BACKGROUND: The incidence of stroke among adults of working age (21–65 yr) is rising (George et al, 2011; Roth & Lovell, 2014). However, the rate of return to work (RTW) is low (O’Brien & Wolf, 2010), with important implications for individuals’ health and well-being, their family units, and the society as whole. Legislation such as the 2013 Return to Work Act (H.R. 3351 and S. 1026) highlight the issue: a national priority to improve functional and employment outcomes of stroke survivors. With their training and expertise, occupational therapy (OT) practitioners are well positioned to address this national/societal need. Yet, little is known about what OT practitioners do and what they perceive to be key barriers and facilitators when it comes to provision of RTW services. Therefore, the purpose of this study was to describe the current practice patterns of OT practitioners with regard to provision of OT services related to RTW for stroke survivors. A secondary purpose is to explore therapists’ perceived competence in and factors that promote or impede the provision of RTW services.

METHOD: Using the American Occupational Therapy Association (AOTA) member and a CE vendor database, 4,000 survey participants were recruited by post and email over a 6-wk period. Inclusion criteria include active licensure as an OT practitioner and ≥1 yr experience with stroke survivors of working age. The electronic survey was developed based on the Occupational Therapy Practice Framework: Domain and Process (3rd ed.; AOTA, 2014), review of RTW literature, and expert input. Data were analyzed using graphical and descriptive methods.

RESULTS: A total of 119 respondents took part in the survey and met the inclusion criteria. Most respondents had >10 yr experience (66%) and work in outpatient settings (61%). Forty-three percent of participants reported that more than half of their clients with stroke are of working age.

The majority of participants agree or strongly agree that OT plays a key role in RTW (92%), recognize their responsibility in addressing RTW (86%), and incorporate RTW in their intervention plan (75%). During the evaluation process, most respondents address physical and cognitive aspects of work; the least number of respondents address psychological and social demands of work and the work environment. For interventions, most respondents focused on cognitive and motor remediation; the least number of respondents focused training on occupation-centered interventions of training in strategies for real-world work tasks and ensuring person–job task–worksite fit.

Although respondents see the value of employer involvement, consultations and advocacy with the employer are rarely practiced; referrals to state services are occasionally completed. Factors that are considered barriers to implementing RTW services include lack of understanding of work-related laws and regulations and mechanisms for reimbursement. Factors facilitating service provision include specialized training and competencies in RTW, organizational support, and having more time to render OT services.

Although most respondents agreed on role of OT and the importance of addressing RTW among stroke survivors, the study reveals crucial gaps in knowledge and skills among practitioners and the need for greater advocacy skills in facilitating RTW among stroke survivors. Furthermore, the preferred biomedical approach of evaluating and remediating motor and cognitive skills calls into question the availability of evidence-based resources, professional readiness, and opportunities for continuing competence among OT practitioners in applying client-centered, occupation-based approaches to RTW for stroke survivors.

IMPACT: Without a doubt, OT practitioners have a distinct role in promoting RTW for working-age clients with stroke. The findings of this study identify specific opportunities in which OT practitioners could further solidify their role through advocacy and professional development and in synthesizing and developing new evidence to inform practice.

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

George, M. G., Tong, X., Kuklina, E. V., & Labarthe, D. R. (2011). Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995–2008. Annals of Neurology, 70, 713–721. http://dx.doi.org/10.1002/ana.22539

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