Experiences of support to return to work after stroke: longitudinal case studies from RETAKE trial
Background Returning to work after stroke has physical, psychological and financial benefits for stroke survivors. However, global evidence estimates return-to-work rates 1 year post stroke at < 50%. Although its importance is acknowledged by policy-makers and healthcare providers, vocational reh...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
NIHR Journals Library
2025-03-01
|
| Series: | Health Technology Assessment |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/WRKS9661 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849391479628234752 |
|---|---|
| author | Diane Trusson Katie Powers Kathryn Radford Audrey Bowen Kristelle Craven Jain Holmes Rebecca Lindley Christopher McKevitt Julie Phillips Ellen Thompson Caroline Watkins David J Clarke |
| author_facet | Diane Trusson Katie Powers Kathryn Radford Audrey Bowen Kristelle Craven Jain Holmes Rebecca Lindley Christopher McKevitt Julie Phillips Ellen Thompson Caroline Watkins David J Clarke |
| author_sort | Diane Trusson |
| collection | DOAJ |
| description | Background Returning to work after stroke has physical, psychological and financial benefits for stroke survivors. However, global evidence estimates return-to-work rates 1 year post stroke at < 50%. Although its importance is acknowledged by policy-makers and healthcare providers, vocational rehabilitation is not always part of National Health Service usual care post stroke. Currently, there is limited evidence of the effectiveness of return-to-work support interventions. RETurn to work After stroKE was a multicentre individually randomised controlled pragmatic trial, with embedded process and health economic evaluations. RETurn to work After stroKE aimed to establish whether Early Stroke Specialist Vocational Rehabilitation plus usual care improves the likelihood of return to work at 12 months post stroke compared to usual care alone. As part of an embedded process evaluation, longitudinal case studies enabled exploration of participants’ experiences of support to return to work in the trial. Objectives This article aims to understand participants’ experiences of being supported to return to work and explores the social and structural factors which support, or act as barriers to, implementation of the Early Stroke Specialist Vocational Rehabilitation intervention. Method A longitudinal case-study approach was used to compare experiences of post-stroke return-to-work support received over 12 months by 15 participants who received the Early Stroke Specialist Vocational Rehabilitation intervention plus usual care, and 11 participants who received usual care only. Data were gathered at three time points using follow-up questionnaires, health records, intervention delivery records and semistructured interviews with participants and seven nominated informal carers. Interviews were also conducted with 1 employer and 11 occupational therapists delivering the intervention. Setting Sixteen National Health Service sites across England and Wales. Findings In the intervention arm, stroke survivors, carers and employers reported benefits from information and support from the treating occupational therapist to facilitate acceptance of, and adaptation to, post-stroke abilities. Participants also valued occupational therapists’ provision of sustained and tailored vocational rehabilitation, co-ordinating their care and advocating for them in return-to-work discussions with their employers. Those unable to return to their previous employment were supported to consider alternative options. In contrast, participants who received usual care only reported feeling abandoned when community rehabilitation support ended, typically after 2–8 weeks. Usual care largely focused on restoring physical function, leaving these participants struggling to find return-to-work information, advice and support. Longitudinal case studies enabled psychosocial and environmental factors impacting on participants’ return-to-work experiences to be considered. Limitations Recruitment to the process evaluation was impacted by the COVID-19 pandemic. It proved difficult to recruit employers for interview, and fewer women participated in the case studies (21 men, 5 women). Direct observation of intervention delivery could not be carried out as planned due to pandemic restrictions on access to clinical areas. Conclusions These case studies highlighted self-reported differences between recipients of the Early Stroke Specialist Vocational Rehabilitation intervention plus usual care and participants allocated to usual care only. Aspects perceived as important in underpinning the differences in support included the length of Early Stroke Specialist Vocational Rehabilitation intervention, occupational therapist advocacy, employer liaison and ongoing workplace monitoring. Provision of these core components as part of post-stroke services may support and help to sustain return to work, with associated benefits for stroke survivors and wider society. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/130/11.
