. Cox regression was used to analyse predictors for time to RTW. Results We identified qualified occupation and large organizational size as work-related predictors for shorter time to RTW after stroke. Being male predicted a faster and higher frequency of RTW. Qualified occupation predicted shorter time to RTW in men but not in women. For women, the only predictor for RTW was physical dependency at discharge. Conclusions Type of work and organizational size are work-related factors of importance for RTW after stroke. Work-related factors were important for RTW in men, but not in women. Reasons for differences between men and women in work-related factors that influence RTW need to be further investigated to better understand how to support women in the RTW process.

Source: Palstam A, Westerlind E, Persson HC, Sunnerhagen KS, Acta Neurologica Scandinavica, 2019 Jan.