Disability management after stroke: its medical aspects for workplace accommodation

Association Between Types of Chronic Disease and Receiving Workplace Accommodations: A Cross-Sectional Study of Japanese Workers

OBJECTIVE

This study aimed to evaluate the association between the type of chronic disease and receiving workplace accommodations.

METHODS

This online cross-sectional study analyzed a self-reported questionnaire administered in Japan. A total of 6775 full-time workers who reported needing work accommodations were included.

RESULTS

Workplace accommodations were more likely to be provided for workers with cancer, mental illness, and benign gynecological disorders than for workers with no disease under treatment. In contrast, workplace accommodations were less likely for workers with low back pain and skin diseases.

CONCLUSIONS

Receiving workplace accommodations depends on the type of chronic disease. Chronic diseases for which workers frequently receive workplace accommodations may be those for which support is encouraged by law. It is necessary to support workers with chronic diseases that do not receive adequate workplace accommodations.

How does Gender Influence Sustainable Return to Work Following Prolonged Work Disability? An Interpretive Description Study

PURPOSE

A sustainable return to work (S-RTW) following prolonged work disability poses different challenges, depending on gender. This article provides a synthesis of gender differences in the issues and factors influencing the S-RTW of workers following such a disability.

METHODS

Using an interpretive description method, an integrative review was conducted of the literature on gender differences in S-RTW issues and factors associated with four major causes of work disability. The initial review concerned the 2000-2016 literature; it was subsequently updated for November 2016-March 2020. To explore and contextualise the results, four focus groups were held with stakeholders representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed.

RESULTS

A total of 47 articles were reviewed, and 35 stakeholders participated in the focus groups. The prevailing traditional gender roles were found to have a major gender-specific influence on the attitudes, behaviours, processes and outcomes associated with S-RTW. These differences related to the (1) cumulative workload, (2) work engagement, and (3) expressed and addressed needs.

CONCLUSIONS

The results highlight the importance of taking into account both professional and personal aspects when integrating gender issues into the assessment of workers' needs and subsequently into interventions.

Structural validity and reliability of the return to work assessment scale among post stroke survivors

BACKGROUND

Return to work (RTW) after injury or illness is a behavior influenced by physical, psychological and social factors. This study aims to determine the structural validity and reliability of a return to work assessment scale using internal consistency and factor analysis.

METHOD

A cross sectional survey research design was adopted for this study involving 101 Post stroke survivors. The return to work assessment scale, which was developed by Ibikunle et al. in 2019, was subjected to structural validity and reliability.

RESULT

The results reveal that 58 (57.4%) were males and 43 (42.2%) females with mean ages of 53.88±10.68 years. Internal consistency was high with a Cronbach's alpha coefficient of 0.81 for Domain 1, 0.93 for Domain 2 and 0.76 for Domain 3.Test-retest reliability analysis gave an ICC of 0.85(p = 0.001) for Domain 1, Domain 2 an ICC of 0.91 (p = 0.001) and Domain 3 an ICC of 0.99 (p = 0.001). The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) value for Domain 1 was X2  = 0.63 and that of Bartlett's test of sphericity value was significant (P = 0.000), Kaiser-Meyer-Olkin measure of sampling adequacy for Domain 2 was 0.84 and the Bartlett's test of sphericity value was significant (P = 0.000), the Kaiser-Meyer-Olkin measure of sampling adequacy for Domain 3 was 0.66 while the Barlett's test of sphericity was significant (p = 0.001). Therefore the factor analysis was appropriate.

CONCLUSION

The return to work assessment scale is a good, internally consistent and reliable tool that has demonstrated good group and structural validity.

Motivation in the return to work process: a self-determination cluster approach

PURPOSE

Motivation may predict return to work (RTW), yet the measurement of motivation needs more scientific evidence. We adopt a dimensional approach, based on the self-determination theory (SDT), distinguishing between amotivation, controlled and autonomous motivation. We seek to explore the presence of these dimensions in sick-disabled patients, and are interested in associations with quality of life, depression, patient's predictions of RTW, and health care provider estimations of patient's motivation.

