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Craven K, De Dios Pérez B, Holmes J, Fisher R, Radford KA. Factors influencing employers' support for employees with acquired brain injuries or mental illness to return to- and stay in work: A qualitative systematic review. Work 2024:WOR230214. [PMID: 38217562 DOI: 10.3233/wor-230214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND People with acquired brain injuries (ABIs) often experience residual limitations and co-morbid mental illnesses that restrict work participation. Employers are key in enabling successful return-to-work and job retention. OBJECTIVE This review aimed to explore employers' perspectives of factors influencing their support for people with ABIs and/or mental illness to return to- and stay in work. Review questions focused on barriers and facilitators to their support, and contextual characteristics present at the time. METHODS Five databases were searched from October 2010 until November 2023 for relevant qualitative studies published in English. Findings from included studies (N = 25) were synthesised using thematic synthesis. RESULTS Included studies focused on employees with ABI or mental illness, rather than dually diagnosed ABI and mental illness. Employers' support was influenced by their awareness/knowledge of- and attitudes towards the employee's condition/illness; their skills and experience in supportive strategies; factors related to provision of work accommodations; and stakeholder influence. Similarities and differences in influential factors were observed across the ABI and mental illness literature. Contextual characteristics related to organisational characteristics, cultural taboo, and involvement of certain stakeholders. CONCLUSIONS ABI survivors (with and without co-morbid mental illness) and their employers may benefit from specialist support and resources to guide them through the return-to-work process. Further research is needed to investigate employers' knowledge of ABI and mental illness and supportive strategies. Exploration of the influence of other stakeholders, socio-demographic characteristics, and contextual factors on employers' return-to-work and retention support for ABI survivors with co-morbid mental illness is warranted.
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Affiliation(s)
- Kristelle Craven
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
| | - Blanca De Dios Pérez
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
| | - Jain Holmes
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
| | | | - Kathryn A Radford
- Centre for Rehabilitation & Ageing Research (CRAR), University of Nottingham, Nottingham, United Kingdom
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Nuccio E, Petrosino F, Simeone S, Alvaro R, Vellone E, Pucciarelli G. The needs and difficulties during the return to work after a stroke: a systematic review and meta-synthesis of qualitative studies. Disabil Rehabil 2023:1-14. [PMID: 38018092 DOI: 10.1080/09638288.2023.2287016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
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. MATERIALS AND 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.
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Affiliation(s)
- Emanuela Nuccio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Petrosino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvio Simeone
- Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Viale Europa, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Coutts E, Cooper K. Return to work for adults following stroke: a scoping review of interventions, factors, barriers, and facilitators. JBI Evid Synth 2023; 21:1794-1837. [PMID: 37255032 DOI: 10.11124/jbies-22-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This scoping review aimed to map the literature on interventions, factors, barriers, and facilitators for return to work for adults post-stroke with or without communication disorders. INTRODUCTION 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. INCLUSION CRITERIA This review considered literature that reported on interventions, barriers, and facilitators for return to work for adults (aged 16 years or older) 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. METHODS 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 narrative supported by tables. RESULTS Of the 106 sources included, 61 addressed demographic-based, socioeconomic-based, impairment-based, or recovery-based factors related to return to work. One of these 61 sources, a narrative review, focused on communication disorders. Thirty-eight sources explored barriers and facilitators for return to work from different stakeholders' perspectives; 3 of these 38 sources, including 2 qualitative studies and 1 narrative review, focused on post-stroke communication disorders. Eleven sources focused on interventions, including 7 studies (reported across 9 sources) that developed or tested return-to-work interventions. Of these primary studies, 1 randomized controlled trial and 1 retrospective cohort study were 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 supporting 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.
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Affiliation(s)
- Emma Coutts
- Speech and Language Therapy, NHS Grampian, Fraserburgh UK
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Robert Gordon University, Aberdeen, UK
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Johnston V, Brakenridge C, Valiant D, Ling CLK, Andrews N, Gane EM, Turner B, Kendall M, Quinn R. Using framework analysis to understand multiple stakeholders' views of vocational rehabilitation following acquired brain injury. BRAIN IMPAIR 2023; 24:347-370. [PMID: 38167182 DOI: 10.1017/brimp.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To explore how vocational rehabilitation (VR) is currently delivered for individuals with acquired brain injury (ABI) across multiple stakeholder groups and identify areas for improvement in service delivery using the Consolidated Framework for Implementation Research (CFIR). METHODS Seven focus groups were conducted with rehabilitation clinicians; outreach providers, insurers/regulators, VR providers and disability employment service providers (n = 44) experienced in VR of individuals with ABI. All groups were audio-recorded and transcribed verbatim. Data analysis was guided by the CFIR constructs. RESULTS All stakeholder groups believed they offered quality VR interventions given available resources and legislation, but many clients fell through the 'cracks'. Themes that were identified included: a) number and complexity of systems supporting VR; b) fractured communication across systems, c) lack of knowledge by both stakeholders and clients in navigating systems, d) lack of expertise in supporting the vocational needs of clients with ABI and e) perceived limited awareness of ABI by employers. CONCLUSION Stakeholders and clients need support to navigate Australia's complex VR pathways. Limited specialist ABI clinicians, VR providers and disability employment services were identified as barriers for effective VR. Domains of the CFIR were appropriate for organising and understanding how VR is delivered.
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Affiliation(s)
- Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD 4310, Australia
| | - Charlotte Brakenridge
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Donna Valiant
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Charmaine Leow Kai Ling
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Nicole Andrews
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia
- Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Services, Brisbane, QLD 4029, Australia
| | - Elise M Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD 4102, Australia
| | - Ben Turner
- The Hopkins Centre, Acquired Brain Injury Outreach Service, Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, QLD, Australia
| | - Melissa Kendall
- The Hopkins Centre, Acquired Brain Injury Outreach Service, Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, QLD, Australia
| | - Ray Quinn
- The Hopkins Centre, Acquired Brain Injury Outreach Service, Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health, QLD, Australia
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Farias L, Holmlund L, Asaba E. Stakeholders' Expectations of Return-to-Work After Spinal Cord Injury: A 1-Year Follow-Up. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:180-187. [PMID: 35574664 PMCID: PMC10021116 DOI: 10.1177/15394492221097355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Understanding the process of return-to-work is key to supporting people's social participation and health after a disability. This phenomenographic study aimed to explore the expectations and ways of understanding return-to-work from the perspectives of three stakeholder types: three workers with spinal cord injuries, their employers, and an occupational therapist coordinator. Participants were interviewed twice, at 6 and 12 months, after having participated in a research-based return-to-work intervention in Sweden. A phenomenographic approach was used to analyze the data. The findings highlight how stakeholders' different expectations prevented them from openly discussing more flexible arrangements to make return-to-work viable and sustainable. The study contributes to occupational therapy practice by raising awareness of the challenges of work reintegration. It also adds to the body of knowledge in occupational science by illuminating how normative social expectations and policy concerning work/productivity influence the return-to-work process.
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Affiliation(s)
| | | | - Eric Asaba
- Karolinska Institutet, Huddinge, Sweden.,Stockholms Sjukhem Foundation, Sweden
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SAAR K, TOLVANEN A, POUTIAINEN E, ARO T. Returning to Work after Stroke: Associations with Cognitive Performance, Motivation, Perceived Working Ability and Barriers. J Rehabil Med 2023; 55:jrm00365. [PMID: 36622215 PMCID: PMC9847477 DOI: 10.2340/jrm.v55.2576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/18/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE 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. DESIGN Prospective cohort study of a clinical sample. SUBJECTS AND METHODS 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.
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Affiliation(s)
- Katri SAAR
- South Savo Social and Health Care and Authority, Suojelius Oy, Espoo
| | - Asko TOLVANEN
- Department of Psychology, University of Jyväskylä, Jyväskylä
| | | | - Tuija ARO
- Department of Psychology, University of Jyväskylä, Jyväskylä
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Murray A, Watter K, McLennan V, Vogler J, Nielsen M, Jeffery S, Ehlers S, Kennedy A. Identifying models, processes, and components of vocational rehabilitation following acquired brain injury: a systematic scoping review. Disabil Rehabil 2022; 44:7641-7654. [PMID: 34606380 DOI: 10.1080/09638288.2021.1980622] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Acquired brain injury (ABI) is a complex injury which impacts engagement with worker roles. Return to work (RTW) rates for individuals with brain injury are low and those who do RTW often report job instability. Vocational rehabilitation (VR) can improve RTW rates and job stability; however, service provision is varied, and no gold standard has been identified. METHODS A systematic scoping review of the literature was completed to explore research activity in VR for individuals with ABI to address the following three questions: what models have been identified to underpin VR in ABI? What clinical processes have been identified to guide provision of VR in ABI? What components of VR have been described and/or recommended in the ABI literature? RESULTS The number of included articles was 57. From these articles, 16 models, nine process steps, eight components, and four service delivery components were identified that were utilised in provision of ABI VR. Implications for practice are discussed. CONCLUSIONS Key processes and components of ABI VR have been identified across a range of models and apply to clients at all phases post-injury. Findings may be used to inform service provision across a range of time points and support clinicians in their delivery of VR to adults with brain injury.Implications for RehabilitationPeople with acquired brain injury (ABI), even severe injury, can be successful with return to work (RTW) when provided appropriate supports.A wide range of models, interventions, and service components have been identified in the literature which can be used to guide clinical and policy development in ABI vocational rehabilitation.Vocational rehabilitation for individuals with brain injury involves a complex interaction of factors, and consideration should be paid to not only the person and their abilities but also job demands and the environment (physical, social, cultural).Vocational rehabilitation services should be accessible and timed to maximise chances of a successful RTW, provided by a coordinated interdisciplinary team and should involve active stakeholder engagement.