Plain language summary Returning to work has physical, mental and financial benefits for stroke survivors. There are also benefits for society when stroke survivors return to work because they contribute to the economy and are less likely to claim state benefits. However, support for stroke survivors to return to work is not always provided as part of usual care following stroke. We designed an intervention called Early Stroke Specialist Vocational Rehabilitation. Specially trained occupational therapists provide stroke survivors, their carers and their employers with information and return-to-work support for 12 months following stroke. To find out what difference it made, we interviewed 15 stroke survivors who received the intervention, plus their carers and occupational therapists. Their experiences were compared with 11 stroke survivors who only received usual care. They were interviewed three times during the first year following stroke. Stroke survivors’ chances of returning to work were affected by a range of factors, including post-stroke impairments and how these impacted their ability to do their job. Employers’ willingness and ability to provide reasonable adjustments were also influential. Stroke survivors who received the intervention benefited from return-to-work support which was designed around their individual needs. They valued the occupational therapist organising their care and discussing return-to-work arrangements with their employers. If they were unable to return to their previous job, occupational therapists discussed alternative options. In contrast, stroke survivors who received usual care often felt abandoned when it finished after 2–8 weeks. Care usually focussed on physical ability, leaving them struggling to find return-to-work information and support. Sometimes they returned to work too early and then experienced problems with long-term effects of stroke, for example, tiredness. Overall, we found that usual care is often insufficient for working-age stroke survivors and their chances of returning, and staying, in work may be improved by the intervention. |
| format | Article |
| id | doaj-art-0c77aef8aeae4b849c0706559536af20 |
| institution | Kabale University |
| issn | 2046-4924 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | NIHR Journals Library |
| record_format | Article |
| series | Health Technology Assessment |
| spelling | doaj-art-0c77aef8aeae4b849c0706559536af202025-08-20T03:41:04ZengNIHR Journals LibraryHealth Technology Assessment2046-49242025-03-0110.3310/WRKS9661NIHR136216Experiences of support to return to work after stroke: longitudinal case studies from RETAKE trialDiane Trusson0Katie Powers1Kathryn Radford2Audrey Bowen3Kristelle Craven4Jain Holmes5Rebecca Lindley6Christopher McKevitt7Julie Phillips8Ellen Thompson9Caroline Watkins10David J Clarke11School of Medicine, University of Nottingham, Nottingham, UKSchool of Medicine, University of Nottingham, Nottingham, UKCentre for Rehabilitation and Ageing Research, School of Medicine, University of Nottingham, Nottingham, UKDivision of Psychology & Mental Health, University of Manchester, Manchester, UKSchool of Medicine, University of Nottingham, Nottingham, UKSchool of Medicine, University of Nottingham, Nottingham, UKSchool of Medicine, University of Nottingham, Nottingham, UKDepartment of Population Health Sciences, King’s College London, London, UKSchool of Medicine, University of Nottingham, Nottingham, UKClinical Trials Research Unit, University of Leeds, Leeds, UKFaculty of Health and Care, University of Central Lancashire, Lancashire, UKSchool of Medicine, University of Leeds, West Yorkshire, UKBackground Returning to work after stroke has physical, psychological and financial benefits for stroke survivors. However, global evidence estimates return-to-work rates 1 year post stroke at < 50%. Although its importance is acknowledged by policy-makers and healthcare providers, vocational rehabilitation is not always part of National Health Service usual care post stroke. Currently, there is limited evidence of the effectiveness of return-to-work support interventions. RETurn to work After stroKE was a multicentre individually randomised controlled pragmatic trial, with embedded process and health economic evaluations. RETurn to work After stroKE aimed to establish whether Early Stroke Specialist Vocational Rehabilitation plus usual care improves the likelihood of return to work at 12 months post stroke compared to usual care alone. As part of an embedded process evaluation, longitudinal case studies enabled exploration of participants’ experiences of support to return to work in the trial. Objectives This article aims to understand participants’ experiences of being supported to return to work and explores the social and structural factors which support, or act as barriers to, implementation of the Early Stroke Specialist Vocational Rehabilitation intervention. Method A longitudinal case-study approach was used to compare experiences of post-stroke return-to-work support received over 12 months by 15 participants who received the Early Stroke Specialist Vocational Rehabilitation intervention plus usual care, and 11 participants who received usual care only. Data were gathered at three time points using follow-up questionnaires, health records, intervention delivery records and semistructured interviews with participants and seven nominated informal carers. Interviews were also conducted with 1 employer and 11 occupational therapists delivering the intervention. Setting Sixteen National Health Service sites across England and Wales. Findings In the intervention arm, stroke survivors, carers and employers reported benefits from information and support from the treating occupational therapist to facilitate acceptance of, and adaptation to, post-stroke abilities. Participants also valued occupational therapists’ provision of sustained and tailored vocational rehabilitation, co-ordinating their care and advocating for them in return-to-work discussions with their employers. Those