BACKGROUND: Return to work is an issue of concern for stroke survivors and
their spouses. Ramifications may include loss of income and self-efficacy.
OBJECTIVE: This study describes the return to work patterns of stroke
survivors and their spousal caregivers post stroke.
METHODS: One hundred fifty-nine dyads were examined for their return to work
patterns at baseline (post hospital discharge) and then at 3 month intervals for one year.
Relationships were determined between work and gender, age, ethnicity, education, type of
insurance, type of stroke, location of stroke, motor and cognitive functional status,
depression, mutuality, and life satisfaction.
RESULTS: Low levels of return to work by stroke survivors (7.5%) and a small
decrease in the amount of working caregivers (from 45.3% to 40.35%) were found one year
post baseline. Variables that predicted return to work changed over the five data points
except for younger age for the caregiver, which was consistently significant across all
data points. Three case scenarios representative of working patterns are offered.
CONCLUSIONS: Further research is needed regarding the return to work needs
of stroke survivors and their spousal caregivers, particularly what role the occupational
therapist may play in facilitating that process.
OvbiageleB, GoldsteinLB, HigashidaRT, HowardVJ, JohnstonSC, KhavjouOA, LacklandDT, LichtmanJH, MohlS,
SaccoRL, SaverJL, TrogdonJG.
Forecasting the future of stroke in the United States: A policy statement
from the American Heart Association and the American Stroke Association.
Stroke2013;44(8):2361–75.
doi: 10.1161/STR.0b013e31829734f2
3.
Centers for Disease Control and Prevention. About
stroke [Internet]. 2014 [updated 2014 Oct 9; cited 2015 Nov 28]. Available from: http://www.cdc.gov/stroke/about.htm
Department of Health and Human Services (US).
National Institutes of Health. National Institute of Neurological Disorders and Stroke.
Office of Communications and Public Liaison. Post-stroke rehabilitation. Bethesda (MD):
2014 Sep 24 Publication No. 14 1846. Available from http://stroke.nih.gov/documents/Post-Stroke_Rehabilitation_english_brochure.pdf
KingRB, AinsworthCR, RonenM,
HartkeRJ.
Stroke caregivers: Pressing problems reported during the first months of
caregiving. J Neurosci Nurs2010;42(6):302–11.
doi: 10.1097/JNN.0b013e3181f8a575
8.
HassanSA.
The impact of stroke on the primary caregiver [PhD
thesis]. Stellenbosch University:
Stellenbosch, South Africa;
2007.
9.
KuluskiK, DowC,
LocockL, LyonsR,
LassersonD.
Life interrupted and life regained? Coping with stroke at a young
age. Int J Qual Stud Health Well-being2014;9:1–12. doi:
10.3402/qhw.v9.22252
10.
MasryYM, MullanB, HackettM.
Psychosocial experiences and needs of Australian caregivers of people
with stroke: Prognosis messages, caregiver resilience, and
relationships. Top Stroke Rehabil2013;20(4):356–68.
doi: 10.1310/tsr2004-356
11.
RothEJ, LovellL.
Employment after stroke: Report of a state of the science
symposium. Top Stroke Rehabi2014;21(Suppl
1):l575–86. doi: 10.1310/tsr21S1-S75
12.
VestlingM, RamelE,
IwarssonS.
Thoughts and experiences from returning to work after
stroke. Work2013;45(2):201–11.
doi: 10.3233/WOR-121554
13.
ScottSL, BondocS.
Occupational therapy’s distinct value for stroke survivors: Facilitating
return to work across the continuum of care. Phys Disabil
Special Interest Sect Q2015;38(3):1–3.
14.
WolfTJ, BaumC,
ConnorLT.
Changing face of stroke: Implications for occupational therapy
practice. Am J Occup Ther2009;63(5):621–5.
doi: 10.5014/ajot.63.5.621
15.
WangY-C, KapelluschJ, GargA.
Important factors influencing the return to work after
stroke. Work2014;47(4):533–59.
doi: 10.3233/WOR-131627
16.
SaekiS.
