Accident vasculaire cérébral (AVC)

Purpose To describe long-term effects on activity, participation, and quality of life (i) at different post-injury starting time points of attention training and (ii) of two different types of rehabilitation with attention training in patients after stroke or traumatic brain injury; and to describe their functioning level. Methods Design: 2 years after rehabilitation intervention, comparisons were made in one cohort receiving attention training subacute (< 4 months) or post-acute (4-12 months) and in one cohort with two different training methods, a process-based and an activity-based method respectively. Patients: 100 patients were recruited from our earlier RCT study. They had mild to moderate stroke or traumatic brain injury with relatively limited symptomatology, and all had moderate to severe attention impairment. Data collection: A questionnaire-based interview: EuroQol 5 dimensions, Occupational Gaps Questionnaire, Work Ability Index, self-assessed work status, self-reported employment conditions, sick leave, and experienced cognitive limitations in work performance. Results An advantage for patients receiving subacute attention training regarding daily activities, work ability and returning to work. Conclusion The results indicate that subacute rehabilitation with attention training (< 4 months) is preferable compared to post-acute intervention (4-12 months). There were only minor differences between the training methods.

© Markovic G; Bartfai A; Schult ML; Ekholm J. Journal of Rehabilitation Medicine. 56:jrm5308, 2024 Jan 12.

Purpose Depression may negatively affect stroke outcomes and the progress of recovery. However, there is a lack of updated comprehensive evidence to inform clinical practice and directions of future studies. In this review, we report the multidimensional impact of depression on stroke outcomes. Methods Data sources: PubMed, PsycINFO, EMBASE, and Global Index Medicus were searched from the date of inception. Eligibility criteria: Prospective studies which investigated the impact of depression on stroke outcomes (cognition, returning to work, quality of life, functioning, and survival) were included. Data extraction: Two authors extracted data independently and solved the difference with a third reviewer using an extraction tool developed prior. The extraction tool included sample size, measurement, duration of follow-up, stroke outcomes, statistical analysis, and predictors outcomes. Risk of bias: We used Effective Public Health Practice Project (EPHPP) to assess the quality of the included studies. Results Eighty prospective studies were included in the review. These studies investigated the impact of depression on the ability to return to work (n = 4), quality of life (n = 12), cognitive impairment (n = 5), functioning (n = 43), and mortality (n = 24) where a study may report on more than one outcome. Though there were inconsistencies, the evidence reported that depression had negative consequences on returning to work, functioning, quality of life, and mortality rate. However, the impact on cognition was not conclusive. In the meta-analysis, depression was associated with premature mortality (HR: 1.61 (95% CI; 1.33, 1.96)), and worse functioning (OR: 1.64 (95% CI; 1.36, 1.99)). Conclusion Depression affects many aspects of stroke outcomes including survival The evidence is not conclusive on cognition and there was a lack of evidence in low-income settings. The results showed the need for early diagnosis and intervention of depression after stroke.

© Shewangizaw S; Fekadu W; Gebregzihabhier Y; Mihretu A; Sackley C; Alem A. PLoS ONE [Electronic Resource]. 18(12):e0294668, 2023.

Purpose To describe which needs and difficulties are experienced by stroke patients and caregivers regarding their return to work and to synthesise the lived experiences of stroke patients and caregivers. Methods A systematic review and metasynthesis was conducted on PubMed, CINAHL, Scopus, Web of Sciences and PsycInfo, in according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research. Studies eligible for the review had to fulfil the following inclusion criteria: qualitative studies, stroke patients and their caregivers in a working age (approximately from 18 to 65 years old), discharged from the hospital. Results Thirty-eight studies involving stroke patients and caregivers were included in this review. For the stroke patients' group, three main themes were identified: (a) Towards the future; (b) Professional support in return to work; and (c) return to work and employment perspective, while for caregivers two main themes were: (a) daily life challenges and role overload; and (b) employment challenges. Conclusions Integrating public employment, social and health services, support for job placement, return to work, and social participation of stroke patients should be more supported in individual rehabilitation programs to help stroke survivors and caregivers in their return-to-work process.

© Nuccio E; Petrosino F; Simeone S; Alvaro R; Vellone E; Pucciarelli G. Disability & Rehabilitation. 1-14, 2023 Nov 28.

Purpose To facilitate return to work (RTW) in patients with stroke, a health and employment support (HES) program was started at Rosai hospitals in Japan. This study aimed to determine the rate of RTW in patients with stroke under this support program. Methods We collected demographic and clinical data of patients with stroke from the implementation reports of the HES program. The program provided coordinated dual support, such as acute medical treatments, and stroke and vocational rehabilitation on the medical side, and management and support on the workplace side. The primary endpoint was RTW. Successful and unsuccessful RTW were examined using the chi2 test. The RTW rate curves were analyzed using the Kaplan-Meier method. Results We enrolled 483 patients; 355 (73%) and 128 (27%) patients had successful and unsuccessful RTW, respectively. Stroke types, neurological findings, and activities of daily living were significant factors for RTW. The Kaplan-Meier method revealed that left hemiplegia, right hemiplegia, and neuropsychological deficits, except for combined disability (hemiplegia with neuropsychological deficits), had similar RTW curves with an RTW rate of > 70%.

© Umemura T; Hachisuka K; Saeki S; Nishizawa S; Yamamoto J. Scientific Reports. 13(1):15795, 2023 09 22.

