The impact of stroke on employment income: A cohort study using hospital and income tax data in Ontario, Canada.

OBJECTIVE: To document the impact of stroke on employment income among people employed at the time of stroke. DESIGN: Population-based cohort study. PARTICIPANTS: People hospitalized for stroke in Ontario, Canada (2010-2014) and people without stroke matched on demographic characteristics. MAIN MEASURES: Robust Poisson regression to estimate the effects of stroke on the probability of reporting employment income on tax returns over 3 years. Quantile regression difference-in-differences to estimate the changes in annual employment income attributable to stroke. RESULTS: Stroke survivors were increasingly less likely to report any employment income poststroke, incidence rate ratios (IRR) 0.87 at 1 year (95% confidence intervals [CI]; 0.85-0.88), 0.82 at 2 years (95% CI; 0.81-0.84) and 0.81 at 3 years (95% CI; 0.79-0.82). IRR for reporting at least 50% of prestroke income levels were 0.76 at 1 year (95% CI; 0.75-0.78), 0.75 at 2 years (95% CI; 0.73-0.77) and 0.73 at 3 years (95% CI; 0.71-0.75). IRR for reporting at least 90% of prestroke income levels were 0.72 at 1 year (95% CI; 0.70-0.74), 0.66 at 2 years (95% CI; 0.64-0.68) and again 0.66 at 3 years (95% CI; 0.64-0.68). Relative changes in annual employment income attributable to stroke varied from a decrease of 13.8% (95% CI; 8.7-18.9) at the 75th income percentile to a decrease of 43.1% (95% CI; 18.7-67.6) at the 25th income percentile. CONCLUSIONS: It is important for healthcare and service providers to recognize the impact of stroke on return to prestroke levels of employment income. Low-income stroke survivors experience a more drastic loss in employment income and may need additional social support.

Intention to Return to Work after Stroke Following Rehabilitation in Ontario.

BACKGROUND.: Returning to work is important for many people following stroke. An estimate of the prevalence of people intending to return to work post-stroke would be helpful in planning services supporting work reintegration. PURPOSE.: This study examined the prevalence of intention to return to work after discharge among stroke rehabilitation inpatients. METHODS.: We performed secondary analysis of National Rehabilitation Reporting System data for all stroke rehabilitation inpatients across Ontario (2012-2017). Intention to return to work was examined by gender, age, and level of disability. FINDINGS.: Among 25,691 stroke rehabilitation inpatients, 4,668 (18.2%) were employed pre-stroke and 2,039 (43.7%) of them intended to return to work. Intention to return to work was somewhat higher among younger and middle-aged stroke survivors and those with mild disability. IMPLICATIONS.: Providers and planners should be aware that almost half of previously employed stroke-rehabilitation inpatients may be seeking services to assist with return to work.

Situating our selves: using mixed media to convey experiences of psychosocial cancer research.

BACKGROUND: In contrast to the field of art therapy, the use of art-making as a form of reflective or creative practice by social scientists by themselves or for themselves has been limited. In this article, we describe the impetus and outcomes for collective art-making within our group of seven health researchers. METHODS: As a group, we represent sociology, psychology, nursing, occupational therapy, and kinesiology, as well as interdisciplinary studies. Guided by a professional artist, we engaged with mixed media to explore our experiences as psychosocial cancer researchers. RESULTS: Findings are brought to light through a process and outcome narrative that highlights the meaningfulness of cancer to researchers. CONCLUSIONS: Key learnings could inform initiatives that other health researchers might undertake if choosing to expand beyond prevalent models of art as intervention for those who are ill to more fully engage those who explore such lines of inquiry.

Operational Definitions and Estimates of Return to Work Poststroke: A Systematic Review and Meta-Analysis.

OBJECTIVE: To examine operational definitions of return to work (RTW) poststroke and provide more precise estimates of RTW through meta-analysis. DATA SOURCES: A systematic search was conducted using MEDLINE, CINAHL, PsycINFO, and SCOPUS (2005 to March 26, 2018). The search strategy involved expansion of medical subjective headings using terms related to stroke and work. The reference lists of review articles and included studies were checked for additional relevant studies. STUDY SELECTION: Studies were included if they (1) quantitatively analyzed RTW outcomes or factors associated with RTW; (2) reported RTW outcomes for participants employed prior to stroke; and (3) were written in English or French. Two reviewers independently screened titles and abstracts. Of 7265 articles initially identified, 55 studies were included. DATA EXTRACTION: Data were extracted and study quality was assessed by 1 reviewer and verified by a second reviewer. DATA SYNTHESIS: Explicit and implicit operational definitions of RTW were determined and categorized. Ranges of RTW estimates were presented for study and participant characteristics. Pooled summary estimates were calculated for comparable studies by follow-up time poststroke: 55.7% at 1 year (95% confidence interval [95% CI], 51.3%-60.0%) and 67.4% at 2 years (95% CI, 60.4%-74.4%). Similar summary estimates were noted when only population-based studies were considered: 56.7% at 1 year (95% CI, 48.3%-65.1%) and 66.7% at 2 years (95% CI, 60.2%-73.2%). CONCLUSIONS: Operational definitions varied across studies and were often not explicitly reported. To promote comparability of RTW outcomes in future studies, we recommend working toward a universal operational definition and consistent follow-up times. The more precise estimates calculated in this review could be used as benchmarks for health care and social service providers.

Cycles of silence: First Nations women overcoming social and historical barriers in supportive cancer care.

