Date Presented 03/26/20
RTW is an essential target for many stroke survivors. As yet, the prevalence of RTW poststroke in developing countries such as Jordan is unknown. Additionally, more research is required to identify factors that contribute to RTW poststroke. This study aims to: (1) determine the prevalence of RTW among stroke survivors in Jordan, and (2) determine the predictors of RTW from a holistic perspective using the Occupational Therapy Practice Framework (OTPF), 3rd edition.
Primary Author and Speaker: Mohammad Nazzal
Additional Authors and Speakers: Huda Yousef, Hanan Khalil
Contributing Authors: Khalid El-Salem, Ziad Hawamdeh, Patrícia Almeida
PURPOSE: Returning to work (RTW) is an essential target for many stroke survivors. As yet, the prevalence of RTW post stroke in developing countries as per Jordan is unknown. Additionally, more research is required to identify factors that contribute to RTW post stroke. This study aims to (1) determine the prevalence of RTW among stroke survivors in Jordan, and (2) determine the predictors of RTW from a holistic perspective using the Occupational Therapy Practice Framework (OTPF) 3rd edition.
DESIGN: This was an observational-cross sectional study in which participants with post stroke were recruited from different governmental, private hospitals and rehabilitation centers representing three different districts of Jordan (Irbid, Amman and Al Zarqa). The inclusion criteria included: being diagnosed with a first-time or recurrent stroke (ischemic or hemorrhagic) at least 3 months earlier but not more than 2 years ago, age ≥ 18 years old at the time of hospitalization, free of any other neurological diseases or transient ischemic attack (TIA), and employed [participant was an employee at the time of stroke onset (full time, part time or self-employment) either in a competitive work (i.e. paid work) or non- competitive work (i.e. household work or voluntary work)]. Participants were excluded if they had (1) a stroke less than three months ago, and (2) retired or unemployed.
METHOD: A complete battery of outcome measures was used to reflect OTPF domains. These included outcome measures of occupations (work, activities of daily living (ADLs), and Instrumental activities of daily living (IADLs)), client factors (body functions and body structures), performance skills (motor skills and social interaction skills), and context and environment. Prevalence data were presented descriptively. Binary logistic regression was conducted to investigate the predictors that have an impact on the RTW post stroke among the studied cohort.
RESULTS: Of 136 recruited stroke survivors, 69 participants were enrolled in this study and completed the battery of outcome measures (45 Males, 24 females, mean age ± SD, 52.2 ± 11.07 years). The mean time since stroke onset was 9.43 months (SD±5.78). Only 29% succeeded in RTW during the first year after stroke onset. The highest percentage of RTW was among craft workers (40%), and those who were self-employed (60%). Of those who resumed work, 35% returned to their previous work, while 65% needed to make work modifications, or change positions or jobs. Factors that correspondingly predicted higher rates of RTW were walking speed (Odds ratio (OR) = 0.004, 95% confidence interval (CI) = 0.00-0.55, P <0.02), as well as absence of environmental restrictions (OR = 21.16, 95% CI = 1.91-233.5, P< 0.013).
CONCLUSION: This study was the first study in Jordan to focus specifically on a wide range of factors affecting RTW post stroke, based on a comprehensive model such as the OTPF. The alarming of low prevalence of RTW among stroke survivors in Jordan emphasizes the essential need to develop a vocational rehabilitation programs aimed to assess and manage factors that have a negative effect on early RTW post stroke. Clinicians should pay attention to enhancing walking abilities and reducing environmental restrictions post stroke, in order to improve the occurrence of RTW. Overall, findings from this study may be important in determining the factors and the time that should be taken into consideration when the stroke survivor is asked to RTW. This is not only important for the client, but also for the work institutions, on how to support the stroke survivors to RTW.
References
Amini, D. A., Kannenberg, K., Bodison, S., Chang, P., Colaianni, D., Goodrich, B., & Lieberman, D. (2014). Occupational therapy practice framework: Domain & process 3rd edition. American Journal of Occupational Therapy, 68, S1-S48.
Arwert, H., Schults, M., Meesters, J., Wolterbeek, R., Boiten, J., & Vlieland, T. V. (2017). Return to work 2–5 years after stroke: a cross sectional study in a hospital-based population. Journal of occupational rehabilitation, 27(2), 239-246. doi: 10.1007/s10926-016-9651-4
Bonner, B., Pillai, R., Sarma, P., Lipska, K., Pandian, J., & Sylaja, P. (2016). Factors predictive of return to work after stroke in patients with mild− moderate disability in India. European journal of neurology, 23(3), 548-553. doi: 10.1111/ene.12887
Edwards, J. D., Kapoor, A., Linkewich, E., & Swartz, R. H. (2018). Return to work after young stroke: a systematic review. International Journal of Stroke, 13(3), 243-256. doi: 10.1177/1747493017743059