Purpose To identify prognostic factors for return to work after stroke. Methods Data sources: PubMed, MEDLINE, Cochrane and Embase were systematically searched. Study selection: Studies had to include people of working age (<65 years old) at the time of stroke (ischemic, haemorrhagic, or subarachnoid haemorrhage). The evaluation of return to work and rate of return to work had to be mentioned. Study selection was done by 2 independent authors. In total, 1241 articles were screened, 39 met all inclusion criteria. Data extraction: Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author. Quality was assessed using the Scottish Intercollegiate Guidelines Network quality assessment tool. Results Among the 39 studies, prognostic factors for return to work were haemorrhagic stroke (odds ratio 0.53 [95% confidence interval 0.45-0.60], n=18 studies), sex (male) (1.26 [1.14-1.40], n=31), aphasia (0.37 [0.20-0.69], n=7), occupation (white collar worker) (1.84 [1.64-2.06], n=17), independence in activities of daily living (3.99 [1.73-9.23], n=7) and stroke severity (NIHSS) (1.23 [1.08-1.39], n=6). Conclusions This meta-analysis highlighted positive and negative prognostic factors associated with return to work after stroke. Two categories were distinguished: modifiable and non-modifiable prognostic factors. This study provides information to help understand the issues, set appropriate objectives and implement appropriate strategies to guide people to return to work after stroke. Randomized controlled studies are needed to better evaluate work-place intervention programs as well as the effects of intravenous thrombolysis, and cognitive and neuropsychological rehabilitation on return-to-work rates after stroke.

© Orange C; Lanhers C; Coll G; Coste N; Dutheil F; Hauret I; Pereira B; Coudeyre E. Archives of Physical Medicine & Rehabilitation.  2023 Oct 03.

Purpose Life after stroke is a comprehensive area that involves engagement in meaningful everyday activities, including work, and can be adversely affected by post-stroke fatigue. This study investigates post-stroke fatigue, its development over time, and its impact on return to work and other everyday life activities. In addition, we investigated whether post-stroke fatigue could predict functioning in everyday life activities one year after stroke. Methods This prospective registry-based study includes 2850 working age (18 - 63 years) patients registered in the Swedish Stroke Register (Riksstroke) during year 2017 and 2018. Post-stroke fatigue and everyday activities were analyzed 3- and 12-months post-stroke. Results The mean age of the included participants was 54 years and the majority, 65%, were men. Three months post-stroke, 43% self-reported fatigue, at 12-months the proportion increased to 48%. About 90% of the patients were independent in basic ADL at 3-month. Dependence in complex activities one year post-stroke was significantly associated with fatigue. Not experiencing fatigue one year after stroke could predict positive functioning in everyday activities, increasing the chance of returning to work (OR = 3.7) and pre-stroke life and everyday activities (OR = 5.7). Conclusion Post-stroke fatigue is a common persistent disability that negatively impacts complex activities; therefore, fatigue needs to be acknowledged and addressed long term after discharge.

© Vollertsen J; Bjork M; Norlin AK; Ekbladh E. Annals of Medicine. 55(2):2269961, 2023.

Purpose Return-to-work is a key rehabilitation goal for many working aged stroke survivors, promoting an overall improvement of quality of life, social integration, and emotional wellbeing. Conversely, the failure to return-to-work contributes to a loss of identity, lowered self-esteem, social isolation, poorer quality of life and health outcomes. Return-to-work programmes have largely focused on physical and vocational rehabilitation, while neglecting to include mood and fatigue management. This is despite the knowledge that stroke results in changes in physical, cognitive, and emotional functioning, which all impact one's ability to return to work. The purpose of this systematic review is to conduct a comprehensive and up-to-date search of randomised controlled trials (RCTs) of return-to-work programmes after stroke. The focus is especially on examining components of mood and fatigue if they were included, and to also report on the screening tools used to measure mood and fatigue. Method Searches were performed using 7 electronic databases for RCTs published in English from inception to 4 January 2023. A narrative synthesis of intervention design and outcomes was provided. Results The search yielded 5 RCTs that satisfied the selection criteria (n = 626). Three studies included components of mood and fatigue management in the intervention, of which 2 studies found a higher percentage of subjects in the intervention group returning to work compared to those in the control group. The remaining 2 studies which did not include components of mood and fatigue management did not find any significant differences in return-to-work rates between the intervention and control groups. Screening tools to assess mood or fatigue were included in 3 studies. Conclusion Overall, the findings demonstrated that mood and fatigue are poorly addressed in rehabilitation programmes aimed at improving return-to-work after stroke, despite being a significant predictor of return-to-work. There is limited and inconsistent use of mood and fatigue screening tools. The findings were generally able to provide guidance and recommendations in the development of a stroke rehabilitation programme for return-to-work, highlighting the need to include components addressing and measuring psychological support and fatigue management.

©  Chen NYC; Dong Y; Kua ZZJ. Frontiers in neurology [electronic resource].14:1145705, 2023.

Purpose To gather knowledge about effective return to work interventions for survivors of stroke. Methods A database search was conducted in MEDLINE, CINAHL, PsycINFO, Scopus, and Web of Science using keywords and medical subject headings. Studies were included if they met the following criteria: (i) studies published in English since the year 2000; (ii) adult patients aged 18-65 with a primary diagnosis of stroke; (iii) working pre-stroke; and (iv) intervention in which one of the primary outcomes is return to work. The methodological quality of included studies was assessed and the evidence synthesised. Results Twelve studies were included, of which three were randomised controlled trials, four were retrospective studies, one was a cohort study, one was an explorative longitudinal study, one was a pre-post treatment observation study and two were pilot studies. The employment rate at follow-up ranged from 7% to 75.6%. Overall, there was limited published evidence regarding the effectiveness of interventions to promote return to work for this population, and it was unclear if return to pre-stroke work was the goal. Conclusion A lack of large, controlled trials, variations in follow-up time and the definitions of return to work accounted for the large range of employment rates at follow-up. There is limited published high-quality evidence regarding the effectiveness of interventions to promote return to work in working-age survivors of stroke.