Disability management after stroke: Its medical aspects for workplace
accommodation. Disabil Rehabil2000;22(13/14):578–82.
doi: 10.1080/09638280050138241
17.
TregerI, ShamesJ, GiaquintoS, RingH.
Return to work in stroke patients. Disabil
Rehabil2007;29(17):1397–403.
doi: 10.1080/09638280701314923
18.
EdwardsDF, HahnM,
BaumC, DromerickAW.
The impact of mild stroke on meaningful activity and life
satisfaction. J Stroke Cerebrovasc Dis2006;15(4):151–7.
doi: 10.1016/j.jstrokecerebrovasdis.2006.04.001
19.
GreenTL, KingKM.
Experiences of male patients and wife-caregivers in the first year
post-discharge following minor stroke: A descriptive qualitative study.
Int J Nurs Stud2009;46(9):1194–200.
doi: http://dx.doi.org/10.1016/j.ijnurstu.2009.02.008
20.
WolfendenB, GraceM.
Returning to work after stroke: A review. Int J
Rehabil Res2009;32(2):93–7.
doi: 10.1097/MRR.0b013e328325a358
21.
KoJY, AycockDM, ClarkPC. A
comparison of working versus nonworking family caregivers of stroke
survivors. J Neurosci Nurs2007;39(4):217–25.
22.
OstwaldSK, GodwinKM, CronSG,
KelleyCP, HerschG, DavisS.
Home-based psychoeducational and mailed information programs for
stroke-caregiving dyads post-discharge: A randomized trial.
Disabil. Rehabil2014;36(1):55–62.
doi: 10.3109/09638288.2013.777806
23.
OstwaldSK, SwankPR, KhanMM.
Predictors of functional independence and stress level of stroke
survivors at discharge from inpatient rehabilitation.
J Cardiovasc Nurs2008;23(4):371–7.
doi: 10.1097/01.JCN.0000317435.29339.5d
DoddsTA, MartinDA, StolovWC, DeyoRA.
A validation of the Functional Independence Measurement and its
performance among rehabilitation Inpatients. Arch Phys Med
Rehabil1993;74(5):531–6.
doi: 10.1016/0003-9993(93)90119-U
26.
GrangerCV, CotterAC, HamiltonBB, FiedlerRC.
Functional assessment scales: A study of persons after
stroke. Arch Phys Med Rehabil1993;74(2):133–8.
27.
HamiltonBB, LaughlinJA, FiedlerRC, GrangerCV.
Interrater reliability of the 7- level Functional Independence Measure
(FIM). Scand J Rehabil Med1994;26(3):115–9.
28.
SheikhJI, YesavageJA.
Geriatric Depression Scale (GDS): Recent evidence and development of a
shorter version. In BrinkTL, editor.
Clinical gerontology: A guide to assessment and intervention.
New York. The Haworth
Press; 1986.
29.
D’AthP, KatonaP, MullanE, EvansS,
KatonaC.
Screening, detection and management of depression in elderly primary care
attenders. I: The acceptability and performance of the 15 item Geriatric Depression
Scale (GDS15) and the development of short versions. Fam
Pract1994;11(3):260–66.
doi: 10.1093/fampra/11.3.260
30.
ArchboldPG, StewartBJ, GreenlickMR, HarvathT.
Mutuality and preparedness as predictors of caregiver role
strain. Res Nurs Health1990;13(6):375–84.
doi: 10.1002/nur.4770130605
31.
OstwaldSK, GodwinKM, CronSG.
Predictors of life satisfaction in stroke survivors and spousal
caregivers twelve to twenty-four months post discharge from inpatient
rehabilitation. Rehabil Nurs2009;34(4):160–74.
doi: 10.1002/j.2048-7940.2009.tb00272.x
32.
