Accident vasculaire cérébral (AVC)

Purpose Stroke is a leading cause of disability, significantly impacting survivors' ability to return-to-work (RTW). This study aims to explore the qualitative experiences of stroke survivors and caregivers participating in a work skills training programme. The research objectives are to understand participants' (i) perceived benefits of the programme, (ii) perceived challenges and drawbacks of the programme, and (iii) suggestions for improvement and future recommendations. Methods Thirteen participants (seven stroke survivors and six caregivers) completed the four-week programme. Data were collected through post-workshop focus group discussions, which was analyzed using thematic analysis. Results Key perceived benefits identified included communication tools, platform for sharing and support, reflections and shifts in mindset, and goal setting and values exploration. Perceived challenges and drawbacks highlighted were difficulty understanding certain workshop content, technical difficulties, and length of workshop sessions. Suggestions for improvement and future recommendations included assessing capacity and readiness to RTW and customizing content to participant needs. Conclusions This study provides valuable insights into the experiences of stroke survivors and caregivers in a work skills training programme. While significant benefits were identified, areas for improvement remain. These insights will guide the development of more effective and tailored interventions grounded in participants' needs and perspectives.

© Chen NYC; Chee A; Dong Y. Disability & Rehabilitation. 1-8, 2024 Sep 16.

Purpose The aim of the study was to synthesize the body of knowledge on the factors that are important to the process of returning to work after ischaemic stroke in young adults under 55 years of age. Methods Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA checklist for scoping reviews were used. A total of 2,249 studies were identified through a bibliographic search in six databases. Results A total of ten studies were finally selected to respond to the research questions. Eight studies were quantitative observational studies, and two studies had a case study design. The rate of returning to work varied between the studies. The frequency of returning to work in young stroke patients, independent of the time of assessment, ranged from 42.4% to 86%. Returning to work after ischaemic stroke in young adults is a complex process and multidimensional problem which is affected by clinical variables (level of neurological deficits, cognitive ability, independency in activities of daily living, fatigue and depression, cardiovascular factors), as well as the socioeconomic and occupational status. Conclusion There is insufficient evidence concerning interventions promoting return to work. Future studies should focus on examining effective interventions to help young stroke survivors return to work.

© Bartonickova D; Gurkova E; Zelenikova R; Kalafutova S. Central European Journal of Public Health. 32(2):108-118, 2024 Jun.

Purpose The international incidence of stroke in people of working age is rising. As such, meaningful work return is a major rehabilitation goal for many individuals, including those with aphasia. This scoping review aimed to outline the post-stroke aphasia evidence related to work outcomes, factors influencing employment along with contemporary vocational-language and communication rehabilitation practice. Methods The review employed terms related to aphasia, stroke, rehabilitation, and return to work in publications preceding 25.6.2023. Data were descriptively analysed, and vocational outcomes were summarized at defined timepoints. Results Of the 908 articles reviewed, 31 papers were included. Individuals with post-stroke aphasia consistently have lower rates of return to work than those post-stroke without aphasia. Employment at one year was 34.29% for those with aphasia compared to 58.46% for people without aphasia. No literature reported vocational-language assessment practices and there were minimal work-focused aphasia interventions identified. There was insufficient evidence to clearly identify person-related, rehabilitation, workplace or other factors influencing work return. Conclusion This scoping review has identified that there are gaps in knowledge about the factors that influence work return and targeted vocational rehabilitation for this group. Future research to optimize return to work for individuals with aphasia is recommended.

© Burfein P; Roxbury T; Doig EJ; McSween MP; de Silva N; Copland DA.  Neuropsychological Rehabilitation. 1-35, 2024 Aug 01.

Purpose People with communication disability after stroke experience low rates of return to vocational roles. Vocational rehabilitation is recommended; however, there are no clear guidelines informing vocational rehabilitation for people with communication disability. Understanding the needs and experiences of this population is critical to improving vocational stroke rehabilitation outcomes. This study aimed to: (1) investigate the experience of vocational rehabilitation for people with communication disability after stroke, (2) identify gaps and, (3) provide preliminary recommendations for tailored service delivery. Methods Seven participants with an identified communication impairment following stroke were recruited from a larger clinical trial of early vocational rehabilitation (20% of total sample, n = 34). To address the study aims, a qualitative design was employed. Semi-structured, in-depth interviews were conducted and analysed using thematic analysis. Data were integrated with demographic and intervention audit data to contextualise participant experiences, identify vocational rehabilitation gaps and inform preliminary recommendations. Results Participants were five men and two women aged 24–69 years whose communication profiles included difficulties with auditory comprehension and information processing, reading comprehension, thinking, executive function and self-regulation, as well as difficulties with verbal and written expression. Vocational rehabilitation was perceived as beneficial but participants identified gaps including limited access to psychological and peer-based support during early rehabilitation, limitations to accessing specialist vocational rehabilitation programs, barriers to accessing ongoing rehabilitation after resumption of vocational activity, and limited preparedness for the degree of impact that their communication changes had on execution of vocational roles and responsibilities. Conclusion Vocational environments are communicatively demanding and people living with acquired communication difficulties face a range of vocation-related participation barriers even when communication difficulties are mild. Greater emphasis on evaluating the vocational communication environment and targeted communication training and preparation for colleagues within the workplace is recommended to reduce barriers faced. Interdisciplinary rehabilitation, inclusive of psychological care, may support working-age stroke survivors to recognise and acknowledge changes in their communication function, lead to improved engagement in the rehabilitation process, and ensure early identification of factors likely to influence successful return-to-vocational activity.