© Pearce G; O'Donnell J; Pimentel R; Blake E; Mackenzie L. International Journal of Environmental Research & Public Health. 20(15), 2023 07 28.

Purpose Returning to work is an important goal after stroke, not only as a recovery indicator but also for facilitating independent living and improved social identity. The aim of this study was to explore the lived experiences of vocational rehabilitation and the return to work pathway after stroke. Method Qualitative data were collected through semi-structured interviews with purposively selected participants who had participated in a vocational rehabilitation trial. All participants were employed at the time of their stroke and were community-living. Interviews were undertaken by occupational therapists and were transcribed verbatim before data were thematically analysed using a framework approach. Results Sixteen participants were interviewed, seven received specialist vocational rehabilitation and nine received usual clinical rehabilitation. Three major themes were identified which highlighted the importance of tailored vocational rehabilitation to address the challenges that arise when returning to the workplace. Stroke survivors perceived the most beneficial components of the specialist vocational rehabilitation intervention to be employer liaison support, fatigue management, and support for cognition and executive processing skills. Conclusions Vocational rehabilitation was perceived to provide an opportunity to influence working after stroke, although areas of unmet need were highlighted. Findings provide direction for the development of future stroke-specific vocational rehabilitation programs.

© Moore N; Reeder S; O'Keefe S; Alves-Stein S; Schneider E; Moloney K; Radford K; Lannin NA. Disability & Rehabilitation. 1-8, 2023 Jul 03.

Purpose Difficulties in returning to work can significantly impact individuals following a stroke (eg, their sense of purpose and self-esteem), not only financially, but also as they adjust to the change in their situation. Such difficulties may arise from communication disorders as well as physical impairments. Previous reviews on return to work post-stroke have focused on specific aspects, such as interventions, or barriers and facilitators, but have not provided a comprehensive map of the field. Further, no systematic or scoping reviews to date have focused on literature addressing return to work for people with communication disorders post-stroke. This scoping review aimed to map the literature on interventions, barriers, and facilitators for return to work for adults post-stroke with and without communication disorders. Methods This review considered literature that reported on interventions, barriers, and facilitators for return to work for adults (aged 16 and over) following an ischemic or hemorrhagic stroke. Records focusing on transient ischemic attacks or acquired brain injury were excluded, as were those in which a comorbidity or disability (eg, learning disability, dementia, respiratory disorder) had a significant impact on the individual's ability to work. This review followed the JBI scoping review methodology. Primary research of any type, systematic and non-systematic reviews, and gray literature from developed countries written in English from 2010 to the present day were identified from 7 databases, 2 gray literature repositories, JBI Evidence Synthesis, and an internet search. Records were screened for relevance to the review topic by 2 independent reviewers and data relevant to the review questions were extracted. Findings were presented as a narrative supported by tables. Results One hundred and six records were included, 61 of which addressed demographic-, socioeconomic-, impairment- and recovery-based factors associated with return to work. One of these 61 records, a narrative review focused on communication disorders. Thirty-eight records explored barriers and facilitators for return to work from different stakeholders' perspectives; 3 of these 38 records, including 2 qualitative studies and 1 narrative review, focused on post-stroke communication disorders. Eleven records focused on interventions, including 7 studies (reported across 9 records) that developed or tested return-to-work interventions. Of these primary studies, 1 randomized controlled trial and 1 retrospective cohort study was identified. The remaining intervention studies were case studies or case series. None of these intervention studies addressed communication disorders. Conclusions While there has been extensive research on factors, barriers, and facilitators for return to work post-stroke, there is a lack of research on interventions to facilitate return to work. There is also a significant gap in the evidence-base on returning to work with a post-stroke communication disorder, highlighting the need for further research in this important area.

© Coutts E; Cooper K. JBI Evidence Synthesis. 2023 Jun 01.

Purpose To assess professional reintegration, the perceived impact of stroke on work, and the main determinants of return to work (RTW) among stroke survivors. Methods A cross-sectional study was performed, based on a cohort of stroke survivors. A structured questionnaire was administered to previously working stroke survivors, 18-24 months post-stroke. Data on sociodemographic characteristics, stroke features and their impact on work, access to rehabilitation services during hospital admission and after discharge, social support, and professional reintegration were reported by 553 stroke survivors. Results On average, 56.6% (95% CI 52.4-60.8) of stroke survivors resumed professional activity, 20 months after stroke. Approximately 90% of survivors who RTW, returned to the same job and same function they performed before stroke. The majority did not receive reintegration support. The main determinants of RTW were lower age, higher socioeconomic status, and better functional status. Conclusions Professional reintegration and vocational support after stroke, remained below the international goals for community reintegration of stroke survivors. Future studies should explore the impact of professional and social reintegration on the psychological health and quality of life of stroke survivors and the barriers, challenges, and strategies used to overcome them, to allow for effective professional reintegration policies.

© Matos J; Moura A; Teixeira F; Henriques A; Alves E. Disability and rehabilitation, 2023 Jun 27, pp. 1-10

Purpose Cerebral venous thrombosis (CVT) is a major cause of stroke in young and middle-aged adults. This study aimed to evaluate the prevalence of post-CVT employability decline and identify factors associated with unemployment. Methods We identified patients first diagnosed with acute/subacute CVT at Xuanwu Hospital, Capital Medical University (January 2018 to June 2021) and invited all survivors to a clinical 6-months follow-up visit after onset. Baseline data were collected from all patients at admission. A modified Rankin Scale (mRS) and employment status were used to assess functional outcomes. Multivariate logistic regression was used to identify independent factors associated with unemployment. Results A total of 303 CVT patients were eligible for this study, 131 (42.23%) patients could not return to work 6-month after discharge. After adjusting for age and sex in multivariate analysis, motor deficits, aphasia, mental disorders, CVT recurrence, National Institutes of Health Stroke Scale (NIHSS) score at admission, and mRS 0-2 at 6-month follow-up were independently associated with employment after CVT. Among 263 patients whose mRS showed a favorable outcome, 102 patients were unable to return to their previous work and the risk factors for impaired ability to return to work were aphasia and CVT recurrence. Conclusions Impaired employability after CVT was associated with motor deficits, aphasia, mental status disorders, and NIHSS score at admission. Even if they recover from CVT without physical disability, patients with a good functional prognosis have a higher risk of employment failure due to their higher rates of aphasia and CVT recurrence.

