Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Psychological Factors and Return to Work After Stroke: The Unseen Challenges of an Unmet Need (#114)

Katherine Sewell 1 , Sophie O'Keefe 2 , Geoffrey Cloud 1 3 , Serena Alves-Stein 3 , Brittni Nielsen 3 , Laura De Lacy 3 , Laura Jolliffe 2 3 4 , Madeleine Smith 1 , Mandy Stanley 5 , Natasha A. Lannin 1 3
  1. Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
  2. Department of Occupational Therapy, Peninusla Health, Frankston, Victoria, Australia
  3. Alfred Health, Melbourne, Victoria, Australia
  4. Monash University, Melbourne, VICTORIA, Australia
  5. School of Medical and Health Sciences, Edith Cowan University, Joondalup, Victoria, Australia

Background:
Many stroke survivors experience significant difficulty returning to work. Vocational rehabilitation programs are designed to enable stroke survivors to re-engage in meaningful work. Existing programs appear to place emphasis on physical and environmental factors associated with vocational re-engagement, whereas psychological and psychosocial characteristics receive less attention.

Aims:
To characterise the psychological and psychosocial factors in a cohort of stroke survivors, prior to their engagement in a vocational intervention program.

Methods:
Stroke survivors who were within four months post-stroke and identified an unmet need relating to work were recruited into a pilot randomised controlled trial (Work Trial). Participants were recruited from acute, rehabilitation and community programs at Alfred Health in Victoria, Australia. At baseline, psychological and psychosocial factors were evaluated: anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), and self-estimated work and social functioning were assessed using the Work and Social Adjustment Scale (WSAS). Univariate analyses were conducted on psychological and psychosocial data collected at recruitment into the trial.

Results:
Thirty-four stroke survivors (male: n = 20; age: mean = 49.7, SD = 12.7, median = 52.5, IQR = 19, range: 21 to 69 years) were recruited. At trial commencement, almost half of the participants (14 of 32, 44%) experienced depressive symptoms and one-third (11 of 32, 34%) demonstrated anxiety, as indicated by a score ≥ 8 on the HADS-D and HADS-A respectively. More than half of the participants (21 of 34, 62%) recorded a greater difficultly when returning, or attempting to return, to previous occupations, activities and roles post-stroke, as indicated by a score ≥ 16 on the WSAS.

Conclusion:
In the Work Trial, stroke survivors commonly reported depressive symptoms, anxiety and increased difficultly in work and social functioning, prior to undertaking a vocational rehabilitation program. Psychological and psychosocial factors should be considered alongside physical and environmental factors within vocational rehabilitation programs for stroke survivors.