a poster arising from a grant from the Evelyn Trust awarded to De Simoni, Mant and Bateman There remains a lack of awareness among employers, clinicians, family members and stroke survivors that stroke can lead to invisible consequences that may be barriers to returning to work or making reasonable adjustments.

1. Implications
• There is need to improve
awareness of invisible impairments
among stroke survivors, work
personnel, clinicians through:
• Interventions and campaigns.
• Implementation and
clarification of existing
guidelines.
• More research is needed on the
potential role of primary care, and
on improving assessment of
invisible impairments (e.g. fatigue).
Key Points
• Despite having returned to work,
people with stroke/TIA experience
difficulties and can be at risk of
losing their job.
• Invisibility of impairments can lead
to misunderstanding around ability
to work.
• Awareness of stroke links with
support received.
• Developing coping strategies, and
support from the workplace helped
people to stay in work.
• Sixty stroke/TIA survivors were included.
• 29 males and 23 females (8 unknown).
• Median age at stroke (range): 44.5 (25-
66).
• All participants experienced ‘invisible’
impairments that affected their ability to
staying in work.
• Stroke survivors face barriers in
returning to work.
• No research has yet focused on those
who have returned to work after stroke.
• Online patient forums could be an
important source for naturalistic patient
data.
Explore barriers and facilitators in
staying in work after a stroke using data
from an online forum.
• Patients with stroke/TIA who had
returned to work were identified using
key words ‘return to work’ (n=31) and
‘back at work’ (n=29).
• Thematic analysis on posts about
work on TalkStroke archives (2004-
2011).
• Coding was repeated independently
on a sample of 15 patients by a
second researcher (ADS).
This was the first study to address
issues with staying in work after stroke
using a novel methodological
approach by qualitatively analysing an
online forum.
Barriers and facilitators to staying in work after stroke: insight from an online forum
Website: http://www.blizard.qmul.ac.uk/research/centres/16-centre-for-primary-care-and-public-health.html
Chantal Balasooriya-Smeekens1, Andrew Bateman2, Jonathan Mant1, Anna De Simoni3
Introduction
Aim
Methods
Discussion
Staying in
work after
a stroke
Support
Understanding
stroke
Health and
impairments
Qualitative findings
Invisibility of impairments and
misunderstanding
A man shared his experience that his boss tells him that he
is being lazy, and that he cannot blame the stroke anymore
for not having motivation for work. [Male, 36-50, stroke type unknown,
job type unknown, N42].
Normality
A wife of a stroke survivor
wrote that it was frustrating
that workmates were
treating her husband in the
same way as before his, as
if he was fully recovered
[Male, 36-50, stroke type unknown,
unknown job, written by carer, N51].
Fatigue: A common invisible
impairment
A woman described that she tries to keep her part-time job,
but that she feels sore and fatigued, and needs to sleep
after getting home. She has to stay in bed the rest of the
day, until her husband comes home and cares for her.
[Female, age unknown, stroke, office/professional job, N13].
Impairments becoming ‘visible’
A woman wrote that her employer has been very
understanding, which she thought may have been because
she has had her stroke in front of everyone at work [Female, 51
and older, stroke, office/professional job, N20].
(Lack of) support at workplace
A man reported that his manager was initially not
good at communicating and understanding him,
however, after he heard at the assessment about the
problems he was having, he became much more
understanding and supportive. [Male, 51 and older,
office/professional job, N28].
The (limited)
role of the GP
He described that the GP
was not willing to extend
the sick leave, as the GP
thought he was fit enough
to return to work, even
with impairments such as
walking, communication
problems, limb spasms
and fatigue, because he
could sit at a desk and
could move all limbs. [Male,
51 and older, stroke, office/
professional job, stroke, N28].
Coping with impairments
A woman described that she needed to get up
earlier in the morning because she had become
slower after her stroke. Getting her clothes ready
the night before, and having a shower in the
evening was also helpful. [Female, 51 and older,
office/professional job, stroke, N20].
Indirect problems
affecting return to work
A woman wrote that her husband was
having a difficult time with his full-time
work. It would have been better if he
had more time at home, however he
had no choice but to go back to work
as they have little financial support.
Apart from tax credit, they did not get
anything because they were self-
employed. [Male, 51 and older, manual job,
stroke, written by carer, N21].
Impairments and
recovery
A man who explained that he
realised he could not do his job
(machinery setter) anymore
physically and mentally, and was
interested in receiving training to
do a different job. [Male, 35 and
younger, manual job, stroke, N16].
1The Primary Care Unit, University of Cambridge; 2The Oliver Zangwill Centre, Ely; 3Centre for Primary Care and Public Health, QMUL
Participants
Acknowledgements: The Evelyn Trust for funding the study; Susan Brentnall (OT) for advice on current practice and policies; the Stroke Association for sharing the archive file of Talkstroke .
Contact: Chantal Balasooriya-Smeekens, cs662@medschl.cam.ac.uk