© Liu, Lu; Jiang, Huimin; Wei, Huimin; Zhou, Yifan; Wu, Yan; Zhang, Kaiyuan; Duan, Jiangang; Meng, Ran; Zhou, Chen; Ji, Xunming. CNS Neuroscience & Therapeutics. 29(4):1086-1093, 2023 04.

Purpose Various strategies are used to motivate individuals with stroke during rehabilitation. However, how physical therapists select the motivational strategies that they use for each individual is yet to be established. Therefore, this study aimed to explore how physical therapists use different motivational strategies for individuals in stroke rehabilitation programs. Methods A criterion sample of 15 physical therapists who have worked in rehabilitation for over 10 years and were interested in an individual's motivation participated in one-on-one semi-structured online interviews. The interviews explored their perspectives and experiences regarding the motivational strategies used depending on each individual's condition. The collected data were analyzed with thematic analysis. Results A total of 9 themes emerged from the data upon thematic analysis and inductive coding. Participants used different strategies to encourage individuals' active participation in physical therapy depending on (1) their mental health, (2) their physical difficulties, (3) their level of cognitive function, (4) their personality, (5) their activities and participation, (6) their age, (7) their human environment, and (8) the type of rehabilitation service where the individual underwent treatment. For example, in cases where an individual lost self-confidence, participants offered practice tasks that the individual could achieve with little effort to make them experience success. The interviews also revealed (9) motivational strategies used regardless of the individual's condition. For instance, patient-centered communication was used to build rapport with individuals, irrespective of their condition. Conclusions This qualitative study suggests that physical therapists use different strategies depending on the individual's mental health conditions, physical problems, level of cognitive function, personality, activities and participation, age, human environment, and the type of rehabilitation service where the individual undergoes treatment to motivate individuals with stroke during physical therapy. The findings of this study can provide experience-based recommendations regarding the selection of motivational strategies for stroke rehabilitation.

© Oyake K; Sue K; Sumiya M; Tanaka S. Physical Therapy. 2023 Apr 05.

Purpose This study aimed to explore the reasons and influencing factors for non-return to work (non-RTW) within 1 year among young and middle-aged patients with stroke and to assess their health-related quality of life (HRQoL) at 1 year across different reasons. Methods The study was conducted as a telephone-based cross-sectional survey. Seven hundred eighty-nine young and middle-aged patients with stroke aged between 18 and 54 years for men and 18 and 49 years for women in the electronic medical system were included. Data collection included demographic characteristics, socioeconomic status, behavioral habits, history of chronic diseases, work status, reasons for non-RTW, and HRQoL. Results Of 789 patients, 435 (55.1%) (mean [SD] age, 47.7 [7.8] years) did not return to work within 1 year after stroke. Among the patients who did not RTW, 58.9% were unable to work, 9.7% retired early, 11.03% became full-time homemakers or were unemployed, and 20.5% were reluctant to work. The disordered multiclass logistic regression model showed that the factors influencing the reasons for non-RTW included age, gender, education, income, health insurance, diabetes comorbidity, ability to perform activities of daily living, and mobility of the right upper extremity. Furthermore, patients who were unable to work had significantly lower HRQoL compared to those who had RTW, followed by those who retired early. Conclusions More than half did not RTW within 1 year in our study. The results will help inform future research to identify interventions to promote RTW and improve HRQoL for young and middle-aged patients with stroke.

© Pan X; Wang Z; Yao L; Xu L. Frontiers in neurology. 14:1078251, 2023.

Purpose While depression after stroke is common and stroke prevalence globally increases in working age populations, the role of return-to-work (RTW) in the pathogenesis of post-stroke depression (PSD) remains unclear. This study examined if RTW is linked to PSD within the first year after ischemic stroke, independently from established risk factors. Method Stroke survivors (n = 176) in their working age (<65 years) recruited from two rehabilitation clinics were assessed for established risk factors: pre-stroke depression, activities of daily living, stroke severity, cognitive impairment, and social support. RTW and depressive symptoms (Geriatric Depression Scale: GDS-15) were assessed six- and twelve-months post-stroke. Multivariate regression analyses were used to assess the cross-sectional and longitudinal relationship between RTW and GDS-15, while controlling for established PSD risk factors. Results Successful RTW was independently associated with lower GDS-15 at both measurement occasions (p < .05), next to the absence of pre-stroke depression and higher social support. Stroke severity predicted GDS-15 at twelve months. The predictive value of six-months RTW for subsequent depressive symptoms beyond the influence of established risk factors was s = -1.73 (p = .09). Conclusion RTW was independently associated with PSD in young stroke survivors within the first-year post-stroke, and exerted a (marginally significant) effect on subsequent depression. Our study highlights the relevance of RTW for young stroke survivors' PSD, beyond the influence of established risk factors. Further assessments examining to what extent fostering RTW contributes to mental well-being after stroke might be promising for PSD prevention, next to evident beneficial economic effects.

© Volz M; Ladwig S; Werheid K. Topics in Stroke Rehabilitation. 30(3):263-271, 2023 Apr.