MATERIALS AND METHODS

A cross-sectional study in 336 patients was conducted. Motivation was assessed using the Motivation at Work Scale (MAWS) and examined in relation to patient outcomes, patient's prediction of RTW, and health care provider estimations of patients' motivation. A cluster analysis was performed, and differential associations between motivational profiles were explored.

RESULTS

Cluster analysis revealed four profiles. Highly controlled profiles were most prevalent, reported poorer mental quality of life, and expected a longer time before RTW, regardless of the level of autonomous motivation. Interestingly, the health care provider's estimation was not related to controlled motivation.

CONCLUSIONS

Our results show that SDT may help to differentiate people with a work disability regarding their motivation to RTW. Most notably, the devastating consequences of controlled motivation are discussed, and clinical implications are provided.Implications for RehabilitationAssessing the different dimensions of motivation in the context of RTW will be a significant advance as the self-report measures appear to be viable tools.Controlled motivation, which indicates that people are motivated to RTW but only because they "have to", has negative consequences yet a high prevalence and should therefore be addressed by the practitioner.Practitioners should keep in mind that employees are motivated by several motives at the same time, with some being more beneficial than others.Controlled motivation can be converted into autonomous (i.e., good quality) motivation by supporting autonomy of the patient, by supporting their relationships with colleagues, managers, and health care providers and by supporting their feeling of competence in the RTW process.

A Vocational Rehabilitation Intervention Framework for People With Rheumatoid Arthritis

This article presents the Illinois Work and Well-Being Model (IW2M) as a framework that can be applied to facilitate vocational rehabilitation interventions for people with rheumatoid arthritis (RA). The model encompasses the interaction of contextual and career development domains to improve participation in the areas of work, society, community, and home. A discussion of the model's implications regarding vocational rehabilitation service and research is offered, with the overall goal of reinforcing career development as the foundation of vocational rehabilitation services for people with RA and other emerging age-related disabling conditions.

Return to work after specialized rehabilitation-An explorative longitudinal study in a cohort of severely disabled persons with stroke in seven countries: The Sunnaas International Network stroke study

INTRODUCTION

Stroke may impose disabilities with severe consequences for the individual, with physical, psychological, social, and work-related consequences. The objective with the current study was to investigate to what extent persons with stroke were able to return to work, to maintain their financial situation, and to describe the follow-up services and participation in social networks and recreational activities.

METHODS

The design was a prospective, descriptive study of specialized stroke rehabilitation in nine rehabilitation centers in seven countries. Semistructured interviews, which focused on the return to work, the financial situation, follow-up services, the maintenance of recreational activities, and networks, were performed 6 and 12 months post discharge from rehabilitation.

RESULTS

The working rate before the onset of stroke ranged from 27% to 86%. At 12 months post stroke, the return to work varied from 11% to 43%. Consequently, many reported a reduced financial situation from 10% to 70% at 6 months and from 10% to 80% at 12 months. Access to postrehabilitation follow-up services varied in the different countries from 24% to 100% at 6 months and from 21% to 100% at 12 months. Physical therapy was the most common follow-up services reported. Persons with stroke were less active in recreational activities and experienced reduced social networks. Associations between results from the semistructured interviews and related themes in LiSat-11 were small to moderate. The study shows that education, age, and disability are predictors for return to work. Differences between countries were observed in the extent of unemployment.

CONCLUSIONS

In this international multicentre study, return to work after severe stroke and specialized/comprehensive rehabilitation was possible, depending on the extent of the disability, age, and education. Altered financial situation, reduced social networks, and reduced satisfaction with life were common psychosocial situations for these patients.

Return to work predictors of stroke survivors and their spousal caregivers

BACKGROUND

Return to work is an issue of concern for stroke survivors and their spouses. Ramifications may include loss of income and self-efficacy.

OBJECTIVE

This study describes the return to work patterns of stroke survivors and their spousal caregivers post stroke.

METHODS

One hundred fifty-nine dyads were examined for their return to work patterns at baseline (post hospital discharge) and then at 3 month intervals for one year. Relationships were determined between work and gender, age, ethnicity, education, type of insurance, type of stroke, location of stroke, motor and cognitive functional status, depression, mutuality, and life satisfaction.

