"I've still got a job to go back to": the importance of early vocational rehabilitation after stroke

Nadia Moore; Sandra Reeder; Sophie O'Keefe; Serena Alves-Stein; Emma Schneider; Katelyn Moloney; Kate Radford; Natasha A Lannin

doi:10.1080/09638288.2023.2230125

"I've still got a job to go back to": the importance of early vocational rehabilitation after stroke

Disabil Rehabil. 2023 Jul 3:1-8. doi: 10.1080/09638288.2023.2230125. Online ahead of print.

Authors

Nadia Moore^{1

2}, Sandra Reeder^{1

3}, Sophie O'Keefe^{1

4

5}, Serena Alves-Stein^{1

2}, Emma Schneider^{1

2}, Katelyn Moloney¹, Kate Radford⁶, Natasha A Lannin^{1

2

5}

Affiliations

¹ Department of Neuroscience, Monash University, Melbourne, VIC, Australia.
² Alfred Health, Melbourne, VIC, Australia.
³ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Department of Occupational Therapy, Monash University, Melbourne, VIC, Australia.
⁵ School of Allied Health, La Trobe University, Melbourne, VIC, Australia.
⁶ School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.

PMID: 37395345
DOI: 10.1080/09638288.2023.2230125

Abstract

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.

Keywords: Stroke; occupational therapy; qualitative research; rehabilitation; return to work; vocational rehabilitation.

Plain language summary

Psychosocial (emotional) and cognitive (memory and planning) changes along with post-stroke fatigue were perceived to be the greatest barriers faced on returning to work and should be key areas for intervention within a vocational rehabilitation program.Vocational rehabilitation interventions should be tailored to each participant, incorporating elements perceived to be important to stroke survivors, including workplace liaison, employer communication and psychological support.Workplaces may benefit from access to information about the range of physical, cognitive and language deficits associated with stroke, and the potential impact these may have on work skills.