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successive increase in working hours per week and
was experienced to facilitate RTW. Those who had
such a stepwise process were satisfied with it. They
perceived that advice clarity about sick leave and to
learn a step-by-step RTW according to one’s capacity
helped them. In order to facilitate work performance
after stroke, Burns and co-workers (23) recommend
performance-based assessments, specific evaluations
of work activities and work environment, education
and interventions that include employer collaboration.
Flexible work schedules are recommended by Hartke
and co-workers (24). Education and assessment of
work ability are important to facilitate RTW accor-
ding to Hellman and co-workers (10). A job analysis
can be a first step in a stepwise RTW process (10)
and supply the rehabilitation team and employers
with early knowledge and factual information about
each patient. Suitable organization platforms at work
where all rehabilitation actors can cooperate are also
of importance for RTW (20).
A stepwise RTW implies a rehabilitation plan that
could be revised several times (25). Also, all rehabi-
litation actors need adequate training and improved
awareness of best practice guidelines to help stroke
patients in their stepwise process to RTW (26, 27).
The third subcategory showed that the participants
wanted early information, an early rehabilitation plan,
early contact with the rehabilitation unit, a contact
person and regular health contacts in order to improve
RTW. Information about healthcare issues, stroke and
its consequences, as well as knowledge about hidden
disabilities, such as overload of sensory stimuli, cog-
nitive impairments and fatigue, were requested. Today
in Sweden, the hospital stay has been shortened and
may be only a few days. This may mean that hidden
disabilities may not be discovered until later at home
when life and work demands increase.
Early information may lead to a clearer picture of the
person’s abilities and limitations and facilitate the RTW
process according to the fourth subcategory. With im-
proved knowledge, patients can, in their turn, provide
improved information to their employers, co-workers
and relatives, who may also need stroke-related in-
formation (10, 21). Brochures and e-health tools (28)
can be developed to inform employers, relatives and
other stakeholders about the consequences of stroke.
Relevant information can be given to employers at
re-activation meetings, and relatives can be informed
at structured follow-ups. A rehabilitation plan, based
on the International Classification of Functioning,
Disability and Health concept (ICF) (29) has been
shown to encourage and increase participation in the
rehabilitation process. Such a rehabilitation plan should
be developed in the early phase and follow the patient
www.medicaljournals.se/jrm
throughout the process. A contact person to provide
psychosocial support and coordination in the RTW
process was asked for, a need also described earlier (10,
20). Such a contact person may also share early discus-
sions of work-related issues with patients, employers
and relatives, which may facilitate RTW (10, 20).
Moreover, regular healthcare contacts were believed
to facilitate RTW and these contacts could be arranged
by organizing structured follow-ups, which are recom-
mended by the national guidelines from the Swedish
National Board of Health and Welfare (9). Another
perceived barrier to RTW was insufficient communi-
cation and coordination between rehabilitation actors.
The participants requested improved communication
within the hospital care, as well as communication
and coordination between the hospital and primary
healthcare. The rehabilitation plan and the designated
contact person discussed earlier can also be used as a
communicator to facilitate improved interaction bet-
ween the healthcare actors. Regular meetings between
all stakeholders can facilitate coordination of the VR,
potential work adjustments and future planning.
In the second category, it was described that in-
creased support in daily life would facilitate RTW.
Transport problems to and from work, as well as
practical help and psychological support for the family
were perceived as barriers to RTW. The participants
had difficulties in managing both work and home
tasks. Transport was a barrier to RTW for those who
had driving restrictions after stroke or those lacking
public transport or with long walking distances. Re-
search indicates that the inability to drive a car may
be a barrier to RTW (23). An interdisciplinary practice
model for adults with mild stroke has been developed
to enable successful return to driving and work. The
model can be used in community rehabilitation to sup-
port recovery, transition, adaptation and community
reintegration (23).
The participants emphasized that lack of practical
help with household chores and children, as well as
psychosocial support for the family, were barriers to
RTW. These aspects have, to our knowledge not been
highlighted previously. Psychosocial family needs may
be addressed in professional counselling, as well as
in a virtual context (23) by, for example, video com-
munication, smart phones or apps. We suggest that
community support services should be developed and
include stroke survivors’ family situation and children.
To further optimize RTW, community support services
should be integrated with the process. Education by
healthcare professionals to relevant stakeholders in
society may improve the situation. After referral and
relevant evaluations, persons with mild stroke can
receive necessary community support, for example