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Gard G1,2, Pessah-Rasmussen H3, Brogårdh C3,4, Nilsson Å3, Lindgren I3,4
1Lund University, Health Sciences, Lund, Sweden, 2Luleå University of Technology, Health Sciences, Luleå, Sweden, 3Lund University, Department of Neurology and Rehabilitation Medicine, Lund, Sweden, 4Lund University, Department of Health Sciences, Lund, Sweden
Background: Having the opportunity to return to work (RTW) after stroke is important for health and well-being and participation in society. In Sweden, we have about 25 000 stroke survivors each year, of which 20% are 65 years or younger. Stroke in younger ages leads to a substantial societal economic burden. Organizational barriers are common for example barriers within the health care context, communication problems and/or negative attitudes towards workplace adjustments.
RTW after stroke can be facilitated by health care-related factors and the accessibility of appropriate services. In Sweden, acute stroke care is provided in stroke units and most patients are discharged directly home. The RTW organization of stroke patients varies between hospitals, municipalities and County Councils. Four stakeholders provide support for RTW in vocational rehabilitation; The Health Care organization, the Social Insurance Office (SIO), the Employment Agency (EA) and the Employers. The health care providers work in a multi-disciplinary team based organization with cooperation between each other and with SIO. Earlier qualitative studies in this area from the stroke patient´s perspective showed that health care is fragmented with communication and co-operations problems between patient and health care providers. A deepened knowledge of stroke survivors´ experiences of health care related facilitators and barriers to improve RTW is needed.
Purpose: To explore stroke survivors´ experiences of health care related facilitators and barriers to improve RTW after stroke.
Methods: A qualitative study using focus group interviews were performed. A sample of 20 stroke survivors were selected from an on-going questionnaire study. All fulfilled the following criteria:
1) being admitted to Skåne University Hospital for acute stroke care,
2) aged 18-64 years at stroke onset,
3) referred to the hospital's stroke rehabilitation outpatient clinic within 180 days after stroke onset, and
4) worked at least 10 hours per week prior to the stroke.
The focus group interviews were analyzed by qualitative content analysis. Written informed consent was obtained from all participants.
Results: An overall theme,” Needs of improved health care organization and societal support” and two categories ´Requesting earlier information, an updated individual rehab plan and coordination´ and ´Increased support from society is warranted´ emerged from the results. The stroke survivors experienced a lack of 1) health-care information, regular contacts and rehabilitation plan` and 2) communication between rehabilitation actors' and in relation to employers. A tailored rehabilitation content and timing was crucial for RTW. They needed information about regulations, and increased psychosocial support and a stepwise RTW process'. They also asked for support from society in terms of help to solve work transport problems and practical help with home care tasks, children and families.
Conclusion(s): The stroke survivors experienced a need of improved health care organization and societal support such as earlier information, an updated individual rehab plan and improved coordination of services.
Implications: Early relevant information, continuous planning and coordination of the vocational rehabilitation, an individual rehabilitation plan and improved psychosocial support have to be developed and used in stroke rehabilitation.
Keywords: return to work, qualitative, stroke
Funding acknowledgements: Funding was provided by Färs och Frosta bank in Sweden
RTW after stroke can be facilitated by health care-related factors and the accessibility of appropriate services. In Sweden, acute stroke care is provided in stroke units and most patients are discharged directly home. The RTW organization of stroke patients varies between hospitals, municipalities and County Councils. Four stakeholders provide support for RTW in vocational rehabilitation; The Health Care organization, the Social Insurance Office (SIO), the Employment Agency (EA) and the Employers. The health care providers work in a multi-disciplinary team based organization with cooperation between each other and with SIO. Earlier qualitative studies in this area from the stroke patient´s perspective showed that health care is fragmented with communication and co-operations problems between patient and health care providers. A deepened knowledge of stroke survivors´ experiences of health care related facilitators and barriers to improve RTW is needed.
Purpose: To explore stroke survivors´ experiences of health care related facilitators and barriers to improve RTW after stroke.
Methods: A qualitative study using focus group interviews were performed. A sample of 20 stroke survivors were selected from an on-going questionnaire study. All fulfilled the following criteria:
1) being admitted to Skåne University Hospital for acute stroke care,
2) aged 18-64 years at stroke onset,
3) referred to the hospital's stroke rehabilitation outpatient clinic within 180 days after stroke onset, and
4) worked at least 10 hours per week prior to the stroke.
The focus group interviews were analyzed by qualitative content analysis. Written informed consent was obtained from all participants.
Results: An overall theme,” Needs of improved health care organization and societal support” and two categories ´Requesting earlier information, an updated individual rehab plan and coordination´ and ´Increased support from society is warranted´ emerged from the results. The stroke survivors experienced a lack of 1) health-care information, regular contacts and rehabilitation plan` and 2) communication between rehabilitation actors' and in relation to employers. A tailored rehabilitation content and timing was crucial for RTW. They needed information about regulations, and increased psychosocial support and a stepwise RTW process'. They also asked for support from society in terms of help to solve work transport problems and practical help with home care tasks, children and families.
Conclusion(s): The stroke survivors experienced a need of improved health care organization and societal support such as earlier information, an updated individual rehab plan and improved coordination of services.
Implications: Early relevant information, continuous planning and coordination of the vocational rehabilitation, an individual rehabilitation plan and improved psychosocial support have to be developed and used in stroke rehabilitation.
Keywords: return to work, qualitative, stroke
Funding acknowledgements: Funding was provided by Färs och Frosta bank in Sweden
Topic: Disability & rehabilitation; Neurology: stroke; Occupational health & ergonomics
Ethics approval required: Yes
Institution: Lund University
Ethics committee: Regional Ethical Board in Lund Sweden
Ethics number: Dnr 2016/1064)
All authors, affiliations and abstracts have been published as submitted.
