Patients’ perceptions of barriers and facilitators influencing ability to return to work post-stroke

Kriel, Saleema (2019-04)

Thesis (MScPhysio)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Introduction: Stroke is a neurological condition that impacts on the functional ability of the individual and affects participation in everyday activities, including returning to work. The various factors resulting from a stroke impacting the individual’s ability to return to work is not fully clarified in the South African context. While there is literature in SA regarding physical disabilities which could affect the stroke patient’s ability to return to work the patient’s perceptions of these factors needs to be better understood. This study therefore addresses the patients’ perceptions of barriers and potential facilitators affecting return to work post-stroke in the Western Cape. Objective: The objective of this study was to better understand the patient’s perception of barriers and facilitators affecting return to work post-stroke. Methods: A qualitative retrospective study was conducted. Participants were recruited from the Delft, Elsies River and Bishop Lavis communities in the Western Cape Province, South Africa. The study included adult males and females from the age of 18, who had a stroke within the four years prior to data collection for this study, affecting their ability to engage in gainful employment. Various data collection tools were used during the course of this study, inclusive of the Modified Rankin scale (mRS), a self-developed sociodemographic questionnaire and Stroke Specific Quality of Life Scale (SS QoL Scale). Individual interviews were conducted with participants in the mentioned communities. Data from the sociodemographic form, mRS and SS-QoL were analysed using frequency tables and reported in tables. Atlas.ti. (Version 6.2.15; 2011) software was used to code and analyse the qualitative data from the interview transcriptions. Results: A total of six participants participated in the interviews. An equal amount of males versus females were included. The age range of the participants was between 51 to 61 years, and one participant was 71 years old. All participants were involved in some form of employment before the onset of the stroke. Examples of this includes a builder/brick layer (n=2), domestic worker (n=1), textile machinist (n=1), repair/handy man (n=1) and managing a small goods shop from their home (n=1). All of these occupations were physically demanding. None of the participants had returned to work at the time of the interviews. The barriers and potential facilitators identified were categorised into environmental and physical factors. Environmental barriers were identified to be due to weather, uneven terrain and transport difficulties. Physical barriers were identified to be due to functional difficulties, psychosocial factors and residual symptoms post-stroke. Potential environmental facilitators were identified to be transport and work ergonomics. Potential physical facilitators were related to greater functional abilities, positive psycho-social factors and good healthcare and/or rehabilitation. Conclusion: Based on the results of this study, it can be concluded that return to work is influenced by several factors. These factors include the functional ability of the individual which is well supported in the literature, their environment, socio-economic status and their psychological well-being. It was however surprising to unravel the extent that the stroke participants’ psychosocial well-being impacted on their perception of barriers and potential facilitators to return to work. Psychosocial factors were found to weigh heavily on an individual’s return to work ability post-stroke. Based on the findings of this study, various recommendations can be made for rehabilitation, and for future studies.

AFRIKAANSE OPSOMMING : Inleiding: ‘n Beroerte is ‘n neurologiese toestand wat impak maak op ‘n individu se funksionele vermoë en wat deelname aan alledaagse aktiwiteite, insluitent terugkeer werk toe, beïnvloed. Die verskeie faktore wat voortspruit uit `n beroerte en wat ‘n individu se vermoë om terug te keer werk toe beïnvloed, word nie ten volle in die Suid-Afrikaanse konteks uitgeklaar nie. Alhoewel daar wel Suid-Afrikaanse literatuur is aangaande die fisiese gestremdhede wat die beroerte pasiënt se vermoë om terug te keer werk toe affekteer, moet die pasiënt se persepsie van hierdie faktore beter begryp word. Hierdie studie fokus dus op die pasiënt in die Wes Kaap se persepsie van hindernisse en fasiliteerders wat terugkeer werk toe na beroerte beïnvloed. Oogmerk: Die doel van hierdie studie was om die pasiënt se persepsie van die hindernisse en fasiliteerders wat terugkeer werk toe na ‘n beroerte beïnvloed, beter te verstaan. Metodologie: ‘n Kwalitatiewe retrospektiewe studie was uitgevoer. Deelnemers is gewerf uit die Delft, Elsies Rivier en Bishop Lavis gemeenskappe in die Wes Kaap Provinsie, Suid-Afrika. Die studie het volwasse mans en vrouens oor die ouderdom van 18 jaar, wie in die afgelope vier jaar ‘n beroerte gehad het, ingesluit. Die beroerte moes ‘n invloed gehad het op hul vermoë om in winsgewende indiensneming betrokke te wees. Verskeie data-insamelingsinstrumente is in die loop van die studie gebruik, insluitend die Modified Rankin-skaal (mRS), ‘n self-ontwikkelde sosiodemografiese vraelys en die Stroke Specific Quality of Life Scale (SS QoL Scale). Individuele onderhoude is met deelnemers in die bogenoemde gemeenskappe gevoer. Data vanuit die sosiodemografiese vraelys, mRS en SS-Qol is geanaliseer deur die gebruik van frekwensie tabelle en is met behulp van tabelle gerapporteer. Atlas.ti. (Weergawe 6.2.15; 2011) sagteware is gebruik om die kwalitatiewe data van die onderhoudstranskripsies te kodeer en te analiseer. Resultate: In totaal het ses individue aan die onderhoude deelgeneem. ‘n Gelyke aantal mans en vrouens was ingesluit. Die ouderdomme van die deelnemers het tussen 51 en 61 jaar gewissel met een deelnemer wat 71 jaar oud was. Alle deelneemers get voor die beroerte gewerk. Voorbeelde hiervan sluit in 'n bouer / baksteenlaag (n = 2), huishulp (n = 1), tekstielwerktuigkundige (n = 1), herstel / handige man (n = 1) en bestuur 'n klein goederewinkel uit hul huis n = 1). Al hierdie beroepe was fisiek veeleisend. Nie een van die deelnemers het ten tyde van hul onderhoud al teruggekeer werk toe nie. Die hindernisse en potensiele fasiliteerders wat geïdentifiseer was, was gekategoriseer in omgewings faktore en fisiese faktore. Omgewings hindernisse wat geïdentifiseer was, was as gevolg van die weer, ongelyke terrein en vervoer probleme. Fisiese hindernisse wat geïdentifiseer was, was as gevolg van funksionele probleme, residuele gestremdhede en simptome na die beroerte, en sielkundige en sosiale faktore. Potensiale omgewings fasiliteerders wat geïdentifiseer was, was vervoer and werks ergonomika. Potensiale fisiese fasiliteerders was verwant aan beter funksionele vermoëns, positiewe psigo-sosiale faktore en goeie gesondheidsorg en/of rehabilitasie. Gevolgtrekking: Gebaseer op die resultate van hierdie studie kan daar tot die gevolgtrekking gekom word dat terugkeer werk toe beïnvloed word deur verskeie faktore. Hierdie faktore sluit die funksionele vermoë van die individu, wat goed ondersteun word in die literatuur, in sowel as hul omgewing, sosio-ekonomise status en hul sielkundige welsyn. Die omvang van die impak wat deelnemers se psigososiale welsyn het op hul persepsie van die hindernisse en fasiliteerders om terug te keer werk toe, was egter verbasend. Daar is bevind dat psigososiale faktore swaar weeg op ‘n individu se vermoë om terug te keer werk toe na ‘n beroerte. Op grond van hierdie bevindinge van die studie kan verskeie aanbevelings gemaak word vir rehabilitasie en vir toekomstige studies.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/106157
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