Purpose This study aims to determine which factors within the first week after a first-ever transient ischemic attack (TIA) or minor ischemic stroke (MIS) are associated with stroke survivors’ ability to return to either partial or full time paid external work (RTpW). Methods In this single-center prospective cohort study, we recruited 88 patients with first-ever TIA or MIS (NIHSS ... 5). Bivariate analyses were conducted between patients that did (RTpW) or did not return to paid work (noRTpW) within 7 days after stroke onset and at 3-months follow-up. Then, we conducted multivariate logistic and negative binomial regression analyses assessing (i) which factors are associated with RTpW at 3 months (ii) the likelihood that patients would RTpW at 3 months and (iii) the number of months necessary to RTpW. Results Overall, 43.2% of the patients did not RTpW at 3 months. At 3-months follow-up, higher anxiety/depression and fatigue-related disabilities were associated with noRTpW. Multivariate analysis showed that higher NIHSS scores at onset and hyperlipidemia (LDL cholesterol > 2.6 mmol/L or statins at stroke onset) were associated with noRTpW at 3 months. Conclusion Stroke severity and/or newly diagnosed hypercholesterolemia at stroke onset in TIA or MIS patients were associated with not returning to paid work at 3 months.

© Wicht CA; Chavan CF; Annoni JM; Balmer P; Aellen J; Humm AM; Crettaz von Roten F; Spierer L; Medlin F. Journal of Personalized Medicine. 12(7), 2022 Jul 06.

Purpose Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Methods Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Results Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, p < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Conclusion Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.

© Powers KE; das Nair R; Phillips J; Farrin A; Radford KA. International Journal of Environmental Research & Public Health. 20(6), 2023 Mar 07.

Purpose To determine the proportion of patients who return to work after inpatient stroke rehabilitation and to identify demographic, clinical, and functional predictive factors for its success. MethodsDesign: A retrospective follow-up study of patients with stroke who were premorbidly working and had completed inpatient rehabilitation in a large metropolitan hospital between January 2016 and December 2017. They underwent a telephone interview at 2 years post discharge. Setting: Inpatient rehabilitation and follow-up post discharge. Participants: A total of 314 patients with stroke (73.9% male) with mean age of 58.9 at time of stroke (N=314). Results A total of 46% of 314 participants returned to work. In multivariable logistic regression analysis, viewing return to work as important (odds ratio [OR], 11.90; 95% confidence interval [CI], 5.15-27.52), absence of language impairment (OR, 9.39; 95% CI, 3.01-29.34), ambulation FIM>=5 (supervision to independence level) on discharge (OR, 4.93; 95% CI, 2.44-9.98), cognitive FIM on discharge >=25 (OR, 2.77; 95% CI, 1.19-6.47), employment in premorbid office work (OR, 2.67; 95% CI, 1.26-5.64), and a lower Charlson Comorbidity Index (CCI) score at discharge (OR, 0.83; 95% CI, 0.68-1.00) were associated with successful return to work.  Conclusions Viewing return to work as important, absence of language impairments on discharge, discharge ambulation FIM>=5, discharge cognitive FIM>=25, employment in premorbid office work, and a lower discharge CCI score were positive predictors of successful return to work.

© Tay SS; Visperas CA; Tan MMJ; Chew TLT; Koh XH. Archives of Rehabilitation Research and Clinical Translation. 5(1):100253, 2023 Mar.

Purpose To evaluate prevalence and factors determining not returning to full-time work 1 year after first-ever mild ischemic stroke. Methods Design: Prospective, observational cohort study with 12-month follow-up. Setting: Stroke units and outpatient clinics at 2 Norwegian hospitals. Participants: We included 84 (N=84) full-time working, cognitively healthy patients aged 70 years or younger who suffered an acute first-ever mild ischemic stroke, defined as National Institutes of Health Stroke Scale (NIHSS) score <=3 points. Interventions: Not applicable. Main Outcome Measures: Vascular risk factors, sociodemographic factors, stroke localization, and etiology were recorded at inclusion. Cognitive impairment, anxiety, depression, fatigue, and apathy 12 months after stroke were assessed with validated instruments. Logistic regression analyses were performed to find correlates of not returning to full-time employment. Results Of 78 patients assessed 1 year after stroke, 63 (81%) had returned to work, 47 (60%) to full-time employment status. Modified Rankin scale score >1 (adjusted odds ratio, 12.44 [95% confidence interval, 2.37-65.43], P=.003) at follow-up was significantly associated, and diabetes (adjusted odds ratio, 10.56 [95% confidence interval, 0.98-113.47], P=.052) was borderline significantly associated with not returning to full-time work. Female sex, NIHSS at discharge, anxiety per point on the anxiety scale, depression per point on the depression scale, and fatigue per point on the fatigue scale were significantly associated with not returning to full-time work after 1 year, but these associations were only seen in the unadjusted models. Conclusions Low functional level that persists 12 months after stroke is related to not returning to full-time work. Patients with diabetes mellitus, female patients, and patients with a higher score on fatigue, anxiety, and depression scales may also be at risk of not returning to full-time work post stroke. Working patients should be followed up with a particular focus on factors determining participation in work and social life.

© Vlachos G; Ihle-Hansen H; Wyller TB; Braekhus A; Mangset M; Hamre C; Fure B. Archives of Rehabilitation Research and Clinical Translation. 5(1):100245, 2023 Mar.