RESULTS

Low levels of return to work by stroke survivors (7.5%) and a small decrease in the amount of working caregivers (from 45.3% to 40.35%) were found one year post baseline. Variables that predicted return to work changed over the five data points except for younger age for the caregiver, which was consistently significant across all data points. Three case scenarios representative of working patterns are offered.

CONCLUSIONS

Further research is needed regarding the return to work needs of stroke survivors and their spousal caregivers, particularly what role the occupational therapist may play in facilitating that process.

Comparison of the Time Course of Return to Work After Stroke Between Two Cohort Studies in Japan

The conditions for stroke rehabilitation such as individual therapeutic procedure and medical treatment system in Japan have drastically changed over the past decade: increasing incidence of ischemic stroke, the use of intravenous recombinant tissue plasminogen activator, hospital specialization, introduction of convalescent rehabilitation wards, and public long-term care insurance. However, it is not known whether these changes have influenced the time course of return to work (RTW) after stroke. In this study we compared the time course of RTW after stroke in Japan that was reported in two cohort studies performed 20 years apart. The cumulative rate of RTW after first stroke was similar in the two studies, even though they were separated by an interval of two decades. This shows that advances in stroke rehabilitation have not impacted RTW, and we suggest that the social security system, particularly sickness benefit, has a strong influence on RTW.

Researching Complex and Multi-Level Workplace Factors Affecting Disability and Prolonged Sickness Absence

Purpose There is growing research evidence that workplace factors influence disability outcomes, but these variables reflect a variety of stakeholder perspectives, measurement tools, and methodologies. The goal of this article is to summarize existing research of workplace factors in relation to disability, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results Predominant factors in the scientific literature were categorized as physical or psychosocial job demands, work organization and support, and workplace beliefs and attitudes. Employees experiencing musculoskeletal disorders in large organizations were the most frequently studied population. Research varied with respect to the basic unit of assessment (e.g., worker, supervisor, policy level) and whether assessments should be based on worker perceptions, written policies, or observable practices. The grey literature suggested that employers focus primarily on defining roles and responsibilities, standardizing management tools and procedures, being prompt and proactive, and attending to the individualized needs of workers. Industry publications reflected a high reliance of employers on a strict biomedical model in contrast to the more psychosocial framework that appears to guide research designs. Conclusion Assessing workplace factors at multiple levels, within small and medium-sized organizations, and at a more granular level may help to clarify generalizable concepts of organizational support that can be translated to specific employer strategies involving personnel, tools, and practices.

Outcomes of return-to-work after stroke rehabilitation: A systematic review

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.

Sickness absence and return to work among Japanese stroke survivors: a 365-day cohort study

OBJECTIVES

The objective of this study was to investigate the cumulative return to work (RTW) rate and to clarify the predictors of the time to full-time RTW (full RTW) and resignation among Japanese stroke survivors, within the 365-day period following their initial day of sickness absence due to stroke.

SETTING

This study was based on tertiary prevention of occupational health in large-scaled Japanese companies of various industries.

PARTICIPANTS

The participants in this study were 382 Japanese workers who experienced an episode of sickness leave due to clinically certified stroke diagnosed between 1 January 2000 and 31 December 2011. Data were obtained from an occupational health register. Participants were followed up for 365 days after the start day of the first sickness absence. The cumulative RTW rates by Kaplan-Meier estimates and predictors for time to full RTW and resignation by Cox regression were calculated.

RESULTS

A total of 382 employees had their first sickness absence due to stroke during the 12-year follow-up period. The cumulative full RTW rates at 60, 120, 180 and 365 days were 15.1%, 33.6%, 43.5% and 62.4%, respectively. Employees who took sick leave due to cerebral haemorrhage had a longer time to full RTW (HR, 0.50; 95% CI 0.36 to 0.69) than those with cerebral infarction. Older employees (over 50 years of age) demonstrated a shorter time to resignation than younger employees (HR, 3.30; 95% CI 1.17 to 9.33). Manual workers had a longer time to resignation than non-manual workers (HR, 0.24; 95% CI 0.07 to 0.78).

