What is a return to work after stroke? 12-month outcomes in a feasibility trial

Abstract

Stroke is the single greatest cause of adult disability in the UK. A quarter of strokes affect people of working age; however, less than half of them return to work. This study described the nature of return to work and the help that people require to go back to work. A total of 46 participants were recruited from one English county. Participants were divided into 2 groups: a group receiving usual care and a group receiving extra rehabilitation. The study assessed their work status, the hours they worked, work accommodations, and what they earned at baseline, 3, 6 and 12 months after stroke. Most people returned to work after a mean of 90 days and stayed with the same employer. However, many people needed changes at work, worked fewer hours and earned less than they did before the stroke. Future research should investigate the implications of work adjustments for stroke survivors and whether the reported reductions in hours, status, roles and responsibilities are viewed as positive or negative. Objective: Stroke is the greatest cause of disability in adults. A quarter of strokes in the UK affect people of working age, yet under half of them return to work after stroke. There has been little investigation into what constitutes "return to work" following stroke. The aim of this study is to describe the work metrics of stroke survivor participants in a feasibility randomized controlled trial of an early stroke-specific vocational rehabilitation intervention. Methods: Retrospective analysis of trial data. Metrics on work status, working hours, workplace accommodations and costs were extracted from trial outcomes gathered by postal questionnaire at 3, 6, and 12 months' post-randomization for 46 stroke participants in a feasibility randomized controlled trial. Participants were randomized to receive vocational rehabilitation (intervention) or usual care (control). Results: Two-thirds (n = 29; 63%) of participants returned to work at some point in the 12 months following stroke. Participants took a mean of 90 days to return to work. Most returned to the same role with an existing employer. Only one-third of participants who were employed full-time at stroke onset were working full-time at 12 months post-stroke. Most participants experienced a reduction in pre-stroke earnings. Workplace accommodations were more common among intervention group participants. More intervention participants than control participants reported satisfaction with work at both 6 and 12 months post-randomization. Conclusion: This study illustrates the heterogeneous nature of return to work and the dramatic impact of stroke on work status, working hours and income. Longitudinal research should explore the socioeconomic legacy of stroke and include clear definitions of work and accurate measures of working hours and income from all sources.

Vocational rehabilitation to enhance return to work after trauma (ROWTATE): protocol for a non-randomised single-arm mixed-methods feasibility study

“…This is particularly true given that our intervention is novel and there is little published work evaluating vocational rehabilitation interventions in our patient population. The strengths of our study are that it builds on previous work developing and testing the feasibility of delivering a complex intervention to facilitate return to work in patients with acquired brain injury and stroke [60,61]. It is being undertaken in two study centres with diverse patient populations, differing geographies and service configurations, allowing exploration of context-specific factors that may influence running of the definitive trial.…”

“…The intervention has been informed by similar interventions previously developed by our team for patients with traumatic brain injury and stroke [60,61]. It has been developed by a multi-disciplinary team comprising OTs, clinical and neuropsychologists, a psychiatrist, vocational rehabilitation experts, a general practitioner, specialists in rehabilitation and trauma medicine, social scientists and patient representatives.…”

Return to work for adults following stroke: a scoping review of interventions, factors, barriers, and facilitators

“…1 Approximately one-fourth of stroke survivors are of working age. 2 Although return-to-work rates following stroke vary considerably, ranging from around 11% to 85%, 3 it has been estimated that more than 9 million workdays are lost in the UK alone each year because of stroke, with 26% of the total annual cost of stroke attributed to loss of productivity. 4 In addition to the economic cost, being out of the workplace due to disability has major psychosocial costs for the individual, causing reduced social capital, sense of purpose, quality of life, and standard of living.…”

“…8 Indeed, returning to work can "enhance recovery, self-esteem, confidence, social identity and overall quality of life." 9(p.953) Its importance is such that the need to promote vocational rehabilitation (which has been defined as a process where those disadvantaged by illness or disability are enabled to access, maintain, or return to employment or other useful occupation) 2 is enshrined in the United Nations Convention on the Rights of Persons with Disabilities. 10 Vocational rehabilitation needs to be supported by a strong evidence base to inform policy and the commissioning of health care services.…”

“…In 2016, there were 80.1 million stroke survivors and 13.7 million new strokes worldwide, giving rise to 116.4 million disability-adjusted life years 1 . Approximately one-fourth of stroke survivors are of working age 2 . Although return-to-work rates following stroke vary considerably, ranging from around 11% to 85%, 3 it has been estimated that more than 9 million workdays are lost in the UK alone each year because of stroke, with 26% of the total annual cost of stroke attributed to loss of productivity 4 …”