Purpose The Return-to-Work Assessment Scale (RAS) was developed in 2021 by Ibikunle et al. to assess return to work among post stroke survivors. The aim of this study was to describe how the conceptual (flag model and ICF) and theoretical framework (C-OAR-SE) were used in developing the RAS. Method The development of the RAS consisted of three phases: (i) Initial item generation (ii) face and content validity (iii) Psychometric testing. With each phase embracing the flag model, international classification of functioning, disability and health (ICF) and the C-OAR-SE an acronym for the six aspects of the theory: 'C' [construct definition], 'OAR' [object representation, attribute classification, and rater entity identification], and 'SE' [selection of item type and answer scale, as well as enumeration. Results A triangulated approach drawn on three separate theories and models. Phase one was developed by using the Flag model which provided the semi structured open ended questions that materialized into the draft instrument while phases two and three were developed using the ICF and the C-OAR-SE. The scale consists of two sections, A and B. Section A comprises general information about post-stroke survivors, which would not be scored, while section B includes three parts that are important to consider when deciding to return to work. Conclusion An instrument called RAS was developed, an excellent, internally consistent, as well as reliable tool that has demonstrated good group and structural validity.

© Ibikunle PO; Rhoda A; Smith MR; Useh U. Work. 2023 Jan 23.

Purpose Work is an occupation of great concern for younger stroke survivors. Given the high rate of people not working after stroke, there is a need to explore work after stroke from a long-term perspective, including not just an initial return to work, but also the ability to retain employment and how this may affect everyday life after stroke. Therefore, the objective of this study was to explore experiences relating to work and to work incapacity among long-term stroke survivors. Method This study used thematic analysis on data gathered through individual semi-structured interviews with long-term stroke survivors. Results The analysis resulted in four themes that together comprised the main theme 'The centrality of work in everyday life', containing descriptions of how everyday life was affected by aspects of work both for those who did work and those who did not return to work after stroke. Conclusion The results highlight the importance of addressing return to work not just as an isolated outcome but as part of everyday life after stroke. The results indicate a need for a more flexible approach to supporting return to work that continues past the initial return.

© Wassenius C; Claesson L; Blomstrand C; Jood K; Carlsson G. Scandinavian Journal of Occupational Therapy. 1-11, 2023 Feb 01.

Purpose Rates of return-to-work after stroke are low, yet work is known to positively impact people's wellbeing and overall health outcomes. Objective: To understand return-to-work trajectories, barriers encountered, and resources that may be used to better support participants during early recovery and rehabilitation. Methods The experiences of 31 participants (aged 25-76 years) who had or had not returned to work after stroke were explored. Interview data were analysed using reflexive thematic analysis methods within a broader realist research approach. Results Participants identified an early need to explore a changed and changing occupational identity within a range of affirming environments, thereby ascertaining their return-to-work options early after stroke. The results articulate resources participants identified as most important for their occupational explorations. Theme 1 provides an overview of opportunities participants found helpful when exploring work options, while theme 2 explores fundamental principles for ensuring the provided opportunities were perceived as beneficial. Finally, theme 3 provides an overview of prioritized return-to-work service characteristics. Conclusion The range and severity of impairments experienced by people following stroke are broad, and therefore their return-to-work needs are diverse. However, all participants, irrespective of impairment, highlighted the need for early opportunities to explore their changed and changing occupational identity.

© Martin RA; Johns JK; Hackney JJ; Bourke JA; Young TJ; Nunnerley JL; Snell DL; Derrett S; Dunn JA. Journal of Rehabilitation Medicine. 55:jrm00363, 2023 Feb 07.

Purpose To investigate post-stroke return-to-work and its associations with cognitive performance, motivation, perceived working ability, and self-perceived barriers to returning to work. MethodsDesign: Prospective cohort study of a clinical sample. Subjects, data collection and analysis: Participants were 77 stroke patients younger than age 69 years. Assessment included a cognitive screening method for stroke patients (CoMet), a questionnaire regarding work-related matters, and a question regarding motivation to return to work. A predictive model of return-to-work was built, and how participants managed in their working life was examined. Results Cognitive performance was significantly connected with returning to work. Three of the 5 individuals who dropped out of working life had cognitive dysfunction. Cognitive performance predicted 80% of those who had not returned and 37% of those who had returned by 6 months after the initial assessment. Self-perceived working ability and barriers predicted 64% of those who had not returned and 78% of those who had returned at the 12-month follow-up. Conclusion Cognitive performance seems to be a crucial predictor of return-to-work post-stroke, but individuals' own evaluations of their working capabilities are also important.

©  Saar K; Tolvanen A; Poutiainen E; Aro T. Journal of Rehabilitation Medicine. 55:jrm00365, 2023 Jan 09.

Purpose Post-stroke return-to-work (RTW) rates reported in Singapore ranged between 38% and 55%, indicating challenges in the RTW process among individuals with stroke. We sought to understand the lived experience of returning to work among individuals with stroke in Singapore. Methods This was a qualitative study using a phenomenological approach. We recruited individuals with stroke who were citizens or permanent residents of Singapore. We conducted semi-structured interviews to collect data on their lived experience of returning to work and analyzed the interview data inductively. Results Twenty-seven participants completed the interviews. Their median age was 61 years (interquartile range = 54 - 64). They were mostly male (n = 19, 70.4%) and married (n = 21, 78%). Twenty participants (74%) returned to work after their stroke. Three major themes emerged from the interviews that underpinned the participants' RTW experience. They were i) direct impact of stroke, ii) realignment of life priorities, and iii) engagement with support and resources. Conclusion RTW after stroke is complex and influenced by personal and environmental factors. Our findings suggest that individuals with stroke need continuing support to overcome stigma and discrimination, to manage expectations of their recovery process, and to better navigate resources during their RTW process in Singapore. We recommend future studies to design and test the feasibility of appropriate interventions based on our proposed strategies to better support individuals with stroke to return to work.

