Journal of Rehabilitation Medicine 51-10 | Page 25

Healthcare-related factors in RTW after stroke
Insufficient communication between rehabilitation
actors hindered return to work
Insufficient communication and coordination between
healthcare professionals and rehabilitation actors (hos-
pital, rehabilitation unit, primary healthcare, social
insurance company); for example, regarding prescrip-
tions and length of sick leave were barriers to RTW.
Repeated short periods of sick leave were stressful and
different physicians had different opinions about the
length of sick leave.
There should’ve been someone to coordinate information
to the Swedish Social Insurance Agency, to work, a contact
person who helps me, who speaks for me and helps me with
for example compensation from insurances.[It would be nice
if] all information was in one and the same place, to get it
from one source only (Inf. 16).
The physicians here at the hospital did not agree with
the stroke rehab physicians about when I was going to start
working (Inf. 5).
I had to run back and forth to the primary healthcare centre
to get [the sick leave] renewed… it was very stressful (Inf. 4).
Increased support in daily life would facilitate return
to work
Lack of support in daily life, such as help with work
transport, practical help in the home situation and
psychosocial support for the families were perceived
as barriers. The participants suggested that increased
support could facilitate RTW.
Work transport problems impeded return to work
Transport to and from work were barriers to RTW for
those who had driving restrictions after stroke, for
those without access to public transportation and for
those who had long walking distances to public trans-
portation. Some participants were allowed to drive,
but did not have the energy to drive longer distances.
Problems with work transport could be reduced by
working from home.
I wasn’t allowed to drive a car, which immediately led to
long days when you had to take the bus and it was a long
walk to the bus. I thought that was the worst part, getting to
and from work (Inf. 6).
Lack of practical help and psychological support for
the family were barriers to RTW. Home care barriers
to RTW were also expressed, such as lack of help with
housework and children and need for psychological
support for the family.
There was no support [from society or other], so my wife had
to take care of every single thing at home. Had I been alone with
the kids, I wouldn’t have been able to go back to work (Inf. 8).
I’m alone in my household. It’s difficult for me to manage
a full-time job and to take care of the entire home (Inf. 6).
745
I did get help from a psychologist. But my family! They
don’t get any questions about support (Inf. 8).
But I would’ve liked support for my family, for my kids, who
still think it’s a bit traumatic… to [get help with] explaining
to the kids… that somebody else had taken care of everyone
in the family (Inf. 17).
DISCUSSION
The aim of this study was to explore stroke survivors’
experiences of healthcare-related facilitators and barriers
to improve RTW after stroke. When analysing the data
from the participants, a theme, “Need for structured
healthcare organization and support for RTW” with 2
categories, “Requesting rehabilitation planning, healt-
hcare information and coordination” and “Increased
support in daily life would facilitate RTW” emerged as
the result. Facilitating factors expressed were a tailored
rehabilitation content with effective treatments, adequate
timing and a structured stepwise RTW process. A lack
of sufficient early healthcare information, rehabilitation
planning and coordination were perceived as barriers.
An early rehabilitation plan, early contact with the reha-
bilitation unit, a contact person, and improved commu-
nication between rehabilitation actors were requested.
Increased support in daily life, including transport to and
from work, home care and psychosocial support for the
families were also requested.
Adequate rehabilitation content and timing facili-
tated RTW according to the first subcategory within
the category “Requesting rehabilitation planning,
healthcare information and coordination”. To receive
a rehabilitation content tailored to the patients’ needs
was experienced as a facilitator. Interdisciplinary
rehabilitation, physiotherapeutic interventions, and
psychosocial support were examples of facilitative
treatments for RTW. The opportunity to rest and re-
cover, to be responsive to bodily signals, but also to
perform regular physical activity, were also mentioned
as facilitators. The rehabilitation has to be coordinated
with vocational rehabilitation (10, 19, 20). However,
not only the content of the rehabilitation, but also the
timing was important for RTW. Early psychosocial
support was requested, but also support after a while,
when new questions about the future arose. A compe-
tent rehabilitation professional may be responsible for
providing such support, knowledge and opportunities
for group discussions. Earlier research has confirmed
the importance of psychosocial information, motiva-
tional support and practical advice (20). It is important
that RTW programmes address psychosocial aspects
(21, 22).
The second subcategory, “Stepwise return to work
facilitates the RTW process” was described as a
J Rehabil Med 51, 2019