CONCLUSIONS

Cumulative RTW rates depended on the subtype of stroke, and older age was a predictor of resignation.

Functional and occupational characteristics predictive of a return to work within 18 months after stroke in Japan: implications for rehabilitation

Objective

This study examined clinical, functional, and occupational factors associated with return to work within 18 months after stroke, specifically focusing on the impact of higher cortical dysfunction on return to work in the chronic phase.

Methods

This prospective cohort study in 21 hospitals specializing in clinical and occupational health recruited consecutive working-age inpatients receiving acute care for their first stroke (n = 351). A unified database was used to extract patient information from hospital records at the time of admission, discharge, and follow-up at 18 months post-stroke. Cox proportional hazard regression analysis was conducted to determine clinical, functional, and occupational factors influencing return to work within 18 months.

Results

Of 351 registered stroke patients (280 males, 71 females, mean age ± SD, 55.3 ± 7.2 years) who met inclusion criteria, 250 responded to the follow-up survey and 101 were lost to follow-up. Half (51 %) succeeded in returning to work during the 18-month follow-up after stroke onset. After adjusting for age, gender, and Barthel index at initial rehabilitation, the following factors were identified as significant predictors of a return to work: white-collar versus blue-collar occupation (hazard ratio (HR) 1.5; 95 % confidence interval (CI) 1.1–2.2), no aphasia (HR 3.0; 95 % CI 1.5–5.9), no attention dysfunction (HR 2.0; 95 % CI 1.0–4.0), and walking ability (HR 3.1; 95 % CI 1.3–7.1).

Conclusions

This study indicated the importance of tailored rehabilitation to alleviate the impact of higher cortical dysfunction and to support return to work by stroke survivors.

Enterprise size and return to work after stroke

INTRODUCTION

It has been hypothesised that return to work rates among sick-listed workers increases with enterprise size. The aim of the present study was to estimate the effect of enterprise size on the odds of returning to work among previously employed stroke patients in Denmark, 2000-2006.

METHODS

We used a prospective design with a 2 year follow-up period. The study population consisted of 13,178 stroke patients divided into four enterprise sizes categories, according to the place of their employment prior to the stroke: micro (1-9 employees), small (10-49 employees), medium (50-249 employees) and large (>250 employees). The analysis was based on nationwide data on enterprise size from Statistics Denmark merged with data from the Danish occupational hospitalisation register.

RESULTS

We found a statistically significant association (p = 0.034); each increase in enterprise size category was followed by an increase in the estimated odds of returning to work.

CONCLUSIONS

The chances of returning to work after stroke increases as the size of enterprise increases. Preventive efforts and research aimed at finding ways of mitigating the effect are warranted.

Analysis of One Stroke Survivor's Transition into Vocational Experiences

Background and Aims: Return to work presents a unique transition for the person with mild stroke who is often unsupported and does not anticipate difficulties from hidden impairments. The aim of this study was to explore the return to work experience from the perspective of one person with mild stroke.

Methods: An inductive thematic analysis was undertaken with a narrative of e-mail correspondence from a person with mild stroke. The analysis follows the participant from three to six years after stroke during a process of upskilling and training for return to work.

Results: The female participant was 32 years old at the time of stroke and returned to tertiary studies after experiencing difficulties with initial return to work. Four themes emerged from the analysis of the narrative: I don't know which identity to choose, My anxieties and reactions, I need support and structure, and I am exhausted.

Discussion: The results demonstrate the impact of hidden impairments on the struggle to reconcile a past with present identity. The process of reconciliation was ongoing and dependent on work-based experiences that enhanced understanding of strengths and limitations, and required adaptations. The impact of fatigue on performance in work and non-work time was highlighted.

