Employment after Stroke

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Employment after Stroke

• Facilitators Barriers
• Literature search
• Sandy James 2007

2
Why?

• Observation of my patient contacts
• Conferences where employers were the problem
• Contact from a researcher for professional
  involvement

3

• Expertise
• Knowledge
• Advice
• Support
• And lots of encouragement!

4
Background

• Anecdotally observationally there seemed a low
  return to work post stroke
• Although research clinical evidence shows that
  return to work (RTW) is an important aspect of
  preserving personal social identity

5
Scoping

• For example
• Adult
• Stroke, CVA, TIA
• Work, employment, job, education
• From 1990, reported in English, from anywhere
• Exclusion
• ADL, leisure

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Abstracts

• All were reviewed as even with specific words
  some did not cover the criteria were discarded
• Research could be divided into four groups
• General aspects of stroke
• On young ischemic strokes
• On the effects of subarachnoid haemorrhage with
  or without aneurysm
• on specific aspects of stroke such as aphasia.

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Employment

• Was rarely the reason for research
• Was used in Q of L research for questionnaires or
  interviews.
• Some research used 14/15 yrs upwards not to use
  this research would have reduced the documents
  used further.

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Research used.

• Numbers in most projects small so percentage
  conclusion ? Reliability.
• Many different assessment tools used for
  function, depression, Q of Life therefore
  difficult to compare
• Criteria were varied

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The Research looking at work

• UK 37 participants identified 4 themes
• Rehabilitation process
• Employer
• Social structure
• Personal
• Another study UK 6 (RTW) 26 perception
  regarding RTW show a gap in providing support for
  people to RTW though people value work.
• .
• USA methodological review re isch stroke found
  comparison studies difficult as RTW is reported
  in different populations, after diverse periods,
  using variable definitions of work stroke.
  Their conclusion was that stroke severity
  measured by ADL most robust predictor for return
  to work. (however social job characteristics
  not measured)

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What facilitated return to work

• Being able to walk / functional capacity /ADL
• Preserved cognitive capacity
• Lack of Aphasia
• Early admission to rehabilitation work should
  be considered what ever the age (OT need to work
  with reemployment services)
• Motivation, will
• Being a white collar worker rather then blue
• High school degree/qualifying for university
  entrance
• Physical requirements of the job
• External support
• One to one support training
• When benefits stopped

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Barrier to return to work

• Severity of Subarachnoid haemorrhage impairs
  working capacity social activity
• Physical disability
• Depression
• Blue collar work
• Executive memory impairment
• Behavioural disturbance (frontal in sah)
• Verbal performance IQ

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Other findings

• high functional recovery at 1yr didnt equate to
  return to work
• Functional outcome better in post then ant circ
  infarcts (Norway)
• Q of L was higher for those who did RTW
• Functional status, employment at admission,living
  at home are a better predictor of outcome then
  age.
• Higher relative risk of stroke found in skilled
  unskilled manual workers
• Social factors including gender,type of
  occupation, employment system socio-economic
  background

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Continued

• Most research agreed that stroke location in
  ischemic strokes didnt inhibite RTW but did in
  Subarachnoid haemorrhage
• However 2 didnt as they found that those with a
  (L) sided stroke (R infarct) were more likely to
  return to work then sided ones

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Conclusion

• So many different tools, research questions etc.
• But influences are both Medical Social
• Physical disability
• Aphasia
• Cognitive ability
• Socio-economics
• Type of previous employment
• support from the employer / or workmates
• The persons drivers

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Finally

• The unfunded research was looking to develop a
  tool which could predict potential for RTW.
• Having done this literature search, I believe
  this is unlikely what seems obvious is the
  patient who had job specific 11 intensive
  training RTW.
• Subarchnoid Haemorrhage may be possible to
  predict
• While 1-1 is expensive I am not advocating it
  I believe we need a specific dedicated RTW
  service in Milton Keynes linked into the
  Neurorehabilitation Unit to give patients the
  opportunity to RTW

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Thank you for Listening.