The Psychology of Stroke in Young Adults: The Roles of Service Provision and Return to Work

Table 3

Promoting return to work.

Consideration/Factor	Evidence	Implications
A very high proportion of young survivors wish to return to work.
Employment is a central life role, bringing intrinsic rewards.	[49, 55, 62, 64]	(i) Consider employment in rehabilitation goal planning for all working-age stroke survivors.
Return to work is associated with better life-satisfaction and quality of life.
A significant proportion of those working before stroke will not return to work. Many of these will want to return.		(i) Psychological therapy should consider this as a major and sudden “loss”.
	[2, 4, 52, 56, 57, 64]	(ii) Such survivors and their carers may require help with adjustment to new circumstances.
		(iii) Encourage survivors to explore creative approaches to developing alternative activities.
Many survivors return to different types of work, including voluntary work.		(i) Provide vocational advice on suitable types of work.
		(ii) Encourage flexibility and exploration of options in survivors.
	[2, 49, 59–61]	(iii) Develop awareness of the Disability Discrimination Act and flexible provisions for disabled employees.
		(iv) Develop connections with potential employers including voluntary organizations.
A positive attitude to return to work is important.	[53, 55, 63]	(i) Individual and group therapeutic interventions to promote the benefits of work and influence attitudes may be beneficial.
Social, demographic and economic factors are important.
(i) Wide variation in return rates between different countries.	[65]	(i) Professionals require good awareness of national employment disability legislation, benefits systems and employment practices.
(ii) Socioeconomic status predicts return to work	[53]	(ii) Individual demographic and socioeconomic factors and should be considered when planning support.
(iii) Gender, ethnicity, and age are associated with return	[51, 54]
Employers’ attitude and support are important determinant of return		(i) Advocacy should be available for those who wish to return to work.
	[53, 55, 56, 63, 64]	(ii) Stroke service should network with agencies that find employment, retrain, or support employment.
		(iii) Network with employers and/or human resources departments to build support for return to work.
Residual disabilities, physical ability and especially weakness are related to return.		(i) Return to original employment may not be realistic in all cases.
	[44–46, 48, 53, 54, 56, 59, 64]	(ii) Professionals should provide realistic feedback, considering the survivors readiness to accept it. Premature pessimistic prognosis should be avoided.
		(iii) Flexible, phased return may be helpful.
		(iv) Long-term support may be required.
Fatigue is an important factor in return.		(i) Recognise fatigue as a common barrier to returning to work.
	[11, 56, 61, 64]	(ii) Consider fatigue management as part of psychological therapy.
		(iii) Plan return to work allowing for effects of fatigue. A phased return may be helpful.
“Hidden” cognitive deficits are a concern for survivors.		(i) Cognitive assessment for all intending to return to work.
		(ii) Consider cognitive rehabilitation.
	[11, 14, 48–50, 53, 56, 61]	(iii) Consider “information prosthesis” and compensatory measures (diaries, pagers, electronic aids).
		(iv) Incorporate into psychological therapy to develop insight and promote adjustment.
Stress due to work is a factor when survivors consider return.	[55]	(i) Concern about work stress and its possible effects on health should be considered.
		(ii) Medical and psychological advice may be helpful.
Assets and resources are influential factors in return.	[55, 56, 61]	(i) Encourage survivors and carers to “audit” their assets and incorporate into their plans.
		(ii) Assets may include; family and social networks, healthcare agencies, employers (managers and human resources/personnel, occupational health).
Psychological disorders are a factor in stroke patients’ return to work.	[52, 60]	(i) Offer treatment for any psychological conditions such as depression, anxiety or PTSD.