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Affiliation(s)
- Alena Murray
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Kerrin Watter
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Vanette McLennan
- Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia.,School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Jessica Vogler
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Mandy Nielsen
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Sarah Jeffery
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
| | - Shelley Ehlers
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Areti Kennedy
- Acquired Brain Injury Transitional Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia.,Division of Rehabilitation, The Hopkins Centre, Metro South Health & Griffith University, Brisbane, Australia
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Libeson L, Ross P, Downing M, Ponsford J. The experience of employers of individuals with traumatic brain injury. Neuropsychol Rehabil 2022; 32:2580-2602. [PMID: 34461816 DOI: 10.1080/09602011.2021.1969252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To understand the experience of employers of individuals with traumatic brain injury (TBI) who have received comprehensive vocational rehabilitation (VR), the factors involved in supporting an individual with TBI to return to work (RTW), and the support needs of employers. METHODS 12 employers completed semi-structured interviews, which were recorded, transcribed, and analysed thematically. RESULTS Five main themes were identified: challenges and impact on employer, managing employee post-injury changes, looking after employee wellbeing, managing conflicting emotions, and utilizing sources of support. Although employers received support with operational challenges, findings suggest they were not prepared for the emotional journey. While they struggled to support employees through the difficult process of realizing they could no longer perform at their pre-injury level, employers strove to find appropriate roles and ensure wellbeing for their injured employees. Despite employers' endeavours, they felt this process was demoralizing for some employees. CONCLUSIONS Advising employers on operational as well as emotional support needs of both employees and employers is an ongoing challenge for VR providers. Although unsupportive employers were not well-represented in this sample, the study highlights the challenges faced and strategies used by employers who have a strong personal investment in the successful RTW of their employees.
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Affiliation(s)
- Lauren Libeson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Pamela Ross
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia.,Epworth HealthCare, Richmond, Australia
| | - Marina Downing
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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Schiffmann B, Finger ME, Karcz K, Staubli S, Trezzini B. Factors related to sustainable employment of people with acquired brain injury or spinal cord injury: The employer's perspective. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:876389. [PMID: 36188914 PMCID: PMC9397857 DOI: 10.3389/fresc.2022.876389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022]
Abstract
BackgroundOf those people with an acquired brain injury (ABI) or spinal cord injury (SCI) who initially successfully returned to paid employment, some exit the workforce before reaching official retirement age. Employers play a central role in ensuring a sustainable work situation for employees with a disability and in preventing such exits. However, the factors and mechanisms involved from the employer's perspective are still poorly understood.PurposeThe purpose was to determine factors which, from employer's perspective, have a particularly positive or negative influence on sustainable employment of people with ABI or SCI.MethodsTwenty semi-structured interviews were conducted with employers of people with ABI or SCI and thematically analyzed.ResultsIdentified factors could be assigned to four thematic areas for both health conditions: socio-demographic and psychological characteristics of the disabled person, their work performance, the work environment, and other social/environmental conditions. Good disability self-management and proactive communication of needs on the part of the employee are contributing factors to long-term employment from the employer's perspective. Differing expectations and assessments of work performance by employees and employers pose a challenge. Employers feel a responsibility to provide an optimal work environment to allow the employee with a disability to reach his or her full potential. This includes appropriate work tasks, development opportunities, a compassionate work team, flexible work arrangements, providing resources to address specific needs, and an inclusive culture. Employers find the support provided by occupational specialists very helpful, as they often lack the knowledge to design the work environment to meet the person's needs.ConclusionsEmployers emphasize the benefits of professional support during vocational rehabilitation to prepare employers and employees for long-term, sustainable employment. Such support is often lacking when changes and problems occur at a later stage. Therefore, people with a disability should be able to communicate their work-related needs and take charge of their own health so that problems that arise can be addressed as early as possible. Continued awareness of the environment is also beneficial. In addition, the expansion of low-threshold health-specific support services for long-term problems was found to be of great importance for employers in Switzerland.
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Affiliation(s)
- Barbara Schiffmann
- Swiss Paraplegic Research, Nottwil, Switzerland
- *Correspondence: Barbara Schiffmann
| | | | - Katarzyna Karcz
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Dunn JA, Hackney JJ, Martin RA, Tietjens D, Young T, Bourke JA, Snell DL, Nunnerley JL, Hall A, Derrett S. Development of a Programme Theory for Early Intervention Vocational Rehabilitation: A Realist Literature Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:730-743. [PMID: 34524575 DOI: 10.1007/s10926-021-10000-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
Purpose Little is currently known about how early intervention vocational rehabilitation (EIVR) works for people with newly acquired neurological conditions such as traumatic brain injury, acquired brain injury and spinal cord injury. This study aims, from a realist framework, to identify relevant literature and develop an initial programme theory to understand how EIVR might work for people experiencing acquired neurological disability. Realist reviews are ideally placed to address the identified knowledge gap as they assist in gaining a deeper understanding of how the intervention works, for whom it works best, and the contexts that promote the activation of desired outcomes. Methods We used a seven-step iterative process to synthesise literature using a realist approach. The steps included: development of initial programme theory, literature search, article selection, extracting and data organising, synthesis of evidence and programme theory refinement. We performed a literature search using the following databases: Cinahl, Embase, EMcare, Medline, PsychInfo and Scopus. Articles were selected if they contributed to the knowledge describing what is EIVR and how it works in newly acquired neurological conditions. Data were extracted and synthesised to develop a programme theory for EIVR. Results Following screening of 448 references, 37 documents were eligible for data extraction. We developed a refined programme theory of EIVR consisting of three contexts (prioritisation of exploring work options, return to work discussed as an option, and workplace support), nine mechanisms (ensuring rehabilitation teams' culture, fostering hope, exploring options, optimising self-efficacy, maintaining worker identity, staying connected, setting goals, engaging employer, and flexing roles) and three outcomes (confidence in ability to work, psychological adjustment, and engagement in solution focussed options). Conclusions This appears to be the first paper to explore how EIVR works, for whom and in what situations. We have produced a programme theory that may provide an initial understanding of EIVR following acquired neurological conditions.
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Affiliation(s)
- Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
| | | | - Rachelle A Martin
- Burwood Academy Trust, Christchurch, New Zealand
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Donna Tietjens
- Wellington Medical and Health Sciences Library, University of Otago, Wellington, Wellington, New Zealand
| | | | - John A Bourke
- Burwood Academy Trust, Christchurch, New Zealand
- Menzies Health Institute, Griffith University, Brisbane, QLD, Australia
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Joanne L Nunnerley
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
- Burwood Academy Trust, Christchurch, New Zealand
| | - Andrew Hall
- New Zealand Spinal Trust, Christchurch, New Zealand
| | - Sarah Derrett
- Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Coutts E, Cooper K. Interventions, barriers, and facilitators associated with return to work for adults following stroke: a scoping review protocol. JBI Evid Synth 2021; 19:3332-3339. [PMID: 34907147 DOI: 10.11124/jbies-20-00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this scoping review is to map what has been reported on interventions, barriers, and facilitators associated with return to work for adults with and without communication disorders following a stroke. INTRODUCTION Difficulties in returning to work following a stroke can have a significant impact on people's lives, not only in terms of the individual's finances (and the economy as a whole), but also in terms of the person's psychosocial adjustment, for example, their sense of role and purpose and their self-esteem. This scoping review aims to map the literature examining interventional approaches, barriers, and facilitators relevant to this topic. INCLUSION CRITERIA This review will include literature on the return to work for adults aged 16 years or older who have had a stroke. It will be restricted to research conducted in developed countries. METHODS Databases that will be searched include MEDLINE, CINAHL, Embase, AMED, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PEDRo, and OTSeeker. Gray literature or unpublished studies will be searched in OpenGrey and ProQuest Dissertations and Theses, as well as professional bodies and organizations whose remit includes stroke and vocational rehabilitation. The search will be limited to studies written in English since 2010. Titles and abstracts will be screened by two independent reviewers and full-text articles assessed against the inclusion criteria by two independent reviewers. Data will be extracted and the findings will be presented in tabular and graphical format along with a narrative summary.
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Affiliation(s)
- Emma Coutts
- Speech and Language Therapy, NHS Grampian, Fraserburgh, UK
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK.,The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, UK
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Allexandre D, Handiru VS, Hoxha A, Mark D, Suviseshamuthu ES, Yue GH. Altered Modulation of the Movement-Related Beta Desynchronization with Force in Stroke - a Pilot Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6751-6754. [PMID: 34892657 DOI: 10.1109/embc46164.2021.9630192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Conventional therapy improves motor recovery after stroke. However, 50% of stroke survivors still suffer from a significant level of long-term upper extremity impairment. Identifying a specific biomarker whose magnitude scales with the level of force could help in the development of more effective, novel, highly targeted rehabilitation therapies such as brain stimulation or neurofeedback. Four chronic stroke participants were enrolled in this pilot study to find such a neural marker using an Independent Component Analysis (ICA)-based source analysis approach, and investigate how it has been affected by the injury. Beta band desynchronization in the ipsilesional primary motor cortex was found to be most robustly scaling with force. This activity modulation with force was found to be significantly reduced, and to plateau at higher force than that of the contralesional (unaffected) side. A rehabilitation therapy that would target such a neuromarker could have the potential to strengthen the brain-to-muscle drive and improve motor learning and recovery.Clinical Relevance- This study identifies a neural marker that scales with motor output and shows how this modulation has been affected by stroke.
