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Meta-Synthesis of Qualitative Research on Facilitators and Barriers of Return to Work After Stroke

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Abstract

Purpose Despite existing rehabilitation services, return to work (RTW) rates among stroke survivors are quite low. An increased number of qualitative studies have been conducted to identify facilitators and barriers to RTW after stroke and to derive recommendations for future interventions. The aim of our study was to carry out a meta-synthesis of those studies and thus strengthen evidence in the field. Methods To identify relevant studies (qualitative studies focusing on RTW after stroke, published in English or German between 2000 and 2015), we conducted a systematic literature search in PubMed, OVID, and Web of Science. After assessing the quality of eligible studies, we synthesized their findings according to meta-ethnographic methodology. Results Fourteen out of 553 studies—three of very high, seven of high, three of medium, and one of low quality—met the inclusion criteria. After the extraction of all first-order concepts and their translation into 64 second-order interpretations, we synthesized the findings by developing a model of RTW factors after stroke. It contains factors related to the person (impairments, coping/adaptation, significance of work/RTW motivation), workplace (job demands/work adaptations, disability management, work climate/social support), and rehabilitation services (availability, accessibility, appropriateness), as well as relevant factors in the interaction of these three stakeholders (work capacity, performance and capability, and initial RTW experiences). Three basic principles—adaptiveness, purposefulness, and cooperativeness—complete the model and led us to its name: the APC model. Conclusions Successful RTW after stroke depends on diverse factors and stakeholders. Rehabilitation strategies have to consider this; otherwise they become RTW barriers themselves.

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Notes

  1. PubMed covers citations for biomedical literature from MEDLINE, life science journals, and online books. The OVID interface offers access to 100 core and niche databases in the area of life sciences, including for example Embase and PsycINFO. Web of Science finally comprises some journals missed by PubMed and Embase.

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Funding

The study was funded partially by the non-profit foundation Schmieder for Sciences and Research.

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Authors and Affiliations

  1. Department of Rehabilitation, German Federal Pension Insurance, Hohenzollerndamm 47, 10704, Berlin, Germany

    Marco Streibelt

  2. Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany

    Betje Schwarz

  3. Schmieder Clinic, Eichhornstraße 68, 78464, Konstanz, Germany

    Dolores Claros-Salinas

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  1. Betje Schwarz
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Correspondence to Marco Streibelt.

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Schwarz, B., Claros-Salinas, D. & Streibelt, M. Meta-Synthesis of Qualitative Research on Facilitators and Barriers of Return to Work After Stroke. J Occup Rehabil 28, 28–44 (2018). https://doi.org/10.1007/s10926-017-9713-2

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