Impact of Stroke on Return to Work

Stroke has a marked impact on the ability to return to work. However, the stroke and its residual cognitive, physical and language deficits do not fully explain return-to-work success. While those with very severe deficits are less likely to return to work, and presence of disability is important, other extrinsic and intrinsic factors, such as having a job to go back to, beliefs and attitudes about work, job markets and the benefits system all play an important part. Vocational rehabilitation services developed with the stroke service user in mind are scarce in the United Kingdom. However, recent government interest in vocational rehabilitation and a recognition that evidence to support poststroke vocational rehabilitation is lacking have prompted efforts to develop new vocational rehabilitation services. People with stroke need specialist vocational rehabilitation services delivered by those who have an in-depth understanding of stroke and its effects. Service developers need to acknowledge and address factors that enable or impede return to work after stroke in service design. Research is needed to evaluate vocational rehabilitation interventions aimed specifically at the needs of stroke patients.

Barriers and facilitators of return to work for individuals with strokes: perspectives of the stroke survivor, vocational specialist, and employer

The purpose of this study was to identify factors that facilitated or acted as a barrier to return to work (RTW) for stroke survivors. We applied 3 approaches to identify the factors. First, we conducted qualitative interviews with 10 stroke survivors about their RTW experience post stroke. Second, we surveyed 21 vocational specialists about barriers and facilitators of RTW based on their clinical practice. Last, we interviewed 7 employers who had experience in interviewing individuals with disabilities or had the authority to make hiring decisions. Descriptions of barriers and facilitators to RTW from these 3 perspectives were illustrated. Identified components were mapped based on the ICF framework. From stroke survivors' perspectives, factors affecting employment after stroke include neurological (motor, cognition, communication), social, personal, and environmental factors. Vocational specialists described similar barriers and facilitators of RTW as the stroke survivors but emphasized personal factors such as flexibility and being realistic in vocational goals. The employers explained that the candidate's disability plays no role in the hiring process and indicated that all applicants must meet the essential job requirements. Some employers described the benefits of having the support of vocational rehabilitation staff and being able to interact with the vocational rehabilitation specialists during the hiring process. The interaction allows the employer to gather initial information (consented to by the job applicant) about the applicants from the vocational rehabilitation service and to be educated about any specific needs related to the applicant's medical issues.

The psychology of stroke in young adults: the roles of service provision and return to work

Literature about the psychological consequences of stroke in those under 65 is reviewed focussing on services and work. Despite similarities, young and old survivors have different experiences and needs. These are attributable to the effects of stroke on age-normative roles and activities, self-image, and the young person's stage in the life-cycle, especially family and work. "Hidden" cognitive impairments, a disrupted sense of self, and the incongruity of suffering an "older person's" disease are salient. Young survivors benefit from services, but experience lack of congruence between their needs and service philosophy, methods, and aims, and consequently have unmet needs. Employment is psychologically salient, and the evidence about return rates, factors that affect return, and the adequacy of employment-related service provision is reviewed. Specific and general recommendations are made for increasing congruence between young survivors' needs and service provision and also for facilitating their return to work.

The return to work after a neuropsychological programme and prognostic factors for success

INTRODUCTION

Several factors influence the return to work (RTW) after brain injury (BI). The aims of the study were to follow-up the RTW after a vocational neuropsychological programme for individuals with a brain injury and to explore factors predicting RTW. The hypothesis was that as self-awareness was already addressed in the programme, severity of injury would have a greater impact on RTW.

METHOD

Sixty-five of 72 persons (median age 27) who had attended the programme 1998-2003 were interviewed about their occupation at 1, 2, 3 and 5 years after the programme. A logistic regression was made with the variables concerning process skill, somatic problems and irritability, the digit symbol coding and pre-morbid occupation to explore predictors of RTW.

RESULTS

The main cause was TBI (44.6%). Before injury 77% were employed or studied and after the injury 80% did not have any occupation. After 5 years 40% had returned to work. The only significant variable in the regression was the pre-morbid occupation.

DISCUSSION

The study stresses the difficulty to know the key elements involved in RTW which confirms the need for rehabilitation to focus on several factors in different contexts in order to affect the outcome.

The personal and workplace factors relevant to work readiness evaluation following acquired brain injury: occupational therapists' perceptions

OBJECTIVE

This study examined the personal and workplace/environmental factors perceived most relevant to work readiness evaluations following acquired brain injury.

