The Needs and Perspectives of People with Stroke and Communication Disabilities in Early Vocational Rehabilitation and Return to Work: A Mixed Methods Prospective Study.

Abstract

Background: People with communication disability after stroke experience lower rates of return to vocational roles when compared to the broader stroke population. Despite this, factors influencing return-to-work for this stroke sub-group are not well understood, with limited research investigating the needs and perspectives of people with communication disability who seek to resume vocational activity. Aim(s): This study aimed to: 1) investigate the vocational rehabilitation experiences of people with communication disability after stroke; 2) identify their return-to-work needs; and 3) provide preliminary recommendations for inclusive vocational rehabilitation service delivery. Method(s): Seven participants with communication disabilities after stroke were recruited from a larger clinical trial of early vocational rehabilitation (20% of total sample (n=34)). A mixed-methods design was employed, with integrated use of quantitative (demographic and intervention audit data) and qualitative (semi-structured, in-depth interview) data. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. Result(s): Participants were five men and two women aged 24-69. Participant communication profile included cognitive-communication disabilities (e.g., impaired attention, retaining verbal and written information), difficulties with verbal and written expression and social communication (e.g., understanding conversation partner cues and context, generating topics and ideas). Participants perceived vocational rehabilitation as beneficial but identified gaps including, limited psychological and peer-based support, lack of targeted rehabilitation specific to participants' vocational roles, poor communication disability awareness within the workplace, multi-layered barriers to accessing to vocational rehabilitation once vocational activity resumes. Conclusion(s): Greater emphasis on evaluating the workplace communication environment and better targeted communication training and preparation for workplace stakeholders is likely to reduce barriers faced by those with communication disability after stroke. Improved multidisciplinary practice during rehabilitation, inclusive of psychological care, may result in participants being more psychologically prepared to acknowledge changes in communication function and result in improved engagement in the rehabilitation process.