ReWork-Stroke : content and experiences of a person-centred rehabilitation programme for return to work after stroke

The process of return to work (RTW) after stroke is complex, less than half of those having stroke in working ages RTW. Guidelines targeting RTW in Sweden is lacking. The overall aim was to enhance the knowledge regarding rehabilitation for return to work after stroke and to explore how the person-centred rehabilitation programme ReWork-Stroke was translated into practice, for people who worked before their stroke, as well as the experiences of the involved stakeholders. Additionally, the aim was to explore changes in work potential and work performance while participating in the rehabilitation programme.

Methods: Study I used a descriptive case study design to explore and describe the core elements of the ReWork-Stroke programme as they were documented by the coordinators, and their experiences of providing the programme to people who had had a stroke. The two interviews with the coordinators and their logbooks were analysed using content analysis. Study II applied a grounded theory approach in order to explore and describe how people that had had a stroke experienced the RTW process while participating in a person-centred rehabilitation programme focusing on RTW. Seven persons with mild or moderate stroke were interviewed twice at their work place during their work-trial. Study III was inspired by grounded theory aiming to explore and describe how co-workers and managers experienced the RTW process involving a colleague who had had stroke and participated in a person-centred rehabilitation programme focusing on RTW including a work-trial. Sixteen interviews were conducted with seven co-workers and four managers during the work-trial of a colleague who had had stroke. Study IV used a mixed method approach with an explanatory sequential design in order to explore changes in work potential and work performance while participating in a person-centred rehabilitation programme for people who worked before their stroke.

Results: Time use, place and format for elements in the programme varied between clients. Core elements identified were: make aware of consequences of stroke; provide information to stakeholders; use of strategies to handle work tasks; assessments, goal-setting and evaluation of work ability; planning/follow up of work trial. The coordinators experienced their role to build an alliance between stakeholders and to give support and guidance during the RTW process. Knowledge of stroke, strategies and a straightforward communication facilitated the possibility to adapt to the situation for the persons that had had stroke. The co-workers and managers experienced various challenges; the emotional challenge of being a supportive co-worker or manager, the challenging experience of having too much responsibility and the challenge of being supportive despite lack of knowledge. Changes in work potential and work performance varied among the participants and were mostly in a positive direction. Various strategies were used by the coordinators in cooperation with those involved at the work place to handle the different needs.

Conclusion: The ReWork-Stroke programme included various elements adapted to the needs of the individuals. The involvement of the coordinator seemed to facilitate the RTW process and collaboration among the different stakeholders. Establishing a commitment between the employer and all involved stakeholders was of importance.

List of scientific papers

I. Johansson, U., Öst Nilsson, A., Hellman, T., Hansen Falkdal, A., von Koch, L., & Eriksson, G. The ReWork-Stroke programme – Content and experiences from the coordinator perspective. [Manuscript]

II. Öst Nilsson, A., Eriksson, G., Johansson, U., & Hellman, T. (2017). Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme. Scandinavian Journal of Occupational Therapy. 24:5, 349-356.
https://doi.org/10.1080/11038128.2016.1249404

III. Öst Nilsson, A., Eriksson, G., Asaba, E., Johansson, U., & Hellman, T. (2019). Being a co-worker or a manager of a colleague returning to work after stroke: A challenge facilitated by cooperation and flexibility. Scandinavian Journal of Occupational Therapy.
https://doi.org/10.1080/11038128.2018.1526318

IV. Öst Nilsson, A., Johansson, U., Ekbladh, E., Bernspång, B., Hellman, T., & Eriksson, G. The return to work process after stroke – Changes in work potential and work performance while participating in a person-centred rehabilitation programme. [Manuscript]