RESEARCH DESIGN

Using a qualitative secondary analysis design 'indicators of success' and 'risks of failure', identified as relevant in a primary study of occupational therapists' evaluation practices, were explored further.

METHOD

Data collected in the primary study, e.g. interviews, practice surveys, evaluation protocols, were re-analysed. Surveys and protocols were used to define participant and practice context characteristics. Interviews were coded, by three investigators, using a constructivist grounded theory approach.

RESULTS

Four themes emerged describing relevant personal client attributes: (1) motivation; (2) physical and functional independence; (3) cognitive abilities; and (4) use of compensatory strategies and feedback. Four themes emerged describing relevant workplace factors: (1) workplace demands; (2) employer risks and burden; (3) risks associated with information sharing; and (4) financial implications associated with return to work.

CONCLUSIONS

Findings suggest that work readiness needs to be viewed as both a client and a workplace issue. Findings are translated into questions for rehabilitation professionals to guide evaluations of work readiness. Recommendations for future research include investigating how professionals weigh factors in their decision-making and exploring strategies relevant from a workplace perspective.

Changing face of stroke: implications for occupational therapy practice

Stroke is one of the most life-altering syndromes affecting the world population. Rehabilitation for people experiencing stroke is focused almost exclusively on self-care activities and being able to return home and has little to no focus on work rehabilitation or community reintegration. The Cognitive Rehabilitation Research Group (CRRG) at the Washington University School of Medicine in St. Louis was formed with the vision of improving everyday life for people after stroke by translating knowledge from neuroscience into treatment programs for productive living. Descriptive analysis of the intake assessment from the CRRG Clinical Core (N = 7,740) revealed three important findings: The age at stroke is decreasing, most strokes are neurologically mild to moderate in nature, and discharge placement decisions are being made largely on the basis of measures of impairment. The changes in the stroke population require occupational therapy to expand rehabilitation beyond the acute management of stroke to address full participation in work, family, and community life.

Returning to work after stroke: a review

This review focuses on the experiences and rehabilitation needs of working age, higher functioning stroke survivors in relation to their 'return to work'. It grew out of the poststroke experience of one of the authors and her realization of the inadequacy of services to facilitate return to work and optimal recovery from stroke. The authors' aim is to present a practice-oriented review that can provide information for future practice and research. Returning to work and sustaining employment are considered key aspects of rehabilitation and recovery by younger stroke survivors. From a psychosocial perspective, successful return to work can enhance recovery and life satisfaction by consolidating self-esteem, confidence and social identity. However, even higher functioning stroke survivors with minimal or no obvious physical disability may experience workplace challenges relating to their neurological condition. Appropriate rehabilitation would include specific preparation for return to work, education within the workplace to facilitate return to work, participation by the stroke survivor in all aspects of the management of their return to work, and an ongoing role for a stroke educator/workplace advocate. In conclusion, further research is required in this area to support stroke survivors in returning to and maintaining employment to achieve their poststroke potential. Thirteen recommendations arising from the existing literature and the lived experience of one of the authors are presented at the end of the review.

Return to work in stroke patients

PURPOSE

To present the current state of knowledge regarding return to work (RTW) following stroke.

METHOD

A comprehensive review of the current stroke rehabilitation literature pertaining to prognostic and treatment factors for RTW following stroke.

RESULTS

Stroke is a major healthcare problem and one of the most expensive diseases in modern society. Stroke results not only in impairment and limitation in basic daily activities; it also impacts on participation in community activities, such as returning to work. Return to work in post-stroke patients has been reported to range between 19% and 73%. Various studies report on return to work in diverse populations, using different follow-up periods, while utilizing variable definitions of stroke and successful work outcomes. The factors positively related to RTW in stroke patients, as found in the literature, are age less then 65 years, high education level and white-collar employment. The significant negative predictor is the severity of stroke. This is indicated by neurological parameters including functional measures of the presence and extent of motor and cognitive impairment. Significantly, the side of the brain damaged and stroke location were not found to be correlated with RTW. Social and financial factors also significantly influence RTW.