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Johansson U, Nilsson AÖ, Falkdal AH, von Koch L, Hellman T, Eriksson G. The delivery of the ReWork-Stroke program: A process evaluation. Work 2021; 70:467-478. [PMID: 34633348 PMCID: PMC8673516 DOI: 10.3233/wor-213585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: The ReWork-Stroke program was developed to meet the need for a person-centered rehabilitation program addressing return to work after stroke and was provided by occupational therapists (OTs). OBJECTIVE: To gain knowledge on the implementation process of the ReWork-Stroke program, the mechanisms of impact, and the contextual factors that might have affected the process. METHODS: A case study design was used. Data were collected by interviews with two ReWork-Stroke providers and their logbooks of 13 clients. Content analysis was applied. RESULTS: The ReWork-Stroke program varied in duration (12–48 weeks) and was largely implemented according to plan regarding components and how they were provided. It was mostly delivered at the workplace. Mechanisms of impact were building alliances with clients, providing intervention at the workplace, informing about stroke, assigning co-workers as tutors for clients, and collaboration between stakeholders. CONCLUSIONS: The ReWork-Stroke program can be implemented according to plan and is a flexible person-centered program in which stakeholders, coordinated by an OT, plan and take actions, mostly at the workplace, for the client’s return to work. A key factor was recognizing the current work ability after stroke. Further program development includes a more structured evaluation and technical solutions for supporting stakeholders.
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Affiliation(s)
- Ulla Johansson
- Centre for Research & Development, Uppsala University, Gävle, Sweden
| | - Annika Öst Nilsson
- Centre for Research & Development, Uppsala University, Gävle, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Annie Hansen Falkdal
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - Lena von Koch
- Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Therese Hellman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
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14
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Leary S, Hurford J, Shanahan N. An expert opinion: Vocational rehabilitation after stroke. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2020. [DOI: 10.47795/oeap6518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Less than half of people return to work following a stroke. For those who do, their return is often complicated by residual 'invisible' symptoms. It is important to ask about work and to provide intervention early in the rehabilitation process. Specialist vocational rehabilitation services can support more complex and long-term interventions, but there is a paucity of service provision which needs to be addressed.
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15
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Radford KA, Craven K, McLellan V, Sach TH, Brindle R, Holloway I, Hartley S, Bowen A, O'Connor R, Stevens J, Philips J, Walker M, Holmes J, McKevitt C, Murray J, Watkins C, Powers K, Shone A, Farrin A. An individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations of early vocational rehabilitation compared with usual care for stroke survivors: study protocol for the RETurn to work After stroKE (RETAKE) trial. Trials 2020; 21:1010. [PMID: 33298162 PMCID: PMC7724443 DOI: 10.1186/s13063-020-04883-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will investigate whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) is more clinically and cost-effective for supporting post-stroke RTW, than UC alone. METHODS Seven hundred sixty stroke survivors and their carers will be recruited from approximately 20 NHS stroke services. A 5:4 allocation ratio will be employed to randomise participants to receive ESSVR plus UC, or UC alone. The individually tailored ESSVR intervention will commence within 12 weeks of stroke onset and be delivered for up to 12 months as necessary by trained RETAKE occupational therapists in the community, participants' homes or workplaces, and outpatient/inpatient therapy settings, via telephone, email, or SMS text message. Outcome data will be collected via self-report questionnaires administered by post or online at 3, 6, and 12 months follow-up. The primary outcome will be self-reported RTW and job retention at 12 months (minimum 2 h/week). Secondary outcomes will include mood, function, participation, health-related quality of life, confidence, intervention compliance, health and social care resource use, and mortality. An embedded economic evaluation will estimate cost-effectiveness and cost-utility analyses from National Health Service (NHS) and Personal Social Services (PSS) perspectives. An embedded process evaluation will employ a mixed methods approach to explore ESSVR implementation, contextual factors linked to outcome variation, and factors affecting NHS roll-out. DISCUSSION This article describes the protocol for a multi-centre RCT evaluating the clinical- and cost-effectiveness of an early vocational rehabilitation intervention aimed at supporting adults to return to work following a stroke. Evidence favouring the ESSVR intervention would support its roll-out in NHS settings. TRIAL REGISTRATION ISRCTN, ISRCTN12464275 . Registered on 26 February 2018.
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Affiliation(s)
- Kathryn A Radford
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK.
| | - Kristelle Craven
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Vicki McLellan
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Room 2.37, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Richard Brindle
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
| | - Ivana Holloway
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester MAHSC, Manchester, M13 9PL, UK
| | - Rory O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Molecular Medicine, University of Leeds, Level D, Martin Wing, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Judith Stevens
- Patient and Public Involvement Collaborator, Hampshire, UK
| | - Julie Philips
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Marion Walker
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Jain Holmes
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Christopher McKevitt
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, 5th Floor Addison House, Guy's Campus, London, SE1 1UL, UK
| | - John Murray
- Different Strokes, Raphael House, Ilford, London, IG1 1YT, UK
| | - Caroline Watkins
- Lancashire Clinical Trials Unit, School of Health, University of Central Lancashire, Brook Building, Room 217, Preston, PR1 2HE, UK
| | - Katie Powers
- Division of Rehabilitation and Ageing, School of Medicine, Medical School Queen's Medical Centre, B-Floor, Nottingham, NG7 2UH, UK
| | - Angela Shone
- Research and Innovation, Jubilee Conference Centre, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Amanda Farrin
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, Level 11 Worsley Building, Leeds, LS2 9JT, UK
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16
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Nilsson AÖ, Johansson U, Ekbladh E, Bernspång B, Hellman T, Eriksson G. Work Potential and Work Performance during the First Try-Out of the Person-Centred Return to Work Rehabilitation Programme ReWork-Stroke: A Case Study. Healthcare (Basel) 2020; 8:healthcare8040454. [PMID: 33147864 PMCID: PMC7711447 DOI: 10.3390/healthcare8040454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This case study explores changes in work potential and work performance for ten people who worked before their stroke while participating in the ReWork-Stroke programme. It describes measures performed by the occupational therapists to enhance work potential and work performance and the participants' level of work re-entry nine months after the start of their work trial. METHODS Ten people who had experienced a mild or moderate stroke participated. Changes were assessed using the Worker Role Interview and the Assessment of Work Performance. Logbooks relating to work potential and work performance were analysed using content analysis. RESULTS The participants' work potential was in general supportive to returning to work at baseline and remained so at the three-month follow-up. Most changes occurred in the environmental factors regarding the participants' belief that adaptations at the workplace would make re-entry possible. Changes concerning work performance were predominately in a positive direction. Seven of the participants returned to paid work. CONCLUSION The ReWork-Stroke programme seems promising for promoting changes in work potential, work performance, and return to paid work. However, further studies are needed to evaluate changes in work potential and work performance and the programme's effectiveness for increasing work re-entry for people who have had stroke.
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Affiliation(s)
- Annika Öst Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, 14152 Huddinge, Sweden; (A.Ö.N.); (U.J.); (G.E.)
- Centre for Research & Development, Uppsala University/Region Gävleborg, 80188 Gävle, Sweden
| | - Ulla Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, 14152 Huddinge, Sweden; (A.Ö.N.); (U.J.); (G.E.)
- Centre for Research & Development, Uppsala University/Region Gävleborg, 80188 Gävle, Sweden
| | - Elin Ekbladh
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden;
| | - Birgitta Bernspång
- Department of Community Medicine and Rehabilitation, Umeå University, 90187 Umeå, Sweden;
| | - Therese Hellman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, 75124 Uppsala, Sweden
- Correspondence:
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, 14152 Huddinge, Sweden; (A.Ö.N.); (U.J.); (G.E.)
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, 75185 Uppsala, Sweden
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17
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Lindgren I, Brogårdh C, Pessah-Rasmussen H, Jonasson SB, Gard G. Work conditions, support, and changing personal priorities are perceived important for return to work and for stay at work after stroke - a qualitative study. Disabil Rehabil 2020; 44:2500-2506. [PMID: 33103509 DOI: 10.1080/09638288.2020.1836522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore work related and personal facilitators and barriers for return to work (RTW) and stay at work after stroke. MATERIALS AND METHODS Twenty individuals post-stroke (median age 52 years; seven women) were interviewed in focus groups. Data were analyzed by using qualitative content analysis. RESULTS An overall theme "Work conditions, support and changed personal priorities influenced RTW and stay at work after stroke" emerged and covered three categories: "Adjustments and flexibility at the work place facilitated RTW and a sustainable work situation", "Psychosocial support and knowledge about stroke consequences facilitated work and reduced stress", and "Changed view of work and other personal priorities". Physical adjustments at the work place and flexibility in the work schedule were perceived facilitators. Support from family and colleagues were important, whereas lack of knowledge of stroke disabilities at the work place was perceived a barrier. Also changed personal priorities in relation to the work and the current life situation influenced RTW in various ways. CONCLUSIONS The individual's opportunities to influence the work situation is a key factor for RTW and the ability to stay at work after stroke. Adjustments, flexibility, support, knowledge of stroke, and receptivity to a changed view of work are important for a sustainable work situation.Implications for rehabilitationPhysical adjustments at the work place, a flexible work schedule and support increase the individual's possibility to RTW and maintain a sustainable work situation after stroke.Changed work and life priorities after a stroke need attention in the RTW process.Rehabilitation professionals have an important role in providing knowledge about the disabilities following stroke, and how they impact work ability. Individually tailored recommendations for work place adjustments which enable RTW and a sustainable work situation are warranted.
