Journal of Rehabilitation Medicine 51-10 | Page 21

J Rehabil Med 2019; 51: 741–748 ORIGINAL REPORT NEED FOR STRUCTURED HEALTHCARE ORGANIZATION AND SUPPORT FOR RETURN TO WORK AFTER STROKE IN SWEDEN: EXPERIENCES OF STROKE SURVIVORS Gunvor GARD, PhD 1,4 , Hélène PESSAH-RASMUSSEN, PhD 2,3 , Christina BROGÅRDH, PhD 1,2 , Åsa NILSSON, MD 2 and Ingrid LINDGREN, PhD 1,2 From the 1 Department of Health Sciences, Physiotherapy Research Group, Lund University, 2 Department of Neurology, Rehabilitation Medicine, Memory Diseases and Geriatrics, Skåne University Hospital, 3 Department of Clinical Sciences, Lund University, Lund, and 4 Department of Health Sciences, Luleå University of Technology, Luleå, Sweden Objective: To explore stroke survivors’ experiences of healthcare-related facilitators and barriers con- cerning return to work after stroke. Design: A qualitative study. Setting: Outpatient stroke rehabilitation unit at a University Hospital in southern Sweden. Participants: A convenience sample of 20 persons admitted to Skåne University Hospital for acute stro- ke care (median age 52 years), in employment of at least 10 h per week at stroke onset and been refer- red to stroke rehabilitation within 180 days. Methods: The interviews were performed by fo- cus groups, and the data were analysed by content analysis. Results: Facilitating factors were a tailored rehabi- litation content with relevant treatments, adequate timing and a structured stepwise return-to-work process. A lack of sufficient early healthcare informa- tion, rehabilitation planning and coordination were perceived as barriers. An early rehabilitation plan, a contact person, and improved communication bet- ween rehabilitation actors were requested, as well as help with work transport, home care, children and psychosocial support for families. Conclusion: Tailored rehabilitation content and a structured stepwise return-to-work process facilita- ted return to work. Insufficient structure within the healthcare system and lack of support in daily life were perceived barriers to return to work, and need to be improved. These aspects should be considered in the return-to-work process after stroke. Key words: stroke; return to work; healthcare; qualitative research. Accepted Aug 14, 2019; Epub ahead of print Aug 28, 2019 J Rehabil Med 2019; 51: 741–748 Correspondence address: Gunvor Gard, Department of Health Sci- ences, Physiotherapy Research Group, Lund University, Lund, Sweden. E-mail: [email protected] T o be able to return to work (RTW) after stroke is important for health and well-being (1) and parti- cipation in society. In Sweden, approximately 23,000 persons have a stroke every year (2), 20% of whom are of working age. Stroke at a younger age leads to LAY ABSTRACT To be able to return to work after stroke is important for health and well-being and participation in society. In this qualitative study, 20 stroke survivors were in- terviewed in focus groups about their experiences of healthcare-related facilitators and barriers. Perceived facilitating factors were a tailored rehabilitation content and a structured stepwise return-to-work process. A lack of sufficient early healthcare information, rehabili- tation planning and coordination were perceived as bar- riers. An early rehabilitation plan, a contact person, and improved communication between rehabilitation actors were requested, as well as help with work transport, home care, children and psychosocial support for fami- lies. These aspects should be considered in order to im- prove the return-to-work process after stroke. a substantial societal economic burden. The degree of disability after stroke is a strong determinant of eco- nomic cost. Concerning indirect costs for sick leave or disability pension, no clear relationship has been found between work absence and level of functional disability among stroke survivors aged 65 years or younger (3). The proportion of persons who RTW ranges from 19% to 73% (4), which indicates a need for an improved RTW process. The United Nations (UN) declare that it is important to promote early RTW for persons with disabilities (5). RTW is a complex process, which can be facilitated or impeded by organizational, environmental or personal factors. Work climate, flexibility in work schedules and work adaptations, realistic occupational goals and availability of rehabilitation services have been shown to facilitate RTW. Also, flexible involvement of family, employers and co-workers, and personal factors, such as coping ability and motivation, facilitate RTW (1, 6, 7). Lack of cooperation between the clinical and employment sector and negative attitudes towards workplace adjustments from employers, as well as personal factors, such as stroke severity, fatigue and depression, are barriers to RTW (1, 6). Self-rated health 3 months after stroke has been shown to be strongly associated with RTW and a sustainable working situa- tion after stroke (8). This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2591