Experiences of return-to-work support: A case-study comparison between recipients of Early Stroke Specialist Vocational Rehabilitation and stroke survivors receiving usual care only

Abstract

Introduction: Twenty-five percent of stroke survivors are of working age, yet the likelihood of successful return-to-work is low. This study compared experiences of recipients of Early Stroke Specialist Vocational Rehabilitation (ESSVR), an intervention to help stroke survivors return to work (RTW), with stroke survivors receiving usual care (UC) only.

Method: Longitudinal case-study exploring experiences of stroke survivors who received ESSVR and those who received usual care (UC) only. Data were gathered using semi-structured interviews at 6 weeks, and 6- and 12-months post-randomisation. Findings were analysed thematically and mapped onto the APC model (Schwartz et al, 2018) which highlights three basic principles guiding RTW: Adaptiveness, Purposefulness and Cooperativeness in interactions between the person, the workplace and rehabilitation services.

Results: Analysis indicates differences between ESSVR and UC participants’ RTW experiences. ESSVR participants report being supported to adapt to new circumstances following stroke by occupational therapists (OTs) providing tailored vocational rehabilitation (VR) and advocating for workplace adaptations and adjustments. Co-ordinated support ensured that stakeholders worked purposefully, with ESSVR OTs providing information and advice over 12 months. This facilitated cooperativeness, enabling a sustained RTW. In contrast, most UC participants reported little or no RTW support. They described a lack of communication and co-ordination between services and feeling ‘abandoned’ following discharge from community services, typically after 12 weeks.

Conclusion: The APC model helped highlight the benefits of ESSVR. Specifically, stakeholders working together to adapt to stroke survivors’ changed abilities, being purposeful in delivery and receipt of VR support, and co-operating with OTs’ recommendations to facilitate successful and sustained RTW.