Journal of Rehabilitation Medicine 51-10 | Page 23

Healthcare-related factors in RTW after stroke
such as “Can you tell more about that?” One of the authors (GG
or IL) was the moderator and led the discussion. Three other
researchers alternated as observers and asked supplementary
questions. All had experience of stroke patients, but had not
met the participants previously. The moderator endeavoured
to create a trusting and supportive atmosphere to encourage all
participants to share their views. The focus groups consisted
of 3–5 participants and lasted for a median of 60 min (range
40–70 min). The discussions were audio-recorded and tran­
scribed verbatim.
Analysis
The data were analysed using qualitative content analysis ac-
cording to Graneheim & Lundman (15) in the following steps:
first, the interview text was read as a whole and all content
answering the research questions were identified as meaning
units and categorized by 2 researchers (GG and IL) indepen-
dently of each other. Thereafter, meaning units were identified,
coded and sorted into subcategories and categories. A theme was
also developed (15). The findings were discussed and validated
several times between all authors. Quotations were inserted to
validate the findings.
Ethics
The project was conducted in accordance with the Declaration
of Helsinki (18) and approved by the Regional Ethics Review
Board in Lund (Dnr 2016/1064). Written informed consent
was obtained from all participants. Collected data were treated
confidentially so that no individual could be identified.
RESULTS
In the analysis, an overall theme “Need for structu-
red healthcare organization and support for return to
work (RTW)” with 2 categories emerged: “Requesting
rehabilitation planning, healthcare information and
coordination”, and “Increased support in daily life
would facilitate RTW”. The theme with categories and
subcategories is described in Fig. 1. Each category and
subcategory is described below with relevant quotations.
Main theme
Categories
Subcategories
743
Requesting rehabilitation planning, healthcare
information and coordination
Adequate rehabilitation content and a stepwise RTW
were facilitating factors, while insufficient commu-
nication between rehabilitation actors were barriers
in the rehabilitation process. To improve the RTW
process, the participants requested more information
about stroke and its consequences and about regula-
tions. Moreover, they asked for a rehabilitation plan
in the early phase after injury, early contact with the
rehabilitation unit, a contact person throughout the
RTW process, and improved coordination between the
rehabilitation actors.
Adequate rehabilitation content and timing
facilitated return to work
RTW was facilitated by adequate rehabilitation con-
tent and timing. Positive experiences of rehabilitation
interventions were, for example, interdisciplinary
team rehabilitation or specific interventions, such as
physiotherapy, cognitive behaviour therapy (CBT),
mindfulness and consultations with occupational
therapists and psychologists. Other facilitators were
to be aware of the importance of rest to recover, to
be responsive to bodily signals, but also to perform
regular physical activity.
That’s [CBT] probably what has made it possible for me to
increase my working hours now. I use mindfulness or guided
meditation… and it helps. I’ve [also] been called up by an
occupational therapist once a month and that’s been very
good… to exchange ideas (Inf. 4).
Some participants reported that it was easier to receive
rehabilitation for physical problems compared with
psychosocial problems. A barrier to RTW was a lack of
satisfactory psychosocial support. Continuing psycho-
social support was needed, as was the opportunity to
Need for structured healthcare organization and support for return to work (RTW)
Requesting rehabilitation planning, health care information and
coordination
Adequate
rehabilitation
content and
timing
facilitated
RTW
Stepwise
return to
work
facilitated
the RTW
process
Lack of
early
information,
regular
contact and a
rehabilitation
plan were
barriers to
RTW
Insufficient
communi-
cation
between
rehabilitation
actors
hindered
RTW
Increased support in daily life
would facilitate RTW
Work
transport
problems
impeded
RTW
Lack of
practical help
and
psychological
support for
the family
were barriers
for RTW
Fig. 1. Theme with cathegories and subcathegories.
J Rehabil Med 51, 2019