CarterJH, StewartBJ, ArchboldPG, InoueI,
JaglinJ, LannonM, Rost-RuffnerE, TennisM, McDermottMP, AmyotD,
BarterR, CorneliusL, DemongC, DobsonJ, DuffJ,
EricksonJ, GardinerN, GaugerL, GrayP,
KaniganB, KirylukB, LewisP,
MisturaK, MalapiraT, PayM,
SheldonC, WinfieldL, Wolfington-ShallowK,
ZoogK, Parkinson
Study Group. Living with a person who has Parkinson’s disease:
The spouse’s perspective by stage of disease. Mov
Disord1998;13(1):20–8.
doi: 10.1002/mds.870130108
33.
CorriganJ. Satisfaction
With Life Scale [Internet]. 2000 [updated 2012; cited 2015 Nov 28]. Available from:
http://www.tbims.org/combi/swls
34.
DienerE, EmmonsRA, LarsenRJ, GriffinS.
The satisfaction with life scale. J Pers
Assess1985;49(1):71–5.
doi: 10.1207/s15327752jpa4901_13
35.
SreedharanSE,
UnnikrishnanJP,
AmalMG, ShibiBS, SarmaS,
SylajaPN.
Employment status, social function decline and caregiver burden among
stroke survivors: A South Indian study. J Neurol Sci2013;332(1-2):97–101.
doi: http://dx.doi.org/10.1016/j.jns.2013.06.026
36.
ErikssonG, AasnesM, TistadM, GuidettiS, von
KochL. Occupational
gaps in everyday life one year after stroke and the association with life satisfaction
and impact of stroke. Top Stroke Rehabil2012;19(3):244–55.
doi: 10130tsr1903-244
37.
HackettML, GlozierN, JanS,
LindleyR.
Returning to paid employment after stroke: The Psychosocial Outcomes In
Stroke (POISE) cohort study. PLoS One2012;7(7):e41795.
doi: 10.1371/journal.pone.0041795
38.
DoucetT, MullerF, Verdun-EsquerC,
DebellixX, BrochardP.
Returning to work after stroke: A retrospective study at the Physical and
Rehabilitation Medical Center “La Tour de Gassies”. Ann Phys
Rehabil Med2012;55(2):112–27.
doi: 10.1016/j.rehab.2012.01.007
39.
WozniakMA, KittnerSJ, PriceTR, HebelJR, SloanMA, GarnerJF.
Stroke location is not associated with return to work after first
ischemic stroke. Stroke1999;30(12):2568–73.
doi: 10.1161/01.STR.30.12.2568
40.
GlozierN, HackettML, ParagV,
AndersonCS.
The influence of psychiatric morbidity on return to paid work after
stroke in younger adults: The Auckland RegionalCommunity Stroke (ARCOS) study, to
Stroke2008;39(5):1526–32.
doi: 10.1161/STROKEAHA.107.503219
41.
HofgrenC, BjórkdahlA, EsbjórnssonE, Stibrant-SunnerhagenK.
Recovery after stroke: Cognition, ADL function, and return to
work. Acta Neurol Scand2007;115(1-2):73–80.
doi: http://dx.doi.org/10.1016/j.jns.2009.02.287
42.
WilzG, SoellnerR.
Work loss following stroke. Disabil
Rehabil2009;31(18):1487–93.
doi: 10.1080/09638280802621432
43.
TryggedS, AhacicK, KåreholtI.
Income and education as predictors of return to working life among
younger stroke patients. BMC Public Health2011;11(1):742–50.
doi: 10.1186/1471-2458-11-742
44.
VestlingM, TufvessonB, IwarssonS.
Indicators for return to work after stroke and the importance of work for
subjective well-being and life satisfaction. J Rehabil
Med2003;35(3):27–131.
doi: 10.1080/16501970310010475
45.
BaumannM, CouffingalS, Le
BihanE, ChauN.
Life satisfaction two-years after stroke onset: The effects of gender,
sex occupational status, memory function and quality of life among stroke patients
(Newsqol) and their family caregivers (Whoqol-bref) in Luxembourg.
BMC Neurol2012;12(1):105–15.
doi: 10.1186/1471-2377-12-105
46.
Vincent-OnabajoG,
AliA, HamzatT.
Quality of life of Nigerian informal caregivers of community-dwelling
stroke survivors. Scand J Caring Sci2013;27(4):977–82.
doi: 10.1111/scs.122017
47.
