Mood, fatigue poorly addressed in post-stroke return-to-work rehab programmes

Despite being significant predictors of return to work (RTW), mood and fatigue are poorly addressed in rehabilitation programmes aimed at improving RTW following a stroke, a systematic review from Singapore suggests.

“RTW is an important outcome and a key rehabilitation goal for many working-age stroke survivors, promoting an overall improvement of quality of life, social integration, and emotional wellbeing,” said the researchers. “[However,] RTW programmes have largely focused on physical and vocational rehabilitation, while neglecting to include mood (eg, depression, anxiety, stress) and fatigue management.”

The investigators searched randomized controlled trials evaluating RTW programmes after stroke, with focus on assessing components of mood and fatigue if they were included. Five trials met the selection criteria (n=626; mean age between 44.0 and 66.7 years). In four studies, participants were employed at the time of their stroke. [Front Neurol 2023;14:1145705]

Three trials included components of mood and fatigue management in the intervention*. In one study, the percentage of participants who had returned to work at the 6-month follow-up was threefold higher in the intervention than the control arm (60 percent vs 20 percent; p<0.001). Moreover, those in the intervention arm had ~5 times higher odds of returning to work than those in the control arm (p=0.002). [Clin Rehabil 2015;29:663-673] Another study mirrored this effect, with more participants in the intervention vs control arm having returned to full-time work at the 12-month follow-up (37.5 percent vs 11.8 percent). [J Rehabil Med 2020;52:jrm00048]

Despite the positive effects in the outcome measures in the two studies, the researchers noted that both were underpowered and had small sample sizes.

In the two studies that did not evaluate elements of mood and fatigue management, no significant differences were found in terms of RTW rates between the intervention and control arms. [Ann Phys Rehabil Med 2022;65:101565; Int J Environ Res Public Health 2020;17:5233] “Although psychological support was not included in their intervention programme, [one of these studies] found less depressive traits to be statistically predictive of RTW post-stroke,” the researchers said.

“These findings suggest that mood and fatigue management may be one of the elements of a rehabilitation programme that makes it successful in promoting RTW post-stroke. However, larger scale studies are still needed to support this finding,” they added.

Support in work reintegration

In stroke survivors, failure to return to work following a stroke could impair self-esteem and quality of life. It may also increase the socioeconomic burden owing to the drop in work productivity. [J Occup Rehabil 2014;24:100-110; Disabil Rehabil 2014;36:409-417]

Moreover, surviving a stroke means dealing with its physical and neurological setbacks, as well as the potential emotional and cognitive changes. “These elements must be addressed in a comprehensive RTW rehabilitation programme … Stroke survivors should be well-supported in their reintegration into working life,” the researchers stressed.

“Given the prevalence of mood dysfunction and fatigue post-stroke, it is imperative to include components addressing and measuring psychological support and fatigue management in all post-stroke rehabilitation programmes for improving RTW outcomes, to ensure that they are comprehensive and holistic,” said the researchers.

While it is encouraging to see that the research community is gradually drawing its attention to this issue, the scarcity of trials included in this review underpins the need for further investigation on the role of post-stroke RTW intervention programmes, the researchers noted. More research is warranted to shed light on the effects of mood and fatigue on RTW after stroke.