Fitting the task to a person with disabilities: A case of return-to-work support for a patient due to left-sided poststroke hemiplegia using tailor-made jigs-and-tools

Abstract

Background: A 45-year-old Japanese male pharmacist developed a stroke in December 2018; hence, he had left-sided hemiplegia due to the after-effects of cerebral stroke. This paper reports the return-to-work (RTW) and after RTW support for poststroke patients from a combined ergonomic and rehabilitation perspective. Methods: From April 2019 to July 2020, we visited hospitals and workplaces multiple times, making various preparations for workplace accommodation and exchanging information as follows: allowing staggered working hours; securing the flow routes in the back room; equipping a cane holder on his working desk; and adjusting the position of the work tablet. In August 2020, after RTW, we conducted a brief evaluation of residual motor function and an on-site task analysis, and we subsequently made a support tool. Results: In July 2020, his RTW was eventually realized. Moreover, as a result of introducing the tailor-made support tool, the duration of certain tasks that he had been claiming to be difficult was reduced when compared to that before support-tool use, and the average task duration before and after support-tool use was 32.8 s and 10 s, respectively (reduced by approximately 69.5%). Conclusion:To augment our efforts, hospital staff, support staff in his workplace, and his employer collaborated to make various workplace accommodations for the smooth realization of RTW before and after RTW. In the present case, the ergonomic and rehabilitation approach after RTW might have contributed to ease of task, work efficiency, and the potential for future job retention. K E Y W O R D Sergonomic and rehabilitation, poststroke, return to work, task analysis How to cite this article: Tani N, Ichikawa F, Mitani R, Akatsu J, Oda S. Fitting the task to a person with disabilities: A case of return-to-work support for a patient due to left-sided poststroke hemiplegia using tailor-made jigs-and-tools.

Return to work for adults following stroke: a scoping review of interventions, factors, barriers, and facilitators

“…As well as the overall low number of sources reporting on intervention studies, our review also concurs with Green et al 32 regarding the significant disparity in how return to work is measured; for example, whether this is a binary "yes" or "no", [66][67][68][69] whether the extent of return to work (in terms of fulfillment of previous hours or role) is taken into account, 16,[63][64][65]67,68 or whether the actual quality of return to work in terms of the stroke survivors' current abilities is measured. [63][64][65]69 This highlights a need for the research community to describe more fully what a return to work involves, and to measure outcomes using more robust and agreed standardized methods, as suggested by the work of the COMET (Core OutcoMes in Effectiveness Trials) Initiative. 130 The observation that only 1 out of 7 intervention studies used a randomized controlled trial design is also worthy of comment, especially as a specific impairment-based intervention was used (as opposed to a more holistic return-to-work or vocational rehabilitation program), and the study did not find that the provision of the intervention treatment improved the likelihood of return to work.…”

“…A further domain reported was the rate of return to work with adaptations of assistive devices, measured by the number of participants requiring these supports 16 . The outcome domain of work performance was also used, measured in 1 study by analysis and interview 69 and in another study by standardized assessment 63–65 . This latter study was the only one to use the outcome of work capacity, again measured by standardized assessement 63–65 .…”

“…(eg,21,61) An additional paper reported solely on barriers to returning to work as experienced by 1 stroke survivor. 62 One systematic review, 30 1 scoping review, 32 and 9 reports from 7 primary studies 16,17,[63][64][65][66][67][68][69] explored return-to-work interventions. Three reports from the same study were included, 1 of which described the development of a return-to-work program, 63 1 reported on the "first try-out" (p.1) of the program, 64 and the third reported on the reflections of the professionals who carried out the intervention.…”

“…Among the 7 primary studies that described return-to-work interventions, 2 described specific impairment-based interventions: 1 explored technological rehabilitation using wearable and/or optic assistive devices, 16 and the other explored visual/perceptual training. 67 The remaining 5 intervention studies described vocational rehabilitation or work support programs 17,[63][64][65][66]68,69 consisting of components such as detailed assessments of the person's functional abilities and work environment 17,66,69 ; individualized physical rehabilitation 17 ; identification of strategies and support needs 17,[63][64][65][66]68 ; liaison with the person's employer 17,[63][64][65]68,69 ; provision of assistive technology or equipment 17,69 ; and work trials either in the person's actual work place [63][64][65]68 or in a volunteer placement designed to replicate the work setting. 66 Only 1 of the intervention studies was a randomized controlled trial, 16 while 1 was a retrospective cohort study.…”

“…66 Only 1 of the intervention studies was a randomized controlled trial, 16 while 1 was a retrospective cohort study. 17 The remaining 5 studies were case studies 69 or case series (with the number of participants ranging from 2 to 10). 64,[66][67][68] Details of the interventions are presented in Table 1.…”