© Mohamad NBZ; Koh NZM; Yeo JPT; Ng MG; Turpin M; Asano M.  Work.  2023 Jan 09.

Purpose The purposes of this study were to (i) describe the lived experiences of participating in a Singaporean vocational rehabilitation (VR) program among individuals with stroke and spinal cord injury and (ii) identify salient features of the program that facilitated their return-to-work process. Methods This was a qualitative phenomenological study. Participants were invited to complete an interview about their return-to-work process after acquiring a disability vis-à-vis their participation in a local VR program. The qualitative data were analyzed inductively. Results Twenty-four middle-aged participants with a stroke or spinal cord injury completed the interviews. The participants’ experiences with the local VR program were largely positive. Several key features of the VR program were identified. These were: (i) providing a multi-disciplinary and individualized program; (ii) building positive collaborations between service providers and participants; and (iii) supporting personal growth among participants. Conclusions The Singaporean VR program demonstrated internationally recommended best practices. These best practices were beneficial for the participants’ return-to-work process, as reflected by their positive feedback about the program. Our study emphasizes the need for comprehensive and evidence-based VR programs to meet the complex needs of individuals with disabilities who want to return to work. Implications for rehabilitation Multi- or inter-disciplinary care services are needed in vocational rehabilitation (VR) programs to support the complex return-to-work process of clients. VR programs should have the capacity to provide client-centered care as their clients may experience diverse, yet unique challenges during their return-to-work process VR service providers play a crucial role in engaging and motivating their clients throughout the program to achieve their return-to-work goals VR service providers should address concurrent or future concerns that could impact on their clients’ ability to return to or remain at work. Multi- or inter-disciplinary care services are needed in vocational rehabilitation (VR) programs to support the complex return-to-work process of clients.VR programs should have the capacity to provide client-centered care as their clients may experience diverse, yet unique challenges during their return-to-work processVR service providers play a crucial role in engaging and motivating their clients throughout the program to achieve their return-to-work goalsVR service providers should address concurrent or future concerns that could impact on their clients’ ability to return to or remain at work.

© Mohamad NBZ; Ng YS; Asano M. Disability & Rehabilitation. Dec2022, p1-11.

Purpose Validation of an instrument consist of three main types: content, criterion and construct. Content validity needs to be determined in order for an instrument to be acceptable for use, validity establishes the fact that an instrument measures exactly what it proposes to measure. The Return-to-work assessment scale (RAS) was developed to measure three aspects of return to work: (Personal factors and/or issues, work issues and contextual factors) in 2021. Objective: To report on the processes followed in establishing the face and content validity of the RAS. Method Twenty participants took part in our study, they were selected purposively and conveniently from a pool of professionals and post stroke survivors. The Delphi survey technique was used to arrive at consensus and professional opinion on the items included in the RAS. Consensus was sought on the items, domains and subdomains included in the RAS that was used to assess return-to-work after a stroke. Our study was concluded after the third round. Results One item was remove out of the original 86, three (3) domains made up of eleven (11) subdomains were retained. The RAS had consensus of 100% after three rounds of scrutiny for all items. Conclusion The RAS was found to be valid, thereby establishing its face and content validity. Clinical implication: The RAS is valid and was recommended for psychometric testing which was the next stage after face and content validity.

©   Ibikunle PO; Rhoda A; Smith MR; Useh U, South African Journal of Physiotherapy. 78(1):1790, 2022.

Purpose Sustaining a stroke frequently leads to difficulties in returning to work, leisure, and social participation. These outcomes are important for occupational therapy practitioners to address. Objective: To determine the current evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve social participation, work, and leisure among adults poststroke. Methods Data sources: MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study selection and data collection:  Primary inclusion criteria were peer-reviewed journal articles published between January 1, 2009, and December 31, 2019, within the scope of occupational therapy that evaluated an intervention to address work, leisure, or social participation poststroke (levels of evidence ranged from Level 1b to Level 2b). Reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Forty-seven articles met the inclusion criteria. Forty-four articles related to social participation were categorized as follows: occupation-based approaches, metacognitive strategy training, education and training approaches, impairment-based approaches, and enriched environment approaches. Three articles related to work and 3 articles related to leisure were not further categorized (2 articles were each included in two categories). Seventeen Level 1b and 30 Level 2b articles were included. The strength of evidence to support occupational therapy interventions for social participation, work, and leisure outcomes is predominantly low. Conclusions Occupational therapy interventions may improve work, leisure, and social participation outcomes poststroke, with the strongest evidence existing for client education, upper extremity training, and cognitive training for improving social participation. What This Article Adds: Occupational therapy practitioners may use the available literature along with clinical reasoning to improve work, leisure, and social participation outcomes among clients poststroke. Additional research is required to build stronger evidence to support clinical decision making in stroke rehabilitation in these areas.

©   Proffitt R; Boone A; Hunter EG; Schaffer O; Strickland M; Wood L; Wolf TJ. American Journal of Occupational Therapy. 76(5), 2022 Sep 01.

Purpose Facilitating return-to-work (RTW) for working-age stroke survivors is a key component of stroke rehabilitation, however, research investigating the long-term outcomes of working-age stroke survivors is lacking. Objective: To investigate the factors that influence long-term RTW for patients enrolled on a community-based early supported discharge (ESD) rehabilitation program in Singapore about five years post stroke. Methods Sixty-nine patients, aged between 18 and 60 years and were employed at the time of their hospitalization, were enrolled into the ESD program between 2012 and 2014. A prospective cohort design was adopted to examine the relationships between the factors- demographic, functional, personal, psychosocial factors and work related- and RTW at five-year follow-up. Details of RTW were collected through questionnaires via telephone follow-up. Results Sixty percent of the participants (n = 49) were selected for Cox and logistic regression analyses of RTW at five-year follow-up. The results indicated that having social problems is a negative predictor of RTW (OR 0.02; 95% CI 0.00-0.22) while being the breadwinner is a positive predictor of RTW (OR 13.79; 95% CI 2.46-77.52). The same factors were also significant in the time to RTW event at five-year follow-up, with a hazard ratio of 0.09 and 4.07, respectively. Conclusions Early identification of the characteristics of stroke patients enrolled into an ESD program who have the potential to RTW would make interventions more targeted, increasing the likelihood of RTW.

