Background: Stroke impacts on a survivor’s ability to participate in community activities such as returning to workand affects people who are still within the working age. The incidence of stroke in people younger than 65 years has increased with almost 5% occurring in those younger than 45 years of age.

Purpose: To establish the effect of a workplace intervention programme on the rate of RTW of previously employed stroke survivors.

Relevance: The workplace intervention programme can be included in stroke rehabilitation and this may enable people with stroke to contribute their skills and abilities to the economy and society. The cost of claims on public social security and occupational benefit schemes can be reduced if employees with stroke are retained at work and this will also help to improve the stroke survivors’ quality of life.

Participants: Eighty stroke survivors (40 in intervention and 40 in control group) between the ages of 18 and 60 years who were employed at the time of having stroke. Participants had a Barthel Index score of at least 60% and stroke for less than eight weeks at the time of baseline assessment.

Methods: A randomized controlled trial with a three and six month follow-up. The workplace intervention programme was tailored according to the functional ability and workplace challenges of each stroke survivor and included work ability assessment; vocational counseling and coaching; adaptation of the work environment; and advice on strategies to compensate for functional limitations. The control group received usual stroke care which took into consideration the stroke survivor’s job requirements, but without work visits and workplace intervention. The primary outcome was return to work (RTW) rate and secondary outcomes were functional level (activities of daily living, mobility and basic cognitive function) and perceived quality of life. The study setting was an urban area within a developing country.

Analysis: Descriptive summary statistics were used to compare baseline characteristics for both groups. For continuous variables that were normally distributed a two sample independent t-test was used. For non-normal distributions a Mann-Whitney U-test was used. Fisher’s exact test was used to test the association between categorical variables for variables which had less than five observations per category; otherwise the Chi-squared test was used. Rate of RTW was assessed by comparing the percentage of participants who returned to work with those who did not, using a two sample independent t test of proportions. All statistical analyses were performed according to the intention to treat analysis. Per protocol analysis was used to establish if any protocol deviations had caused bias. Missing data was not imputed.

Results: The average age of the stroke survivors was 45 years (SD: 8.7); average stroke duration was 4.6 weeks (SD: 1.8); 39 (49%) had left hemiplegia and 41 (51%) had right hemiplegia. At six months follow-up: there were 35 stroke survivors within the intervention group and 37 within the control group. Stroke survivors in the intervention group were 5.2 times more likely to RTW than those in the control group; and for every unit increase in the activities of daily living and cognitive assessment scores, the likelihood of RTW increased by 1.7 and 1.3 respectively; those who returned to work had better quality of life than those who did not RTW (p = 0.05; Confidence Interval: -19.8 – 0.3).

Conclusion: Overall, these results suggest the need to direct resources towards increasing work place intervention strategies after stroke.