CONCLUSIONS

RTW in stroke patients should be considered one of the indicators of a successful rehabilitation as it influences self-image, well-being and life satisfaction. There is still a considerable lack of knowledge regarding effective assessments and interventions in vocational rehabilitation in stroke patients.

Activity limitations in personal, domestic and vocational tasks: a study of adults with inborn and early acquired mobility disorders

PURPOSE

To compare activity limitations at the workplace with those in the home situation.

SUBJECTS AND METHODS

Sixty-nine subjects, 22-49 years of age, with inborn or early acquired mobility disorders and with experience of vocational employment were studied. They were interviewed to assess their level of dependence according to the Functional Independence Measure (FIM) and Instrumental Activity Measure (IAM) and in 22 vocation-related items. Rasch analysis was perfomed in order to assess the relative difficulty of the items. In the vocational items the subjects rated perceived difficulty on a 4-level scale. Satisfaction in one general and six domain-specific areas was rated on a 6-level scale.

RESULTS

Forty-six per cent of the subjects were dependent in one or several FIM items, 90% in IAM items and 38% in the vocation-related items. In 15 of these items great difficulty was reported by few subjects. Collapsing the 7-category scale for dependence to four categories gave the best Rasch model. Most of the IAM items were the hardest to manage without assistance. FIM social-cognitive and cognitive vocation-related items were the easiest items. Most subjects were satisfied in the general and domain-specific areas.

CONCLUSIONS

Activities related to household tasks and transportation demonstrated the highest level of dependence, whereas it was easier to acquire independence in most vocation-related tasks.

Stroke patients' experiences of return to work

Purpose. The aim of this study was to describe the experience of return to work (RTW) after stroke from the patient's perspective.Method. Six patients who had their first ever stroke in 2001, were <65 years of age and were working at the time of their stroke were included. Information was obtained via an open-ended interview. The material was transcribed verbatim and analysed using Giorgi's empirical phenomenology.Results. Rehabilitation was perceived as primarily aimed at restoring bodily functions and a return to everyday activities, rather than at promoting a return to work. It was not experienced as adapted to the participants' needs or their age. The workplace was experienced as very important in the rehabilitation process. When the informants experienced that the rehabilitation professionals were not taking action, they took control of the situation themselves. The informants expressed pride in their own capacity to take the initiative and in their ability to take action. Both self-employed and employed informants said they had possibilities and opportunities to take action since their work situation was flexible. The informants' adaptation to a new role at work was perceived as facilitated by the understanding and positive attitude of co-workers.Conclusion. Among this group of stroke patients, the individual patient's capacity and ability to return to work was enhanced by motivation or "will" and self-efficacy in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. There are similarities between the RTW process and processes of health promotion.

What are the social consequences of stroke for working-aged adults? A systematic review

BACKGROUND AND PURPOSE

Approximately one fourth of strokes occur in people aged <65 years. UK current policy calls for services that meet the specific needs of working-aged adults with stroke. We aimed to identify the social consequences of stroke in working-aged adults, which might subsequently inform the development and evaluation of services for this group.

METHODS

We reviewed quantitative and qualitative studies identifying social consequences for working-aged adults with stroke using multiple search strategies (electronic databases, bibliographic references, hand searches). Social consequences were defined as those pertaining to the World Health Organization International Classification of Functioning, Disability and Health domain "participation." Two authors reviewed articles using a standardized matrix for data extraction.

RESULTS

Seventy-eight studies were included: 66 were quantitative observational studies, 2 were quantitative interventional studies, 9 were qualitative studies, and one used mixed methods. Seventy studies reported data on return to work after stroke with proportions ranging from 0% to 100%. Other categories of social consequences included negative impact on family relationships (5% to 54%), deterioration in sexual life (5% to 76%), economic difficulties (24% to 33%), and deterioration in leisure activities (15% to 79%).

CONCLUSIONS

Methodological variations account for the wide range of rates of return to work after stroke. There is limited evidence of the negative impact of stroke on other aspects of social participation. Robust estimates of the prevalence of such outcomes are required to inform the development of appropriate interventions. We propose strategies by which methodology and reporting in this field might be improved.