© Teo SH; Fong KNK; Chen Z; Chung RCK. Work. 2022 Aug 18.

Purpose Rates of stroke in people of working age are increasing. Returning to work (RTW) after stroke is a key rehabilitation aspiration for younger stroke survivors. A pilot community-based Stay at Work Initiative (SAWI) was developed and delivered from March 2017 to December 2019. SAWI used a co-ordination based approach, covering rehabilitation and vocational recovery to support RTW in younger stroke survivors. The aim of the study was to conduct a feasibility evaluation of SAWI. Methods A mixed methods approach was taken considering quantitative and qualitative data. Quantitative data included employment, mood, anxiety and fatigue outcomes at time of engagement with the service and at 6-months post-stroke. Qualitative data was collected on a sub-sample of SAWI clients who volunteered to participate in a semi-structured interview. Results Overall, there were 93 referrals to SAWI, with 42 clients completing an initial service meeting. Average working hours pre-stroke were high (mean 46.9, SD 22.0, range 5–100 hours/week). By 6 months post stroke, 71% n = 29 of 41) of SAWI clients were working. For those with 6-month questionnaire information (n = 19), there was a significant reduction in cognitive fatigue, overall fatigue levels, and perceived impact of stroke on employment (medium effect sizes of r = 0.36, 0.34 and 0.40 respectively). No significant difference was seen on measures of mood or anxiety from pre- to post-intervention. Qualitative interviews with six SAWI participants highlighted the importance of personalised support that addresses individual needs during the RTW journey. A significant number of eligible participants referred to SAWI can engage with the service. Conclusion RTW is able to be assessed as are potential predictor variables. Seventy one percent of participants had RTW at 6 months post-stroke. Mood, self-efficacy, adjustment, and fatigue likely impact RTW. Qualitative interviews identified that SAWI’s personalised support, tailored to individual need, was valued.

© Turner A; De Wet TJ; McMurray J; Wrobel A; Smith H; Clissold B; Mohebbi M; Kneebone I. Journal of Vocational Rehabilitation. Aug 2022, p1-14.

Purpose Stroke is one of the leading causes of death and disability in the industrialized world and a large part of stroke survivors is of working age. A very important goal for these people is to return to work after stroke as it facilitates independent living and guarantees a high level of self-esteem and life satisfaction.  Aim: To find the main factors that facilitate and hinder the return to work (RTW) in people who suffered from stroke through an overview of systematic reviews. Methods A systematic search using keywords and medical subject heading terms was conducted in January 2022, three electronic databases were searched: Medline (PubMed), Scopus and ISI Web. The articles that address the question of returning to work or maintaining employment of people of working age after stroke were included in the systematic review, as well as studies describing factors that facilitate and/or hinder RTW after stroke. Only systematic reviews written in English language were included in this overview. Results The search revealed 180 records after removing duplicates, but only a total of 24 systematic reviews were included in the overview. This research shows that in people who have suffered from a stroke, individual abilities, socioeconomic factors, healthcare factors, and disabilities resulting from the stroke itself are the most critical factors influencing the RTW. Conclusion Future research should focus on cognitive disabilities, as main RTW hindering factor, and vocational rehabilitation, as the more suitable factor for improving the RTW in stroke survivors.

© La Torre G; Lia L; Francavilla F; Chiappetta M; De Sio S. Medicina del Lavoro. 113(3):e2022029, 2022 Jun 28.

Purpose Return to work is a key rehabilitation goal for people with cardiovascular disease (CVD) because employment matters to individuals and societies. However, people recovering from CVD often struggle with returning to work and maintaining employment. To identify people in need of vocational counselling, we examined the probability of feeling under pressure to return to work following CVD. Methods We conducted a combined survey- and register-based study in   randomly selected, population-based cohort of 10,000 people diagnosed with atrial fibrillation, heart failure, heart valve disease, or ischaemic heart disease in 2018. The questionnaire covered return-to-work items, and we reported the probabilities of feeling under pressure to return to work with 95% confidence intervals (CIs) in categories defined by sex, age, and CVD diagnosis. Results The survey response rate was 51.1%. In this study, we included 842 respondents (79.7% men) aged 32-85 years, who had returned to work following a sick leave. Overall, 249 (29.7%) had felt pressure to return to work. The probability of feeling under pressure to return to work ranged from 18.3% (95% CI: 13.1-24.6) among men aged > 55 years with atrial fibrillation to 51.7% (95% CI: 32.5-70.6) among women aged <= 55 years with atrial fibrillation. In addition, 66.0% of all respondents had not been offered vocational rehabilitation, and 48.6% of those who reported a need for vocational counselling had unmet needs. Survey responses also indicated that many respondents had returned to work before feeling mentally and physically ready. Conclusion A substantial proportion of people with cardiovascular disease feel under pressure to return to work, and this pressure is associated with age, sex, and diagnosis. The results show that vocational rehabilitation must be improved and emphasize the importance of ensuring that cardiac rehabilitation programmes include all core rehabilitation components.

© Bernt Jorgensen SM; Johnsen NF; Gerds TA; Brondum S; Maribo T; Gislason G; Kristiansen M. BMC Public Health. 22(1):1059, 2022 May 27