© Lanyon L, Shiggins C, Baker C, Stein SA, O'Keefe S, Schneider EJ, Godecke E, Radford K, Lannin NA. International Journal of Language & Communication Disorders. Aug2024

Purpose Professional reintegration is an indicator of recovery and a common goal for many stroke survivors. However, data on the effect of professional reintegration on the quality of life (QoL) of stroke survivors is scarce. Aims: To assess and synthesize the available evidence, and identify the gaps on the effect of professional reintegration on the QoL of stroke survivors. Methods A scoping review was performed, following PRISMA-ScR guidelines. The electronic databases PubMed, ISI Web of Science, PsycINFO, and SciELO were searched for empirical, peer-reviewed, original, and full-length studies on the effect of professional reintegration on QoL of stroke survivors. The main quantitative findings were synthesized and qualitative data was explored by thematic content analysis. Results The included studies, 7 quantitative, 1 qualitative, and 1 mixed-methods, were published between 2009 and 2021. The assessment of QoL was highly heterogenic but globally most studies reported a significant and positive association between return to work (RTW) and QoL, 3 to 36 months post-stroke. For some stroke survivors, being able to focus on their rehabilitation was more important for their QoL than RTW. Conclusions The results highlight the importance of investing in professional reintegration after stroke to improve survivors' QoL. Further mixed-methods longitudinal research, performed in different countries and settings, with higher, homogeneous, and comparable samples, providing a broader approach to professional reintegration and the use of specific and standardized instruments to assess subjective domains of stroke survivors' QoL, is needed.

© Matos JIF; Teixeira F; Alves E. Journal of Stroke & Cerebrovascular Diseases. 107858, 2024 Jul 10.

Purpose Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact. Objectives: 1) compare characteristics for individuals who before stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators. Methods Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan-Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed. Results A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension. Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator. Conclusion Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified.

© Garcia-Rudolph A; Wright M; Cisek K; Garcia L; Cusso H; Sauri J; Opisso E. Topics in Stroke Rehabilitation. 31(6):604-614, 2024 Sep.

Purpose To explore the associations between fatigue impact and (a) personal and stroke-related characteristics, (b) functional impairments and (c) work-related factors among individuals who have returned to work after stroke. Methods Design: A cross-sectional exploratory study. Subjects: 87 working stroke survivors. Data collection and analysis: This study comprises data from a postal survey targeting work ability and perceived stroke-related consequences 1 year after stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Factors associated with having fatigue (FSS total score >= 4) were identified using univariable and multivariable logistic regression analyses. Three domain-specific multivariable models and 1 final combined model were created. Results Fatigue was reported by 43% of the participants. Several factors representing all the investigated domains were associated with fatigue. In the final combined regression model, self-perceived low cognitive functioning, low decision control at work and high quantitative job demands had the strongest independent effects on the odds of having fatigue. Conclusion Among people who were working 1 year after stroke, fatigue was associated with both personal and stroke-related characteristics as well as functional impairments and work-related factors. This highlights the complex nature of post-stroke fatigue. Fatigue management interventions should have a comprehensive approach and also consider the work environment.

© Norlander A; Lindgren I; Brogardh C. Journal of Rehabilitation Medicine. 56:jrm18668, 2024 Mar 14.

Purpose Knowledge on long-term participation is scarce for patients with paid employment at the time of stroke. Objective: Describe the characteristics and the course of participation (paid employment and overall participation) in patients who did and did not remain in paid employment. Methods Patients with paid employment at the time of stroke completed questions on work up to 30 months after starting rehabilitation, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P, Frequency, Restrictions and Satisfaction scales) up to 24 months. Baseline characteristics of patients with and without paid employment at 30 months were compared using Fisher's Exact Tests and Mann-Whitney U Tests. USER-P scores over time were analysed using Linear Mixed Models. Results Of the 170 included patients (median age 54.2 interquartile range 11.2 years; 40% women) 50.6% reported paid employment at 30 months. Those returning to work reported at baseline more working hours, better quality of life and communication, were more often self-employed and in an office job. The USER-P scores did not change statistically significantly over time. Conclusion About half of the stroke patients remained in paid employment. Optimizing interventions for returning to work and achieving meaningful participation outside of employment seem desirable.

© van Meijeren-Pont W; van Velzen JM; Volker G; Arwert HJ; Meesters JJL; de Kloet AJ; van Bennekom CAM; Vliet Vlieland TPM; Tamminga SJ; Oosterveer DM. Work. 77(3):839-850, 2024.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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