unable to return to their previous employment were supported to consider alternative options. In contrast, participants who received usual care only reported feeling abandoned when community rehabilitation support ended, typically after 2–8 weeks. Usual care largely focused on restoring physical function, leaving these participants struggling to find return-to-work information, advice and support. Longitudinal case studies enabled psychosocial and environmental factors impacting on participants’ return-to-work experiences to be considered. Limitations Recruitment to the process evaluation was impacted by the COVID-19 pandemic. It proved difficult to recruit employers for interview, and fewer women participated in the case studies (21 men, 5 women). Direct observation of intervention delivery could not be carried out as planned due to pandemic restrictions on access to clinical areas. Conclusions These case studies highlighted self-reported differences between recipients of the Early Stroke Specialist Vocational Rehabilitation intervention plus usual care and participants allocated to usual care only. Aspects perceived as important in underpinning the differences in support included the length of Early Stroke Specialist Vocational Rehabilitation intervention, occupational therapist advocacy, employer liaison and ongoing workplace monitoring. Provision of these core components as part of post-stroke services may support and help to sustain return to work, with associated benefits for stroke survivors and wider society. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 15/130/11. Plain language summary Returning to work has physical, mental and financial benefits for stroke survivors. There are also benefits for society when stroke survivors return to work because they contribute to the economy and are less likely to claim state benefits. However, support for stroke survivors to return to work is not always provided as part of usual care following stroke. We designed an intervention called Early Stroke Specialist Vocational Rehabilitation. Specially trained occupational therapists provide stroke survivors, their carers and their employers with information and return-to-work support for 12 months following stroke. To find out what difference it made, we interviewed 15 stroke survivors who received the intervention, plus their carers and occupational therapists. Their experiences were compared with 11 stroke survivors who only received usual care. They were interviewed three times during the first year following stroke. Stroke survivors’ chances of returning to work were affected by a range of factors, including post-stroke impairments and how these impacted their ability to do their job. Employers’ willingness and ability to provide reasonable adjustments were also influential. Stroke survivors who received the intervention benefited from return-to-work support which was designed around their individual needs. They valued the occupational therapist organising their care and discussing return-to-work arrangements with their employers. If they were unable to return to their previous job, occupational therapists discussed alternative options. In contrast, stroke survivors who received usual care often felt abandoned when it finished after 2–8 weeks. Care usually focussed on physical ability, leaving them struggling to find return-to-work information and support. Sometimes they returned to work too early and then experienced problems with long-term effects of stroke, for example, tiredness. Overall, we found that usual care is often insufficient for working-age stroke survivors and their chances of returning, and staying, in work may be improved by the intervention.https://doi.org/10.3310/WRKS9661vocational rehabilitationstrokerandomised controlled trialoccupational therapistsreturn-to-work |
| spellingShingle | Diane Trusson Katie Powers Kathryn Radford Audrey Bowen Kristelle Craven Jain Holmes Rebecca Lindley Christopher McKevitt Julie Phillips Ellen Thompson Caroline Watkins David J Clarke Experiences of support to return to work after stroke: longitudinal case studies from RETAKE trial Health Technology Assessment vocational rehabilitation stroke randomised controlled trial occupational therapists return-to-work |
| title | Experiences of support to return to work after stroke: longitudinal case studies from RETAKE trial |
| title_full | Experiences of support to return to work after stroke: longitudinal case studies from RETAKE trial |
| title_fullStr | Experiences of support to return to work after stroke: longitudinal case studies from RETAKE trial |
| title_full_unstemmed | Experiences of support to return to work after stroke: longitudinal case studies from RETAKE trial |
| title_short | Experiences of support to return to work after stroke: longitudinal case studies from RETAKE trial |
| title_sort | experiences of support to return to work after stroke longitudinal case studies from retake trial |
| topic | vocational rehabilitation stroke randomised controlled trial occupational therapists return-to-work |
| url | https://doi.org/10.3310/WRKS9661 |
| work_keys_str_mv | AT dianetrusson experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT katiepowers experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT kathrynradford experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT audreybowen experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT kristellecraven experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT jainholmes experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT rebeccalindley experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT christophermckevitt experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT juliephillips experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT ellenthompson experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT carolinewatkins experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial AT davidjclarke experiencesofsupporttoreturntoworkafterstrokelongitudinalcasestudiesfromretaketrial |