Table 3 Draft design of the Stroke Return to Work Intervention Programme

Phase 1:

Assessment Phase

This is the first phase of the programme where preliminary interview is conducted with the clients and at the workplace to obtain information about the stroke survivor’s work ability and the job respectively

• Functional capacity evaluation

• Job analysis;

• Workplace ergonomic assessment

• 3–5 sessions of 60 min per session. OR

• 6–10 sessions of 60 min per session

Phase 2:

Work Intervention Training phase

This phase comprises of 2 focus areas where clinic based work interventions are provided to clients

Focus area 1: Non-work specific intervention/training section

• General functional skills training

• 5–9 sessions of 60 min per session OR

• 10–15 sessions 60 min per session OR

• 16–20 sessions of 60 min per session

Focus area 2: Work specific intervention/training section

• Vocational counselling and career planning

• Prevocational skills training (such as work competence, communication skills, work behavior, interviewing skills, education of legal aspects of work)

• Formal education and training to improve job competitiveness

• Work hardening that is inclusive of simulated task training

Phase 3:

Work Test Placement

This is a continuation of the previous phase. In this phase, other stakeholders in the RTW process of the stroke survivor are engaged. The interventions provided are both clinic and work based

Intervention in the phase include:

• Education and preparation of clients, family, employer and co-worker about client’s abilities

• Identification of suitable work opportunities/jobs

• Work trials (practice of work skills in real work environment)

• Job coaching and on-going support at the workplace• Ongoing environmental and ergonomic modification (structure, equipment, and organizational ergonomics).

• Minimum of 5 sessions over a month period (60 min each); OR

• Minimum of 8 sessions over a month duration (60 min each) OR

• Minimum of 15sessions over a month duration (60 min each)

Phase 4:

Clients Full Participation in the Worker Role

This is the final phase of the RTW programme where the stroke survivor is fully reintegrated back to work

In this phase,

• Clients is able (are trained) to make decisions about strengths and weaknesses

• Clients can (are trained to) identify whether they require ongoing rehabilitation services for specific skills (if needed)

• OT involvement is gradually decreased (tapered)

• A month duration of 3 contact sessions of 60 min each OR

• 3 contact sessions over a period of 3 months (60 min each) OR

• No time-line linked to employment of period (this is based on job availability) but OT contact is limited to 1–2 sessions per month over a period of 3 months

Implementation Strategies and Period for the RTW intervention

This section describes the strategies by which the different phases of the interventions are to be operationalized

Implementation Strategies:

• Use of Multidisciplinary team-based approach

• Use of Interdisciplinary team-based approach

• Client-centered (client is involved in decision making process throughout the intervention).

• Interventions are individually tailored to meet clients need

• Use of case manager to coordinate return to work process

Commencement of Rehabilitation Programme

• During out-patient rehabilitation

• During in-patient rehabilitation

• After out-patient rehabilitation

• After the completion of medical intervention by physician

• When client is independent in performing ADL tasks (self-care and mobility)

• When client is independent in performing leisure activities

• When client is fully reintegrated in the community (such as participation in social groups)