BACKGROUND: First Nations people with cancer in Canada confront several critical inequities in physical and psychosocial domains. First Nations women are at a particular disadvantage as they are disproportionately affected by social determinants of health, but how they navigate these challenges within their communities is poorly understood. OBJECTIVE: Our study explores survivorship experiences of First Nations women with cancer and their caregivers. Drawing from a larger data set on survivorship, we identify several major barriers to cancer communication and support in First Nations communities. METHODS: Our team conducted a participatory, arts-based study using several data collection methods (interviews, sharing sessions, photovoice, and other creative activities) with 43 participants (24 cancer survivors and 19 caregivers) from four First Nations communities in Canada. RESULTS: Two major themes have emerged out of our data analyses: (1) suffering without support leads to cycles of silence and (2) community-based supports can disrupt these cycles. We identified several social, historical, and institutional barriers to speaking about cancer and finding/providing support; however, communities met the challenge of silence through voluntary and unsolicited provision of support. CONCLUSIONS: Widespread silence around cancer reflects both the limited access First Nations people have to formal, supportive programs and services, as well as the creative ways they provide emotional, social, and financial support within their informal networks. Beyond the support of their communities, they also required institutional provision of care that is culturally safe, addressing the colonial impacts on cancer communication and the disproportionate burdens of disease in First Nations communities.

Loss, adaptation and new directions: The impact of arm morbidity on leisure activities following breast cancer.

The impact of arm morbidity on leisure and quality of life is an understudied area in cancer survivorship. The purpose of this study was to qualitatively describe the impact of breast cancer-related arm morbidity on leisure participation in Canadian women. A grounded theory approach was used to generate thematic categories and a model. Drawing on participants from a larger cohort study (n = 740), 40 women with arm morbidity symptoms were purposively sampled and interviewed. Three themes emerged: a sense of loss, adapting participation, and new directions. Women with arm morbidity may experience an abrupt loss of previously enjoyed leisure activities and engage in a process of adapting to discover new meanings and directions. Comprehensive, person-centred cancer survivorship programs may assist with adaptation to arm morbidity.

Physicians' perspectives on cancer survivors' work integration issues.

OBJECTIVE: To explore physicians' perspectives on supporting cancer survivors' work integration (WI) issues. DESIGN: Using vignette methodology, 10 physicians were individually interviewed. Interviews were audiorecorded, transcribed, and subsequently analyzed. SETTING: Ontario. PARTICIPANTS: A total of 10 physicians participated: 5 oncologists and 5 FPs. METHODS: An inductive interpretive description approach was used to identify themes across the entire data set. MAIN FINDINGS: Physicians primarily focused on patients' medical needs and did not spontaneously address WI issues with them. Instead, it was their patients who raised WI issues, most often owing to insurance requirements. Physicians readily completed insurance forms to aid patients' well-being, but they did not believe their guidance was empirically sound based upon their limited WI training; rather, they recognized other health professionals, such as occupational therapists, as being better equipped to address cancer survivors' WI issues. Despite this recognition, referrals for WI support were not routinely facilitated owing to a lack of resources or knowledge. CONCLUSION: Owing to a lack of training and time, as well as the belief that WI issues are not part of their mandate of care, physicians perceive themselves as ill-equipped to address cancer survivors' WI issues. These findings underscore the need for enhanced awareness of cancer survivors' WI issues and the need for accessible support services offered by duly trained health care professionals, such as occupational therapists, ideally working in a multidisciplinary team to holistically address cancer survivors' unique needs.

Survivors' experiences of return to work following cancer: A photovoice study.

BACKGROUND: For many working-age cancer survivors, return to work represents a quality-of-life indicator. However, there is currently a lack of resources to assist survivors with navigating this process. PURPOSE: As a first step toward informing resources to address this gap, 10 female survivors' return-to-work experiences were explored. METHOD: Photovoice methods were combined with interviews. Photographs and text were analyzed to identify key themes. FINDINGS: Return to work was psychosocially motivated. Survivors independently decided if they would take leave and, if so, when they would return to work. Successful work reintegration was characterized as respectful, collaborative, and customized to each survivor's ongoing limitations and variable recovery. IMPLICATIONS: The findings underscore a holistic, client-centred, and collaborative approach to successful return to work with cancer survivors. Occupational therapists, with their vocational rehabilitation knowledge and responsive practice philosophy, are well positioned to address this gap in survivorship support.

Working alliance development in occupational therapy: a cross-case analysis.

BACKGROUND: Despite reverence afforded the therapeutic relationship construct in occupational therapy, many occupational therapists feel ill equipped to use themselves therapeutically to enhance the relationship with their clients. Furthermore, although occupational therapists often link the strength of the therapeutic relationship to therapy outcomes, related occupational therapy specific research has been limited. According to the psychotherapy literature, the working alliance is one element of the therapeutic relationship which has in fact been linked to therapy outcomes. METHODS: A mixed-methods, prospective, multiple case study approach was used to compare the experiences of the working alliance by both occupational therapists and clients across four therapeutic dyads. RESULTS: Several key elements were identified in this study's qualitative data as shaping the process of alliance development in occupational therapy including: the fostering of an interpersonal connection; the use of humour as therapeutic modality; an impetus to act that leads to functional enhancements; a shared sense of success and a positive feedback mechanism created through successfully attaining clearly delineated, client-centred therapy goals. CONCLUSIONS: By considering these identified elements, occupational therapists may focus upon tangible considerations towards enhanced therapeutic use-of-self in the development of sound working alliance with their clients potentially improving therapy outcomes.