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Affiliation(s)
- Ingrid Lindgren
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Christina Brogårdh
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Stina B Jonasson
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
| | - Gunvor Gard
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
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18
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Johansson U, Hellman T, Öst Nilsson A, Eriksson G. The ReWork-Stroke rehabilitation programme described by use of the TIDieR checklist. Scand J Occup Ther 2020; 28:375-383. [PMID: 32689853 DOI: 10.1080/11038128.2020.1790654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND 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. MATERIALS AND 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.
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Affiliation(s)
- Ulla Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Centre for Research & Development, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | - Therese Hellman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Annika Öst Nilsson
- Centre for Research & Development, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
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19
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How primary care can help survivors of transient ischaemic attack and stroke return to work: focus groups with stakeholders from a UK community. Br J Gen Pract 2020; 70:e294-e302. [PMID: 31988086 DOI: 10.3399/bjgp20x708149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/13/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Evidence about how primary care can best enable survivors of transient ischaemic attack (TIA)/stroke return to work is limited. AIM 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. METHOD 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. CONCLUSION 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.
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20
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Guzik A, Kwolek A, Drużbicki M, Przysada G. Return to work after stroke and related factors in Poland and abroad: A literature review. Work 2020; 65:447-462. [PMID: 31985482 DOI: 10.3233/wor-203097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The incidence of stroke is growing in various parts of the world and the condition most commonly affects the adult population. OBJECTIVES The purpose of the study is to provide a narrative review of papers published in the last 11 years in English and in Polish and focusing on demographic characteristics of individuals returning to work after stroke, return to work rates, length of time post stroke to return to work as well as health conditions, or personal and environmental factors associated with return to work after stroke. The study also presents the situation regarding return to work after stroke in Poland in comparison to other countries. METHODS The narrative review covers Polish and foreign literature published between 2007 and 2018. The number of records initially identified through English databases search amounted to 4,912. Five records were additionally identified through other sources (Polish databases). Ultimately 26 (21 foreign, 5 Polish) refereed publications were selected to be reviewed in this study, based on their relevance in terms of specific inclusion/exclusion criteria. RESULTS The appraisal of Polish and English-language literature shows that stroke survivors' ability to return to work varies; in our country the rate being 43% and outside of Poland reaching the rate of 74.7%. Average time frames for return to work for stroke survivors include from 3 to 6 months, from 12 to 18 months and up to 3 years post stroke. One of the most frequently reported positive factors in the English-language literature is individually tailored vocational rehabilitation. There is a scarcity of studies related to return to work after stroke in Poland. CONCLUSIONS The findings from studies included in this narrative review may suggest a need to improve the situation in Poland with regard to measures related to return to work after stroke, including vocational rehabilitation which is insufficiently available in Poland.
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Affiliation(s)
- Agnieszka Guzik
- Institute of Physiotherapy, Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Andrzej Kwolek
- Institute of Physiotherapy, Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Mariusz Drużbicki
- Institute of Physiotherapy, Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Grzegorz Przysada
- Institute of Physiotherapy, Medical Faculty, University of Rzeszow, Rzeszow, Poland
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21
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Coole C, Konstantinidis ST, Ablewhite J, Radford K, Thomson L, Khan S, Drummond A. Comparing face-to-face with online training for occupational therapists in advising on fitness for work: Protocol for the CREATE study. Br J Occup Ther 2020. [DOI: 10.1177/0308022619893563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction Occupational therapists play a key role in advising on fitness for work; however, there is a concern that they lack knowledge and confidence in using the Allied Health Professions health and work report (formerly the Allied Health Professions advisory fitness for work report), developed in the United Kingdom. Comparing a reusable learning object with face-to-face training for occupational therapists in advising on fitness for work (CREATE) compares face-to-face training with online training for occupational therapists in completing the Allied Health Professions health and work report. Method A mixed methods study. Phase 1, occupational therapists will co-design an online training resource. A standardised face-to-face group-based training session will also be developed based on the same content. Phase 2, a feasibility study will be conducted. Thirty occupational therapists will either attend face-to-face group training or access the online resource. Data on self-reported knowledge and confidence in using the Allied Health Professions health and work report will be collected at baseline, 1 week and 8 weeks post-training. Feedback on the training will be collected by interview and, for the online resource, using an online tool. Results Quantitative results will be predominantly analysed descriptively. If appropriate, between-group responses will be compared using the Mann–Whitney test. Qualitative findings will be analysed thematically. Conclusion CREATE will have made a significant contribution to the debate around appropriate training methods in advising on fitness for work.
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Affiliation(s)
- Carol Coole
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Joanne Ablewhite
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Kate Radford
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Louise Thomson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sayeed Khan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
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22
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Grant M, Rees S, Underwood M, Froud R. Obstacles to returning to work with chronic pain: in-depth interviews with people who are off work due to chronic pain and employers. BMC Musculoskelet Disord 2019; 20:486. [PMID: 31656184 PMCID: PMC6815386 DOI: 10.1186/s12891-019-2877-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022] Open
Abstract
Background The global burden of chronic pain is growing with implications for both an ageing workforce and employers. Many obstacles are faced by people with chronic pain in finding employment and returning to work after a period of absence. Few studies have explored obstacles to return-to-work (RTW) from workers’ and employers’ perspectives. Here we explore views of both people in pain and employers about challenges to returning to work of people who are off work with chronic pain. Methods We did individual semi-structured interviews with people who were off work (unemployed or off sick) with chronic pain recruited from National Health Service (NHS) pain services and employment services, and employers from small, medium, and large public or private sector organisations. We analysed data using the Framework method. Results We interviewed 15 people off work with chronic pain and 10 employers. Obstacles to RTW for people with chronic pain spanned psychological, pain related, financial and economic, educational, and work-related domains. Employers were concerned about potential attitudinal obstacles, absence, ability of people with chronic pain to fulfil the job requirements, and the implications for workplace relationships. Views on disclosure of the pain condition were conflicting with more than half employers wanting early full disclosure and two-thirds of people with chronic pain declaring they would not disclose for fear of not getting a job or losing a job. Both employers and people with chronic pain thought that lack of confidence was an important obstacle. Changes to the job or work conditions (e.g. making reasonable adjustments, phased return, working from home or redeployment) were seen by both groups as facilitators. People with chronic pain wanted help in preparing to RTW, education for managers about pain and supportive working relationships. Conclusions People with chronic pain and employers may think differently in terms of perceptions of obstacles to RTW. Views appeared disparate in relation to disclosure of pain and when this needs to occur. They appeared to have more in common regarding opinions about how to facilitate successful RTW. Increased understanding of both perspectives may be used to inform the development of improved RTW interventions.
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Affiliation(s)
- Mary Grant
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
| | - Sophie Rees
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Robert Froud
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,Institute of Health Sciences, Kristiania University College, Oslo, Norway
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23
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Jarvis HL, Brown SJ, Price M, Butterworth C, Groenevelt R, Jackson K, Walker L, Rees N, Clayton A, Reeves ND. Return to Employment After Stroke in Young Adults: How Important Is the Speed and Energy Cost of Walking? Stroke 2019; 50:3198-3204. [PMID: 31554503 PMCID: PMC6824505 DOI: 10.1161/strokeaha.119.025614] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. 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.
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Affiliation(s)
- Hannah L Jarvis
- From the Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, United Kingdom (H.L.J., S.J.B., N.D.R.)
| | - Steven J Brown
- From the Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, United Kingdom (H.L.J., S.J.B., N.D.R.)
| | - Michelle Price
- Powys Teaching Health Board, Neuro Rehabilitation, Newtown Hospital, United Kingdom (M.P.)
| | - Claire Butterworth
- Cardiff and Vale University Health Board, Physiotherapy, Llandough Hospital, United Kingdom (C.B.)
| | - Renee Groenevelt
- Hywel Dda University Health Board, Physiotherapy, Pembrokeshire, Wales, United Kingdom (R.G.)
| | - Karl Jackson
- Betsi Cadwaladr University Health Board, Physiotherapy, Ysbyty Gwynedd, Bangor, Wales, United Kingdom (K.J.)
| | - Louisa Walker
- Cwm Taf University Health Board, Physiotherapy Department, Keir Hardie Health Park, Merthyr Tydfil, Wales, United Kingdom (L.W., N.R.)
| | - Nia Rees
- Cwm Taf University Health Board, Physiotherapy Department, Keir Hardie Health Park, Merthyr Tydfil, Wales, United Kingdom (L.W., N.R.)
| | - Abigail Clayton
- Abertawe Bro Morgannwg University Health Board, Therapy Services, Heol Maes Eglwys, Swansea, Wales, United Kingdom (A.C.)
| | - Neil D Reeves
- From the Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and Engineering, Manchester Metropolitan University, United Kingdom (H.L.J., S.J.B., N.D.R.)
