Exploring occupational therapists' perceptions, current practices and confidence levels in supporting return to work after stroke: A mixed-methods study.
Paula Reddan, Deirdre Connolly, Louise Keating
UK occupational therapists feel confident in their stroke return-to-work role, but practice skews toward physical and cognitive impairment work.
Work-specific assessments and employer engagement are used rarely; confidence drops to 47% for employer-related tasks. Most learned on the job and want targeted training.
Key findings
1Assessment and intervention practice is predominantly impairment-based: 90% always or frequently complete non-standardised physical assessments, 84% use non-standardised functional assessments, and 82% use cognitive screens, while 66% rarely or never complete work-specific assessments.
2Confidence is high for the overall role (71% agree or strongly agree) and for client-related interventions (74%), but drops to 47% for employer-related interventions and 37% for discussing work-related legislation.
3Work-specific interventions (work hardening, work site visits, ergonomic advice, adapting working hours, managing emotional demands) are used significantly more by OTs with over 10 years' experience and by those in outpatient settings, while 63% rarely or never provide workplace equipment or conduct work site visits.
Still to come
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Sixty-eight survey respondents and a single focus group of four participants is a small, single-country sample; findings describe UK OT practice and cannot be generalised to other countries or to OTs in different specialities. The focus group was planned as three sessions of 6–8 participants but only one was held due to time constraints of a master's programme and NHS pressures, limiting the depth and range of qualitative data. Recruitment was constrained by a 6-week window, a change in RCOT communication policies that prevented direct email to members, and the UK's third national lockdown in January 2022, all of which may have reduced and skewed the respondent pool. The researcher is a practising occupational therapist specialising in stroke rehabilitation, which introduces potential bias in both the survey design and the focus group moderation, despite member checking and a second coder. The study is descriptive: it reports what OTs say they do and feel, not whether their current approach produces better or worse return-to-work outcomes for patients. The survey was adapted from a US instrument and piloted with six OTs; the authors do not report psychometric properties of the adapted version.
Declared interests
The authors declare no conflicts of interest and no financial support for the research, authorship, or publication. However, a funder is named: the Royal College of Surgeons in Ireland. This is internally inconsistent with the 'no financial support' statement and is worth noting.
The easy way to misread this
Do not read the low use of work-specific assessments and employer engagement as evidence that these approaches do not help stroke survivors return to work. The paper is a description of current practice, not a test of effectiveness. The authors themselves cite prior randomised controlled trials (Ntsiea et al., 2015; Trexler et al., 2010) showing that OT-led case-coordination interventions increase return-to-work rates, and they attribute the gap to systemic barriers (time pressure, discharge targets, lack of training, employer consent, and equipment availability) rather than to the interventions being ineffective.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →