Lived Experience of Stroke Survivors Returning to Work

PURPOSE: Stroke is the leading cause of long-term disability. Despite intensive rehabilitation, many stroke survivors will continue to experience lasting impairments that may prevent them from resuming past occupational roles. Only a small percentage of stroke survivors are able to return to work, and for most who do return to work, it is a protracted and expensive process (Hackett, Glozier, Jan, & Lindley, 2012). Furthermore, not many who return to work are able to resume the same roles or achieve their optimal level of productivity.

Much of available occupational therapy (OT) literature has addressed return to work after stroke (O’Brien & Wolf, 2010), but a knowledge gap remains about the experiences of stroke survivors returning to work and working. Thus, the purpose of this study is to describe the lived experience of stroke survivors with regard to returning to and being engaged in work after the onset of their stroke.

DESIGN: Phenomenology

PARTICIPANTS: Participants were recruited from outpatient centers that provide neurorehab services and stroke support groups. Criteria for participation included age 21 yr or older, ≥2 yr after initial stroke onset, and currently employed for > 6 mo. Purposive sampling according to demographic factors, type of employment, and job title was considered to ensure sufficient variation of experiences among participants. Three participants met the criteria and consented to the study.

METHOD: A semistructured interview questionnaire was developed and piloted among content experts. Student researchers underwent training through mock interviews to ensure consistency of style. Participants underwent at least two in-depth interviews by trained student researchers; each interview lasted 60–90 min and was audio recorded and transcribed. Two student researchers (one present during the interview and another unfamiliar with the participant) separately read and reread and open coded the transcripts. Uncoded transcripts were sent to participants as part of member checking. Differences in coding between student researchers were discussed and reconciled with the lead researcher, who also acted as a peer reviewer and manager of the audit trail.

RESULTS: Four themes emerged from the analysis of participants’ lived experiences about returning to work: (1) adaptation to new role while maintaining a sense of identity; (2) positive outlook and intrinsic drive as key to success; (3) proving others wrong; and (4) acknowledgment of self-imposed barriers. Although these represent common mutually exclusive themes, there were nuances to each participant’s experience that point to the individualized nature of the first-person phenomena.

DISCUSSION: The experience of returning to work after stroke is influenced by the individual’s functional recovery, rehabilitation process, and the presence of support (Roth & Lovell, 2014). Our study adds to the literature by highlighting the importance of developing a sense of self-efficacy and a strong intrinsic motivation to be productive and adapt to one’s own limitations while overcoming self-imposed barriers about returning to work. Returning to work may not be the first thing in the client’s goals and may seem to be a remote possibility at the early stages of recovery; however, an open dialogue and focus on the client’s physical and psychosocial readiness to return to work should be important components of the rehab process.

IMPACT STATEMENT: The study findings support the role of OT in promoting return to work for stroke survivors. It is hoped that OT practitioners look beyond the traditional rehab practice of focusing on self-care independence and remediation of performance skills and consider engagement in productive work as another primary occupational need and targeted outcome in stroke rehabilitation.

References

Hackett, M. L., Glozier, N., Jan, S., & Lindley, R. (2012), Returning to paid employment after stroke: The Psychosocial Outcomes In Stroke (POISE) cohort study. PLoS ONE 7, e41795. http://dx.doi.org/10.1371/journal.pone.0041795

O’Brien, A. N., & Wolf, T. J. (2010). Determining work outcomes in mild to moderate stroke survivors. Work, 36, 441–447. http://dx.doi.org/10.3233/WOR-2010-1047

Roth, E. J., & Lovell, L. (2014). Employment after stroke: Report of a State of the Science Symposium. Topics in Stroke Rehabilitation, 21(Suppl. 1), S75–S86. http://dx.doi.org/10.1310/tsr21S1-S75