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Li W, Wolbring G. Analysis of engagement between ethics and return-to-work discourses in respective academic literature. Work 2019; 64:3-19. [PMID: 31450533 DOI: 10.3233/wor-192973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Return-to-work (RTW)/back-to-work (BTW) interventions that are designed to rehabilitate individuals impaired from fulfilling employment roles are facing challenges. Ethics discourses, including ethics theories, principles and concepts, are meant to give guidance on what one ought to do or not to do and RTW professionals could use them to respond to their challenges. OBJECTIVE A scoping review was performed to investigate to what extent 33 ethics concepts, theories, and principles are employed in RTW/BTW academic literature, and to what extent RTW/BTW is engaged with in ethics linked academic journals. METHODS Three academic databases were searched, and 147 article results were extracted from our literature review to be thematically analyzed. RESULTS Searches with n = 11 ethics concepts and n = 4 ethics theories generated results. The content of 20 RTW/BTW article results demonstrated conceptual engagement between RTW and ethics discourses. Only one article in ethics-related journals conceptually engaged with RTW/BTW. CONCLUSION Ethics theories and principles were not used extensively in RTW/BTW academic literature and RTW/BTW is a topic under-engaged within ethics-related journals. Our findings indicate opportunities for further research, like conducting interviews, to better understand our findings and how to respond to them.
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Affiliation(s)
- Wentao Li
- Community Rehabilitation and Disability Studies, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gregor Wolbring
- Community Rehabilitation and Disability Studies, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Nouri F, Coole C, Narayanasamy M, Baker P, Khan S, Drummond A. Managing Employees Undergoing Total Hip and Knee Replacement: Experiences of Workplace Representatives. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:451-461. [PMID: 30132175 PMCID: PMC6531398 DOI: 10.1007/s10926-018-9805-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Introduction There is little research on return to work (RTW) from a workplace perspective following hip and knee replacement (THR/TKR) despite employers and other workplace personnel having a key role. Our aim was to explore the experiences of individuals in the workplace in managing employees undergoing THR/TKR. Methods Employers and other workplace representatives from a cross-section of employment sectors and sizes, with experience of managing employees undergoing THR/TKR in the previous 12 months, were recruited. Interviewees included small business owners, line managers, colleagues, human resources managers and occupational health advisers. Semi-structured, qualitative interviews were conducted and data were analysed thematically. Results Twenty-five individuals were interviewed. The main themes identified were accommodating the employee, and barriers and facilitators to RTW. Accommodations included changes to the work environment, amended duties, altered hours, changed roles and colleague support. Perceived barriers and facilitators to RTW included the role of GPs and occupational health, surgical issues, characteristics of the work environment and of employees. Conclusions Employers are motivated to effect supported RTW for employees undergoing THR/TKR but have insufficient guidance. Strategies are required to signpost employers to existing RTW advice, and to develop recommendations specific to lower limb arthroplasty. Communication between medical practitioners and employers should be facilitated in order to enhance the RTW experience of individuals undergoing THR/TKR.
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Affiliation(s)
- Fiona Nouri
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Carol Coole
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Paul Baker
- South Tees NHS Hospitals Trust, James Cook University Hospital, Middlesbrough, TS3 4BW, UK
| | - Sayeed Khan
- The Buckingham Centre, Collingwood Health, 30 Bradford Road, Slough, SL1 4PG, UK
| | - Avril Drummond
- School of Health Sciences, Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
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Ezekiel L, Collett J, Mayo NE, Pang L, Field L, Dawes H. Factors Associated With Participation in Life Situations for Adults With Stroke: A Systematic Review. Arch Phys Med Rehabil 2019; 100:945-955. [DOI: 10.1016/j.apmr.2018.06.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 01/09/2023]
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Sen A, Bisquera A, Wang Y, McKevitt CJ, Rudd AG, Wolfe CD, Bhalla A. Factors, trends, and long-term outcomes for stroke patients returning to work: The South London Stroke Register. Int J Stroke 2019; 14:696-705. [DOI: 10.1177/1747493019832997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and purpose There 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. Methods Patterns 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. Results Among 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). Conclusion Although 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.
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Affiliation(s)
- Arup Sen
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Alessandra Bisquera
- School of Population Health & Environmental Sciences, King’s College London, London, UK
| | - Yanzhong Wang
- School of Population Health & Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Christopher J McKevitt
- School of Population Health & Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Anthony G Rudd
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Population Health & Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Charles D Wolfe
- School of Population Health & Environmental Sciences, King’s College London, London, UK
- National Institute for Health Research Comprehensive Biomedical Research Centre, Guy’s & St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Ajay Bhalla
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Population Health & Environmental Sciences, King’s College London, London, UK
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Öst Nilsson A, Eriksson G, Asaba E, Johansson U, Hellman T. Being a co-worker or a manager of a colleague returning to work after stroke: A challenge facilitated by cooperation and flexibility. Scand J Occup Ther 2019; 27:213-222. [DOI: 10.1080/11038128.2018.1526318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Annika Öst Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Centre for Research & Development, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Unit for Research, Education and Development, Stockholm Sjukhem Foundation, Stockholm, Sweden
- Department of Healthcare Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Ulla Johansson
- Centre for Research & Development, Uppsala University/Region of Gävleborg, Gävle, Sweden
| | - Therese Hellman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
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Kobylańska M, Kowalska J, Neustein J, Mazurek J, Wójcik B, Bełza M, Cichosz M, Szczepańska-Gieracha J. The role of biopsychosocial factors in the rehabilitation process of individuals with a stroke. Work 2019; 61:523-535. [PMID: 30475778 PMCID: PMC6398539 DOI: 10.3233/wor-162823] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: A large proportion of individuals with a stroke are unable to return to work, although figures vary greatly. Due to the very high cost of post-stroke care, both tangible and intangible, in the form of long-term social consequences, it seems extremely important to search for factors responsible for the low efficiency of the rehabilitation and recovery process, because this fact has direct influence on future employment. Such knowledge would enable physiotherapists to quickly identify those patients who are at risk of rehabilitation breakdown, in order to provide them with special care and include them in intensive therapeutic treatments. OBJECTIVE: The aim of the study was to assess the efficacy of post-stroke rehabilitation, evaluated within the biopsychosocial aspect. METHODS: The study consisted of 120 patients after first stroke, including 48 women and 72 men aged 58.0 (±8.6). The measure of the effects of physiotherapy in the present study was not only the improvement of the functional state (simple and complex activities of daily life, locomotive activities), but also the improvement of the mental state (mood and the sense of well-being, level of acceptance of illness, perceived self-efficacy) and the reduction of pain. The Mini-Mental State Examination, the Geriatric Depression Scale, the Generalized Self-Efficacy Scale, the Acceptance of Illness Scale, the Visual Analogue Scale, the Barthel Index, the Instrumental Activity of Daily Living and the Rivermead Mobility Index were used. All parameters were measured twice: on admission to the ward and after three weeks of physiotherapy. The characteristics of the study group were presented using descriptive statistics. The analysis of interdependence of the efficacy of physiotherapy used two non-parametric tests: the Mann-Whitney U test to compare two groups, and the Kruskal-Wallis ANOVA test to compare a greater number of groups. Correlations between characteristics with continuous distributions were assessed using Spearman’s rank correlation coefficient (ρ), and in case of categorical variables, Pearson’s chi-squared (χ2) correlation coefficient. Linear regression was used to determine the hierarchy of the influence of particular characteristics on the efficacy of physiotherapy. RESULTS: Statistical analyzes show that patient’s age, time since stroke, number of comorbidities, family care capacity, marital status of the patient and also a low level of acceptance of illness, depression symptoms and lack of a sense of self-efficacy were related with low efficacy of post-stroke rehabilitation CONCLUSIONS: Comprehensive neurological rehabilitation, taking into account mental challenges and socio-economic circumstances of individuals with a stroke is essential in order to achieve high efficacy of physiotherapy. Important external factors may play a pivotal role in returning to work as well and should be taken into account during rehabilitation. Of interest should be to assess more biopsychological factors, such as acceptance of illness and a sense of self-efficacy referred to as barriers to return to work.