Clinical utility of predictors of return-to-work outcome following work-related musculoskeletal injury

INTRODUCTION

Clinical expertise is one source of evidence that is generally under-utilised in the development of an evidence-base in rehabilitation. The current study aimed to incorporate this valuable clinical expertise in determining the utility of multiple predictors of return-to-work outcome following injury.

METHODS

Following systematic review of the rehabilitation literature and review, a total of 85 predictors were evaluated for clinical relevance by an expert panel of rehabilitation practitioners (n = 12). Each predictor was rated according the importance of the predictor in rehabilitation, its potential for modification and its classification into one of seven broad areas. In addition, practitioners were asked to provide a rationale as to why the predictor was important to rehabilitation. Analyses were conducted using inter-rater agreement statistics and text analysis.

RESULTS

Predictors that were most commonly reviewed in the literature were not considered to be of greatest clinical utility, according to the current sample. From the total predictor set, only nine predictors were identified as clinically useful (i.e., both highly important and highly modifiable). Text analysis of the qualitative data revealed that these nine predictors highlighted the significance of time, context and engagement in rehabilitation practice.

CONCLUSION

In the current study, predictors that were considered most clinically relevant were those that generally described workplace related processes. The findings confirmed the underlying supportive and collaborative processes that integrate predictors and account for their influence on outcome. Future rehabilitation efforts and indeed, individual outcomes, could benefit by incorporating these key predictors in targeted programs.

The association between stroke location and return to work after first stroke

Although various factors, including age, race, job category, disability, and cortical function, have been associated with return to work (RTW) after stroke, few studies have examined the influence of stroke location on RTW. We conducted a retrospective cohort study on the association between stroke location and RTW after first stroke. The patients were all younger than age 65 years and were working at the time of their stroke (n = 126). A follow-up questionnaire evaluated RTW. Data were analyzed using the Cox proportional hazards model for hazard ratios (HRs) of successful RTW, taking potential confounding factors into consideration. The Cox model revealed that maximum weakness (HR 3.74, normal vs severe), apraxia (10.7, no vs yes), and occupation (2.11, white collar vs blue collar) were significant predictors, but stroke location was not a significant predictor. We conclude that stroke location is less important than other easily measured factors in predicting RTW.

Return to work and the person with heart failure

Heart failure (HF) is an economic and social problem for millions of Americans. Medical bills and living costs can be an overwhelming stress on the person diagnosed with this life-threatening disorder. Once the acute condition has been stabilized, nurses are often called on to provide counseling and to act as an advocate for the person with HF who is attempting to return to work. The purpose of this article is to review the literature on return to work and to offer suggestions for the nurse who is treating persons with HF. It is recommended that nurses be prepared to assess patients with HF, to provide resources, and to act as an advocate as needed. Further research is needed on the safe and effective transition of persons with HF into the workforce.

Work integration issues go beyond the nature of the communication disorder

The ability to obtain and maintain employment is one of society's most valued life participation events and is often considered in measurements of quality of life (QOL). Many workplaces now require good communication skills and this may jeopardize the opportunity for persons with communication disorders (CD) to access interesting jobs. Sarno, Silverman, and Levita (1970) have long emphasized that functioning is a result of the interaction of psychosocial factors as well as communication disorder characteristics. The current study gathered perceptions from different groups of persons with CD, from service providers and employers on the barriers to work integration. The results show that many barriers are common across types of CD. Such examples are noise, tasks requiring speed, having to speak to groups of persons and the attitudes of others. Although some common barriers were identified between the service providers and the persons with CD, service providers placed more emphasis on psychological adaptation aspects than did persons with CD. Employers generated an equivalently long list of barriers but were also very concerned about job market issues.

LEARNING OUTCOMES

As a result of this activity, the following learning outcomes will be realized: participants will be able to (1) identify barriers that service providers and persons with CD each perceive; (2) identify differences in the perceptions of each group concerning barriers; (3) learn ways to modify or eliminate barriers that interfere with successful employment among individuals with CD.