GilworthG, PhilM,
CertAd, SansamKAJ, KentRM.
Personal experiences of returning to work following stroke: An
exploratory study. Work2009;34(1):95–103.
doi: 10.3233/WOR-2009-0906
48.
SatinkT, CupEH,
IlottI, PrinsJ,
de
SwartBJ, Nijhuis-van der
SandenMW. Patient’s
views on the impact of stroke on their roles and self: A thematic synthesis of
qualitative studies. Arch Phys Med Rehabil2013;94(6):1171–83.
doi: http://dx.doi.org/10.1016/j.apmr.2013.01.011
49.
ScottSL, BondocS. Back
on the job: Promoting return to work after stroke. OT
Pract2016;21(10):8–13.
50.
RadfordKA, WalkerMF.
Impact of stroke on return to work. Brain
Impair2008;9(2):161–9.
doi: 10.1186/ISRCTN55406009
51.
DésironHAM, de
RijkA, Van
HoofE, DonceelP.
Occupational therapy and return to work: A systematic literature
review. BMC Public Health2011;11(1):615–28.
doi: 10.1186/1471-2458-11-615
52.
FrankAO.
Starting vocational rehabilitation early after stroke
[letter]. BMJ (Int Ed)2013;347:f4278. doi: http://dx.doi.org/10.1136/bmj.f4278
TeasellR, MehtaS,
PereiraS, McIntyreA, JanzenS, AllenL,
LoboL, VianaR.
Time to rethink long-term rehabilitation management of stroke
patients. Top Stroke Rehabil2012;19(6):457–62.
doi: http://dx.doi.org/10.1310/tsr1906-457
55.
CullerKH, WangY-C, ByersK,
TrierweilerR.
Barriers and facilitators of return to work for individuals with strokes:
Perspectives of the stroke survivor, vocational specialist, and
employer. Top Stroke Rehabil2011;18(4):325–40.
doi: 10.1310/tsr1804-325
56.
SaitoY, MineoM,
YaedaJ. Work
support for working age persons who have experienced a stroke in Japan: Cooperation
between hospital and work support agencies. Work2013;45(2):267–72.
doi: 10.3233/WOR-131593
57.
WolfendenB, GraceM.
Vulnerability and post-stroke experiences of working-age survivors during
recovery. Sage Open2015;5(4):1–14.
doi: 10.1177/2158244015612877
58.
NtsieaMV, Van
AswegenA, LordS,
OlorunjuSS.
The effect of a workplace intervention programme on return to work after
stroke: A randomized controlled trial. Clin Rehabil2015;29(7):663–73.
doi: 10.1177/0269215514554241
59.
BaldwinC, BruscoNK.
The effect of vocational rehabilitation on return-to-work rates post
stroke: A systematic review. Top Stroke Rehabil2011;18(5):562–72.
doi: 10.1310/tsr1805-562
60.
LengCM.
Description of a return-to-work occupational therapy programme for stroke
rehabilitation in Singapore. Occup Ther Int2008;15(2):7–99.
doi: 10.1002/oti.248
61.
O’BrienAN, WolfTJ.
Determining work outcomes in mild to moderate stroke
survivors. Work2010;36(4):441–7.
doi: 10.3233/WOR20101047
62.
American Occupational Therapy Association. Occupational
therapy practice framework: Domain and process, 3rd
edition, Am J Occup Ther2014;68(Suppl.
1):S1–48. doi: 10.5014/ajot.2014.682006
63.
KaskutasV.
AOTA continuing education article: Occupational therapy’s role in helping
clients work. OT Pract2012;17(9):CE1–CE8.
64.
GuptaJ, SabataD. AOTA
continuing education article: Maximizing occupational performance of older workers:
Applying the Person-Environment-Occupation model. OT
Pract2010;15(7):CE1–CE8.
65.
WhiteCL, PoissantL, Coté-LeBlancG, Wood-DauphineeS.
Long-term caregiving after stroke: The impact on caregivers’ quality of
life. J Neurosci Nurs2006;38(5):354–60.