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Affiliation(s)
- Marzena Kobylańska
- Department of Physiotherapy, University School of Physical Education, Wroclaw, Poland
| | - Joanna Kowalska
- Department of Physiotherapy, University School of Physical Education, Wroclaw, Poland
| | - Jolanta Neustein
- Department of Neurological Rehabilitation, Wroclaw Centre for Rehabilitation and Sports Medicine, Wroclaw, Poland
| | - Justyna Mazurek
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
| | - Bartosz Wójcik
- Department of Neurological Rehabilitation, Wroclaw Centre for Rehabilitation and Sports Medicine, Wroclaw, Poland
| | - Małgorzata Bełza
- Department of Neurological Rehabilitation, Wroclaw Centre for Rehabilitation and Sports Medicine, Wroclaw, Poland
| | - Michał Cichosz
- Department of Neurological Rehabilitation, Wroclaw Centre for Rehabilitation and Sports Medicine, Wroclaw, Poland
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Saeki S, Hachisuka A, Itoh H, Kato N, Ochi M, Matsushima Y. Overview of the returning to work after stroke. ACTA ACUST UNITED AC 2019. [DOI: 10.3995/jstroke.10668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Satoru Saeki
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Akiko Hachisuka
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Hideaki Itoh
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Noriaki Kato
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Mitsuhiro Ochi
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
| | - Yasuyuki Matsushima
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health
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31
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Interdisciplinary Approaches to Facilitate Return to Driving and Return to Work in Mild Stroke: A Position Paper. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Palstam A, Törnbom M, Sunnerhagen KS. Experiences of returning to work and maintaining work 7 to 8 years after a stroke: a qualitative interview study in Sweden. BMJ Open 2018; 8:e021182. [PMID: 30012785 PMCID: PMC6082484 DOI: 10.1136/bmjopen-2017-021182] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To explore how persons experienced return to work (RTW) and their work situation 7 to 8 years after a stroke. DESIGN An explorative qualitative design with individual interviews. The data analysis was inductive thematic and three researchers collaborated during the analysis process. PARTICIPANTS The study population included five women and eight men who had a stroke during 2009-2010, received care at the Sahlgrenska University Hospital in Gothenburg, Sweden and RTW after stroke and it was a heterogenic sample based on age, occupation, stroke severity and time to RTW. RESULTS The analysis led to four themes; motivated and RTW while struggling with impairments, mixed feelings in the RTW process, still at work though restricted and social support for a sustainable work situation. The themes revealed that participants were motivated to RTW while struggling with impairments. The RTW process evoked mixed feelings of worry and grief over lost functions but also acceptance and gratitude for being able to work. Although maintaining work 7 to 8 years after experiencing a stroke, most were restricted in some way. Fatigue and cognitive impairments meant having to set limits, omit work tasks and rest at work, but also rest during free time and refraining from social activities in order to manage work. Participants avoided work-related stress if they could because of aggravated symptoms and/or fear of a new stroke. Support from supervisors and colleagues was often crucial for a sustainable work situation. CONCLUSION Maintaining work can be a continuous struggle with invisible impairments many years after a stroke. Strategies for managing work are dependent on each individual work situation, where support and understanding at work seem to be crucial for a sustainable work situation.
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Affiliation(s)
- Annie Palstam
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Törnbom
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina Stibrant Sunnerhagen
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Peters SE, Truong AP, Johnston V. Stakeholders identify similar barriers but different strategies to facilitate return-to-work: A vignette of a worker with an upper extremity condition. Work 2018; 59:401-412. [DOI: 10.3233/wor-182692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Susan E. Peters
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia
- Brisbane Hand and Upper Limb Research Institute, Brisbane, QLD, Australia
- Harvard Center for Work, Health and Wellbeing, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anthony P. Truong
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia
- School of Medicine, Griffith University, QLD, Australia
- Department of Allied Health, Pindara Private Hospital, Benowa, QLD, Australia
| | - Venerina Johnston
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, QLD, Australia
- RECOVER Injury Research Centre, The University of Queensland, Herston, QLD, Australia
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Schwarz B, Claros-Salinas D, Streibelt M. Meta-Synthesis of Qualitative Research on Facilitators and Barriers of Return to Work After Stroke. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:28-44. [PMID: 28536888 DOI: 10.1007/s10926-017-9713-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose Despite existing rehabilitation services, return to work (RTW) rates among stroke survivors are quite low. An increased number of qualitative studies have been conducted to identify facilitators and barriers to RTW after stroke and to derive recommendations for future interventions. The aim of our study was to carry out a meta-synthesis of those studies and thus strengthen evidence in the field. Methods To identify relevant studies (qualitative studies focusing on RTW after stroke, published in English or German between 2000 and 2015), we conducted a systematic literature search in PubMed, OVID, and Web of Science. After assessing the quality of eligible studies, we synthesized their findings according to meta-ethnographic methodology. Results Fourteen out of 553 studies-three of very high, seven of high, three of medium, and one of low quality-met the inclusion criteria. After the extraction of all first-order concepts and their translation into 64 second-order interpretations, we synthesized the findings by developing a model of RTW factors after stroke. It contains factors related to the person (impairments, coping/adaptation, significance of work/RTW motivation), workplace (job demands/work adaptations, disability management, work climate/social support), and rehabilitation services (availability, accessibility, appropriateness), as well as relevant factors in the interaction of these three stakeholders (work capacity, performance and capability, and initial RTW experiences). Three basic principles-adaptiveness, purposefulness, and cooperativeness-complete the model and led us to its name: the APC model. Conclusions Successful RTW after stroke depends on diverse factors and stakeholders. Rehabilitation strategies have to consider this; otherwise they become RTW barriers themselves.
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Affiliation(s)
- Betje Schwarz
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | | | - Marco Streibelt
- Department of Rehabilitation, German Federal Pension Insurance, Hohenzollerndamm 47, 10704, Berlin, Germany.
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Peters SE, Coppieters MW, Ross M, Johnston V. Perspectives from Employers, Insurers, Lawyers and Healthcare Providers on Factors that Influence Workers' Return-to-Work Following Surgery for Non-Traumatic Upper Extremity Conditions. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:343-358. [PMID: 27586696 DOI: 10.1007/s10926-016-9662-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Return-to-work (RTW) stakeholders have varied roles and may therefore hold their own perspectives regarding factors that may influence outcomes. This study aimed to determine stakeholders' perspectives on factors influencing RTW following surgery for non-traumatic upper extremity conditions. METHODS A questionnaire was distributed to RTW stakeholders via gatekeeper organizations. Stakeholders rated 50 potential prognostic factors from 'not' to 'extremely' influential. Data were dichotomized to establish stakeholders' level of agreement. Disagreements between stakeholder groups were analyzed using χ 2. The relationship between stakeholder demographic variables and rating of a factor was determined via regression analysis. RESULTS One thousand and eleven stakeholders completed the survey: healthcare providers (77.8 %); employer representatives (12.2 %); insurer representatives (6.8 %); and lawyers (3.2 %). Factors with the highest stakeholder agreement for influencing RTW were: self-efficacy (92.2 %); post-operative psychological status (91.8 %); supportive employer/supervisor (91.4 %); employer's willingness to accommodate job modifications (90.7 %); worker's recovery expectations (88.3 %); mood disorder diagnosis (86.6 %); post-operative pain level (86.4 %); and whether the job can be modified (86.3 %). Disagreements between stakeholder groups were found for 19 (36 %) factors. The strongest disagreements were for: age; gender; obesity; doctor's RTW recommendation; and presence of a RTW coordinator. Respondents' characteristics (e.g., age, workers' compensation jurisdiction, work experience, stakeholder group) were associated with factor rating. CONCLUSION The factors stakeholders rated as having the greatest influence on RTW were predominately psychosocial and modifiable. These variables should be the focus of future research to determine prognostic factors for RTW for workers with upper extremity conditions, and to develop effective RTW interventions.
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Affiliation(s)
- Susan E Peters
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia.
| | - Michel W Coppieters
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
- Department of Orthopaedics, Princess Alexandra Hospital, Woolloongabba, Australia
- Orthopaedic Surgery, School of Medicine, The University of Queensland, St Lucia, Australia
| | - Venerina Johnston
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Ladegaard Y, Skakon J, Elrond AF, Netterstrøm B. How do line managers experience and handle the return to work of employees on sick leave due to work-related stress? A one-year follow-up study. Disabil Rehabil 2017; 41:44-52. [DOI: 10.1080/09638288.2017.1370733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Yun Ladegaard
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Janne Skakon
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Friis Elrond
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Research and Knowledge Centre, The Danish Veteran Centre, Ringsted, Denmark
| | - Bo Netterstrøm
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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Matérne M, Lundqvist LO, Strandberg T. Opportunities and barriers for successful return to work after acquired brain injury: A patient perspective. Work 2017; 56:125-134. [PMID: 28035941 PMCID: PMC5302032 DOI: 10.3233/wor-162468] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Many people who suffer an acquired brain injury (ABI) are of working age. There are benefits, for the patient, the workplace, and society, to finding factors that facilitate successful return to work (RTW). OBJECTIVE: The aim was to increase knowledge of opportunities and barriers for a successful RTW in patients with ABI. METHOD: Five men and five women with ABI participated. All had successfully returned to work at least 20 hours a week. Their experiences were gathered by semi-structured interviews, which were subsequently subjected to qualitative content analysis. RESULTS: Three themes that influenced RTW were identified: individually adapted rehabilitation; motivation for RTW; and cognitive and social abilities. An individually adapted rehabilitation was judged important because the patients were involved in their own rehabilitation and required individually adapted support from rehabilitation specialists, employers, and colleagues. A moderate level of motivation for RTW was needed. Awareness of the person’s cognitive and social abilities is essential, in finding compensatory strategies and adaptations. CONCLUSIONS: It seems that the vocational rehabilitation process is a balancing act in individualized planning and support, as a partnership with the employer needs to be developed, motivation needs to be generated, and awareness built of abilities that facilitate or hinder RTW.
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Affiliation(s)
- Marie Matérne
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Thomas Strandberg
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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Hoeffding LK, Nielsen MH, Rasmussen MA, Norup A, Arango-Lasprilla JC, Kjær UK, Burgdorf KS, Quas KJ, Schow T. A manual-based vocational rehabilitation program for patients with an acquired brain injury: study protocol of a pragmatic randomized controlled trial (RCT). Trials 2017; 18:371. [PMID: 28793916 PMCID: PMC5550982 DOI: 10.1186/s13063-017-2115-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/23/2017] [Indexed: 12/02/2022] Open
Abstract
Background An acquired brain injury (ABI) is a complex injury often followed by a broad range of cognitive, physical, emotional, and behavioral disabilities. Because of these disabilities, vocational rehabilitation (VR) is a challenging task, however, of great importance, since approximately 75% of the patients with ABI are of working age. Thus, standardized clinically effective and cost-effective methodologies regarding VR for patients with ABI are highly needed. Therefore, the aim of this study is to evaluate the effect of an individually targeted manual-based VR for patient with ABI compared to conventional VR (usual care). Methods This study is an interventional, two-arm, six-month follow-up, cluster randomized controlled trial involving four municipalities in the Zealand Region and the Capital Region of Denmark. A total of 84 patients with ABI evenly distributed across four municipalities will be included in the study. The patients will randomly be allocated in a 1:1 ratio to the VR intervention provided by a specialized Brain Injury Centre or the conventional VR provided by the municipalities (usual care). The six- to nine-month intervention will consist of individual and group therapies as well as a work placement program including supported employment. Furthermore, the intervention will include a family intervention program followed up by support to one individual family caregiver. The primary outcomes are increased work or study rate at six-month follow-up. Moreover, a budget impact analysis and possibly a cost-utility analysis of the intervention will be performed. Discussion This study consists of a comprehensive multidiciplinary VR intervention involving several parties such as the municipalities, a specialized rehabilitation team, and patients’ own family caregivers. If this intervention is proven successful when compared to the conventional VR, it will provide evidence for a manual-based individualized holistic approach in returning to work after an ABI. Furthermore, the study will contribute with novel knowledge regarding feasibility and clinical effectiveness of the VR intervention relevant to clinicians, researchers, and policymakers. Trial registration ClinicalTrials.gov, NCT03086031. Registered on 21 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2115-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise K Hoeffding
- Research and development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark.,Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark.,Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Maria Haahr Nielsen
- Research and development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark.,Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Morten A Rasmussen
- Faculty of Science, Chemometrics and Analytical Technology, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Prospective Studies on Asthma in Childhood, Faculty of Health and Medical Sciences, University of Copenhagen & Danish Pediatric Asthma Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Norup
- National Study on Young Brain Injury Survivors, Department of Neurology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain.,IKERBASQUE. Basque Foundation for Science, Bilbao, Spain
| | | | - Kristoffer Sølvsten Burgdorf
- Research and development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark.,Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kirsten Jensen Quas
- Neuropsychologist, Head of Research and Development at Brain Injury Center BOMI, Roskilde, Denmark
| | - Trine Schow
- Research and development, Brain Injury Center BOMI, Maglegaardsvej 15, 4000, Roskilde, Denmark.
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Tiedtke CM, Dierckx de Casterlé B, Frings-Dresen MHW, De Boer AGEM, Greidanus MA, Tamminga SJ, De Rijk AE. Employers' experience of employees with cancer: trajectories of complex communication. J Cancer Surviv 2017; 11:562-577. [PMID: 28710544 PMCID: PMC5602070 DOI: 10.1007/s11764-017-0626-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/23/2017] [Indexed: 01/25/2023]
Abstract
Purpose Remaining in paid work is of great importance for cancer survivors, and employers play a crucial role in achieving this. Return to work (RTW) is best seen as a process. This study aims to provide insight into (1) Dutch employers’ experiences with RTW of employees with cancer and (2) the employers’ needs for support regarding this process. Methods Thirty employer representatives of medium and large for-profit and non-profit organizations were interviewed to investigate their experiences and needs in relation to employees with cancer. A Grounded Theory approach was used. Results We revealed a trajectory of complex communication and decision-making during different stages, from the moment the employee disclosed that they had been diagnosed to the period after RTW, permanent disability, or the employee’s passing away. Employers found this process demanding due to various dilemmas. Dealing with an unfavorable diagnosis and balancing both the employer’s and the employee’s interests were found to be challenging. Two types of approach to support RTW of employees with cancer were distinguished: (1) a business-oriented approach and (2) a care-oriented approach. Differences in approach were related to differences in organizational structure and employer and employee characteristics. Employers expressed a need for communication skills, information, and decision-making skills to support employees with cancer. Conclusions The employers interviewed stated that dealing with an employee with cancer is demanding and that the extensive Dutch legislation on RTW did not offer all the support needed. We recommend providing them with easily accessible information on communication and leadership training to better support employees with cancer. Implications for cancer survivors • Supporting employers by training communication and decision-making skills and providing information on cancer will contribute to improving RTW support for employees with cancer. • Knowing that the employer will usually be empathic when an employee reveals that they have been diagnosed with cancer, and that the employer also experiences difficulties and dilemmas, might lower the threshold to discuss wishes regarding disclosure, communication, and work issues. • The interests of employer and employee in relation to RTW are interrelated; both have responsibility and a role to play, and are in need of support.
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Affiliation(s)
- C M Tiedtke
- Department of Social Medicine, Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.
| | - B Dierckx de Casterlé
- Department of Public Health & Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - M H W Frings-Dresen
- Academic Medical Center, Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - A G E M De Boer
- Academic Medical Center, Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - M A Greidanus
- Academic Medical Center, Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - S J Tamminga
- Academic Medical Center, Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - A E De Rijk
- Department of Social Medicine, Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
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40
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Aryal B, Komokata T, Imoto Y. Conquering the deadly stroke: Perspective on a surgeon's odyssey. Ann Med Surg (Lond) 2017; 18:14-15. [PMID: 28507732 PMCID: PMC5423324 DOI: 10.1016/j.amsu.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/17/2017] [Accepted: 04/30/2017] [Indexed: 12/03/2022] Open
Abstract
An odyssey of a Japanese surgeon, who survived a life-threatening hemorrhagic stroke. Self-motivation and adherence to work ethics displayed by the surgeon to return to work is admirable. Passion is a detrimental factor that enables surgeons to overcome a roadblock to their career.
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Affiliation(s)
- Bibek Aryal
- Cardiovascular and Gastroenterological Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Teruo Komokata
- Department of Surgery, Kagoshima Medical Center, National Hospital Organization, Kagoshima, Japan
| | - Yutaka Imoto
- Cardiovascular and Gastroenterological Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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41
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Hellman T, Bergström A, Eriksson G, Hansen Falkdal A, Johansson U. Return to work after stroke: Important aspects shared and contrasted by five stakeholder groups. Work 2016; 55:901-911. [DOI: 10.3233/wor-162455] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Therese Hellman
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Aileen Bergström
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Gunilla Eriksson
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Annie Hansen Falkdal
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - Ulla Johansson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Research and Development, Region of Gävleborg, Gävle, Sweden
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42
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Öst Nilsson A, Eriksson G, Johansson U, Hellman T. Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme. Scand J Occup Ther 2016; 24:349-356. [DOI: 10.1080/11038128.2016.1249404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Annika Öst Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Ulla Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Therese Hellman
- Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Solna, Sweden
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43
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Donker-Cools BHPM, Schouten MJE, Wind H, Frings-Dresen MHW. Return to work following acquired brain injury: the views of patients and employers. Disabil Rehabil 2016; 40:185-191. [PMID: 27830952 DOI: 10.1080/09638288.2016.1250118] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate which factors are experienced as facilitators of or barriers to return to work (RTW), or as solutions to RTW-problems, by patients with acquired brain injury (ABI) and by employers. DESIGN Qualitative study. METHOD Ten patients with ABI and seven employers participated in semi-structured interviews. Patients and employers were unrelated. Transcripts were open coded. Factors perceived to be facilitators, barriers, or solutions to RTW-problems were grouped on a thematic basis. RESULTS Both patients and employers distinguished patient-related and work-related facilitators. When questioned about barriers, both patients and employers emphasized the importance of work-related factors such as sensory overload at the workplace and condition-related factors such as fatigue. Patients regarded poor guidance and support as barriers, but employers did not. Employers and patients suggested that solutions to RTW-problems were work-related, if necessary backed up by professional supervision. Patients also mentioned the need for understanding and acceptance of the limitations resulting from ABI. CONCLUSIONS Both patients and employers mentioned work-related and patient-related facilitators, work-related and condition-related barriers, and work-related solutions to RTW-problems. Patients mentioned lack of guidance and support as barriers, and stressed the need for understanding and acceptance of the limitations resulting from ABI in any RTW-solution. Implications for rehabilitation •Patients and employers are important stakeholders in the return to work (RTW) process of a patient with acquired brain injury (ABI) •Professionals in rehabilitation practice, occupational and insurance physicians need to help patients and employers to realize RTW •Professionals have to be aware of the perspectives of patients and employers regarding RTW, such as: ^Little understanding of limitations resulting from ABI ^Work-related aspects hindering RTW, such as sensory overload and high work pressure ^Condition-related barriers to RTW such as (invisible) cognitive limitations and fatigue ^Need for professional assistance during the RTW process.
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Affiliation(s)
- Birgit H P M Donker-Cools
- a Academic Medical Center, Department: Coronel Institute of Occupational Health , University of Amsterdam , Amsterdam , T he Netherlands.,b Research Center for Insurance Medicine , Amsterdam , The Netherlands
| | - Maria J E Schouten
- a Academic Medical Center, Department: Coronel Institute of Occupational Health , University of Amsterdam , Amsterdam , T he Netherlands.,b Research Center for Insurance Medicine , Amsterdam , The Netherlands
| | - Haije Wind
- a Academic Medical Center, Department: Coronel Institute of Occupational Health , University of Amsterdam , Amsterdam , T he Netherlands.,b Research Center for Insurance Medicine , Amsterdam , The Netherlands
| | - Monique H W Frings-Dresen
- a Academic Medical Center, Department: Coronel Institute of Occupational Health , University of Amsterdam , Amsterdam , T he Netherlands.,b Research Center for Insurance Medicine , Amsterdam , The Netherlands
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Klein R, Menon BK, Rabi D, Stell W, Hill MD. Air, rail and road: Medical Guidelines for Employees with a History of Cerebrovascular Disease. Int J Stroke 2016; 11:860-867. [DOI: 10.1177/1747493016660101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background An acute medical condition following a previous stroke among those who operate trains, airplanes, and commercial vehicles can result in serious accidents. There are guidelines in place to assist physicians and employers in assessing the risks of returning to work after stroke but the extent and comprehensiveness across nations and among safety-critical occupations are not widely known. Methods Medical guidelines currently in place to regulate safety critical occupations including railway engineers, pilots and commercial vehicle drivers were systematically reviewed. Electronic and hand literature searches as well as review of grey literature for Canada, the USA, the UK, and Australia were conducted. Results There is no consistent set of guidelines that address the risk of a second catastrophic event after an initial cerebrovascular event in those employed in safety critical occupations in the four countries assessed. Some broad principles existed between the different countries and occupations but there was major variation in the approach to cerebrovascular disease and its impact on those working in safety-critical occupations. Conclusions A synthesis of current knowledge would assist in establishing risks of a catastrophic event in those who have already suffered from cerebrovascular illness. This will allow the creation of medical guidelines which could be applied to any safety critical occupation in any nation.
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Affiliation(s)
- Rebecca Klein
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Doreen Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - William Stell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Bramwell D, Sanders C, Rogers A. A case of tightrope walking. INTERNATIONAL JOURNAL OF WORKPLACE HEALTH MANAGEMENT 2016. [DOI: 10.1108/ijwhm-01-2015-0006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Given that current policy in the UK is focused on encouraging individuals with long-term health conditions (LTCs) to work wherever possible, the purpose of this paper is to explore employer’s and manager’s perspectives of supporting those with LTCs as any successful workplace engagement will largely be influenced by their readiness to be supportive.
Design/methodology/approach
– In total, 40 semi-structured in-depth interviews were conducted with employers’ and managers’ from a range of organisations in the north-west of England during the period March 2011 to January 2012. Comparative analysis of the data was guided and informed by grounded theory principles.
Findings
– All bar one participant typified their role as one of a difficult “balancing” act of additional and often incompatible demands, pressures and feelings. It was evident that coping with this ambivalent situation incurred an emotional consequence for participants.
Practical implications
– Employers’ and managers’ response to ambivalent feelings may serve to undermine their capacity to translate supportive intentions into tangible action and are thus reflected in employee’s perceptions of unsupportive relations. Developing an intervention to raise awareness of the potential for this situation and subsequent impact on the return to work process would be beneficial for all stakeholders – the government, employees and employers alike.
Originality/value
– This in-depth study gives voice to employers and managers whose experiences and perceptions of supporting people with LTCs is largely unknown and empirically under-researched. Findings add to the wealth of research from the employee perspective to provide a more nuanced picture of the workplace for those working with and/or supporting those with LTCs.
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Balasooriya-Smeekens C, Bateman A, Mant J, De Simoni A. Barriers and facilitators to staying in work after stroke: insight from an online forum. BMJ Open 2016; 6:e009974. [PMID: 27053267 PMCID: PMC4823433 DOI: 10.1136/bmjopen-2015-009974] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore barriers and facilitators to staying in work following stroke. DESIGN Qualitative analysis of posts regarding staying in work following stroke using the archives of an online forum for stroke survivors. PARTICIPANTS 60 stroke survivors (29 male, 23 female, 8 not stated; mean age at stroke 44 years) who have returned to work, identified using terms 'return to work' and 'back at work'. SETTING Posts from UK stroke survivors and family members on Talkstroke, the forum of the Stroke Association, between 2004 and 2011. RESULTS Stroke and transient ischaemic attack (TIA) survivors reported residual impairments that for many had impact on work. Most impairments were 'invisible', including fatigue, problems with concentration, memory and personality changes. Participants described positive (eg, back at work being better than expected) and negative work experiences, including being at risk of losing the job because of stroke-related impairments. Barriers to successfully staying in work included lack of understanding of stroke--in particular invisible impairments--of survivors, employers and general practitioners (GPs), and lack of support in terms of formal adjustments, and 'feeling supported'. Stroke survivors described how they developed their own coping strategies, and how workplace and employer helped them to stay in work. CONCLUSIONS Despite having been able to return to work after a stroke, people may still experience difficulties in staying in work and risking losing their job. There is a need to improve awareness, in particular of invisible stroke-related impairments, among stroke survivors, work personnel and clinicians. This might be achieved through improved assessments of residual impairments in the workplace and in general practice. Future studies should investigate the effect of unrecognised fatigue and invisible impairments on staying in work following stroke, and explore the potential role for primary care in supporting stroke survivors who have returned to employment.
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Affiliation(s)
| | - Andrew Bateman
- The Oliver Zangwill Centre, The Princess of Wales Hospital, Ely, Cambridgeshire, UK
| | - Jonathan Mant
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anna De Simoni
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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47
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Frostad Liaset I, Lorås H. Perceived factors in return to work after acquired brain injury: A qualitative meta-synthesis. Scand J Occup Ther 2016; 23:446-57. [DOI: 10.3109/11038128.2016.1152294] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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48
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Wei XJ, Liu XF, Fong KNK. Outcomes of return-to-work after stroke rehabilitation: A systematic review. Br J Occup Ther 2016. [DOI: 10.1177/0308022615624710] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The purpose of this systematic review was to identify the outcomes of return-to-work for stroke survivors of working age after conventional stroke rehabilitation or vocational rehabilitation. Method Searches were performed using three electronic databases for literature published in English in the 10-year period 2004–2014 which included a population of working age stroke survivors who had previously participated in conventional or vocational rehabilitation, and which presented the outcomes of return-to-work. Findings The literature search yielded 10 studies that satisfied our selection criteria. Three studies involved vocational rehabilitation. Studies illustrated and compared the vocational status at or among different stages of ‘pre-stroke’, ‘post-stroke and before rehabilitation discharge’, ‘rehabilitation discharge’ and ‘follow-up’. The employment rate at follow-up ranged from 7% to 81.1%. Conclusion Methodological variations accounted for the wide range of return-to-work rates. There was limited evidence to support the conclusion that rehabilitation increases return-to-work rates for stroke survivors of working age, but recent studies showed that improvements in fatigue and cognitive function after stroke rehabilitation were related to good return-to-work outcomes. Either specialised vocational rehabilitation, conventional stroke rehabilitation or their combination is needed to increase return-to-work rates and improve the quality of life for stroke survivors of working age.
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Affiliation(s)
- Xi-Jun Wei
- PhD Candidate, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Xue-feng Liu
- Lecturer, School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, China
| | - Kenneth NK Fong
- Associate Professor, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR
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49
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Richards J, Sang K. Trade unions as employment facilitators for disabled employees. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2015. [DOI: 10.1080/09585192.2015.1126334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Donker-Cools BHPM, Daams JG, Wind H, Frings-Dresen MHW. Effective return-to-work interventions after acquired brain injury: A systematic review. Brain Inj 2015; 30:113-31. [PMID: 26645137 DOI: 10.3109/02699052.2015.1090014] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To gather knowledge about effective return-to-work (RTW) interventions for patients with acquired brain injury (ABI). METHODS A database search was performed in PubMed, EMBASE, PsycINFO, CINAHL and the Cochrane Library using keywords and Medical Subject Headings. Studies were included if they met inclusion criteria: adult patients with non-progressive ABI, working pre-injury and an intervention principally designed to improve RTW as an outcome. The methodological quality of included studies was determined and evidence was assessed qualitatively. RESULTS Twelve studies were included, of which five were randomized controlled trials and seven were cohort studies. Nine studies had sufficient methodological quality. There is strong evidence that work-directed interventions in combination with education/coaching are effective regarding RTW and there are indicative findings for the effectiveness of work-directed interventions in combination with skills training and education/coaching. Reported components of the most effective interventions were tailored approach, early intervention, involvement of patient and employer, work or workplace accommodations, work practice and training of social and work-related skills, including coping and emotional support. CONCLUSION AND IMPLICATIONS Effective RTW interventions for patients with ABI are a combination of work-directed interventions, coaching/education and/or skills training. These interventions have the potential to facilitate sustained RTW for patients with ABI.
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Affiliation(s)
- Birgit H P M Donker-Cools
- a Academic Medical Center, University of Amsterdam , Coronel Institute of Occupational Health , Amsterdam , the Netherlands.,b Research Center for Insurance Medicine , Amsterdam , the Netherlands
| | - Joost G Daams
- a Academic Medical Center, University of Amsterdam , Coronel Institute of Occupational Health , Amsterdam , the Netherlands
| | - Haije Wind
- a Academic Medical Center, University of Amsterdam , Coronel Institute of Occupational Health , Amsterdam , the Netherlands.,b Research Center for Insurance Medicine , Amsterdam , the Netherlands
| | - Monique H W Frings-Dresen
- a Academic Medical Center, University of Amsterdam , Coronel Institute of Occupational Health , Amsterdam , the Netherlands.,b Research Center for Insurance Medicine , Amsterdam , the Netherlands
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