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| Name | Class |
|---|---|
| Helsinki University Central Hospital | OTHER |
| Finnish Work Environment Fund | OTHER |
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The aim of this randomized controlled trial (RCT) is to investigate whether cognitive job accommodation intervention enhances return to work, work ability and performance after ischemic stroke in working-age population. The main questions are:
Researchers will compare the intervention group to a control group returning to work after stroke with current healthcare practices and work procedures.
Participants:
Introduction: Strokes are one of the most significant conditions affecting cognition among working-age adults. Incidence of stroke increases in older age and due to the lengthening of working careers, more people are experiencing strokes while still employed. Additionally, the incidence of strokes among younger workers has increased over recent decades. In Finland, 2000 - 3000 work-aged persons suffer a stroke annually. The majority experiences cognitive or emotional symptoms post-stroke, and for about half of them, these symptoms become long-lasting or permanent. The cognitive demands of modern work have steadily increased, and the severity of cognitive symptoms has been shown to strongly predict the likelihood of returning to work after a stroke. While job accommodation has been shown to be an effective way to support return to work after many illnesses, there is limited research on its benefits following a stroke. Furthermore, there is lack of research on cognitive job accommodation, despite health professionals finding it particularly challenging.
Aims: To evaluate the effect of job accommodations after stroke on various work and health related outcomes. In addition, information about working-aged stroke patients returning to work and the practices of job accommodation is provided. In the future these results can potentially be applied also to other conditions affecting cognition.
Participants and methods: This study will recruit 18-68 year old stroke patients who are returning to work (n ≈ 100). Participants will be randomized into either a job accommodation intervention group or a control group. The study will assess the benefits of cognitive job accommodation in terms of absenteeism, presenteeism, work modifications, perceived work ability, health indicators and cognitive and emotional symptoms. Participants will be followed through web-based surveys and novel cognitive tests over a 12-month period. The study will adopt a multidisciplinary approach (ergonomics, occupational psychology, neuropsychology, and medicine) and will be based on the International Classification of Functioning, Disability, and Health (ICF) model. Cognitive job accommodation will utilize an established model, a design form, and an instructional video.
Collaborators and target organizations: The research will be conducted in collaboration with the Helsinki University Hospital Neurocenter and the Finnish Institute of Occupational Health. In addition to these organizations the study is funded by the Finnish Work Environment Fund. The target organizations include occupational health services and workplaces of stroke survivors.
Utilization of Results: The methods developed in this study can be used in future collaborations between workplaces, occupational health services, and specialized healthcare. The findings can also be applied to other conditions that cause cognitive difficulties and require job accommodation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cognitive job accommodation | Experimental |
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| Reference group | No Intervention | Employees return to work according to standard health care and workplace procedures. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cognitive job accommodation | Other | Job accommodation focused on the cognitive aspects at work |
|
| Measure | Description | Time Frame |
|---|---|---|
| Absenteeism and presenteeism | Absenteeism and presenteeism are evaluated with World Health Organization's Health and Work Performance Questionnaire (HPQ) using both absolute and relative measures. Absolute absenteeism: hours in 4 week (higher value indicates worse outcome). Absolute presenteeism: single question measure of own job performance (score 0-10) analyzed according to the HPQ instructions (higher value indicates better outcome). Relative absenteeism: working hours in 4 week / expected working hours in 4 week. Relative presenteeism: evaluation of own job performance (score 0-10) / evaluation of most other workers job performance (score 0-10). This score is restricted to the range of 0.25 to 2.0 according to HPQ instructions. In both relative scores higher values indicate better outcome. | 6 and 12 months |
| Work ability | Estimate of the current work ability measured with single question (score range 0-10, higher score indicate better outcome) from Work Ability Index. Estimate of future work ability measured with single question (categorical variable: yes, no, maybe) from Work Ability Index. | 6 and 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Perceived success in returning to work | Subjectively evaluated success in returning to work. Single item question with 5 point Likert scale (5= very good; 1= very bad). | 6 and 12 months |
| Cognitive demands of work and related difficulties |
| Measure | Description | Time Frame |
|---|---|---|
| Cognitive test performance | Performance in web-based cognitive tests measuring reaction time, attention, executive functions and verbal memory functions. Applied cognitive tests are Task Switching test and Verbal memory test (modified version of the RAVLT). | 6 and 12 months |
| Level of social support |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Teemu I Paajanen, Dr | Contact | +358438250389 | teemu.paajanen@ttl.fi | |
| Nina Nevala, Dr | Contact | nina.nevala@ttl.fi |
| Name | Affiliation | Role |
|---|---|---|
| Teemu I Paajanen, Dr | Finnish Institute of Occupational Health | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Helsinki University Hospital Stroke Unit | Recruiting | Helsinki | Uusimaa | 00029 | Finland |
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| ID | Term |
|---|---|
| D000083242 | Ischemic Stroke |
| D060825 | Cognitive Dysfunction |
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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Randomized clinical trial
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Frequency of different cognitive demands at work and related perceived difficulties measured with Brain Work Questionnaire. Frequency values are reported as averaged occurrence/week (lower values indicate better outcome), and related difficulties in ordinal response variable (0=no difficulties, 1=sometimes difficult, 2=often difficult). Higher value indicates worse outcome.
| 3 and 12 months |
| Cognitive symptoms at work | Cognitive symptoms at work measured with The Cognitive Function at Work Questionnaire total score (score range 0-58: higher value indicates worse outcome) | 6 and 12 months |
| Stress | Estimates of perceived stress. General stress measured with single item stress question (score range 1-5, lower value indicates better outcome). Theme specific stress (at home, work and financial). Ordinal 4 point response scales. Questions from INTERSTROKE study. | 6 and 12 months |
| Sick leave days | Number of days on sick leave after returning to work. Higher value indicates worse outcome. | 6 and 12 months |
| Insomnia symptoms | Frequency of insomnia symptoms measured with single item question with ordinal 5 point scale (5=Every night or nearly every night; 1=never). Higher value indicates worse outcome. | 6 and 12 months |
| Fatigue symptoms | Fatigue symptoms measured with Fatigue Assessment Scale (FAS). Total score range 10-50. Higher score indicates worse outcome. | 6 and 12 months |
| Stroke related life satisfaction | Perceived life satisfaction based on the Young Stroke Questionnaire (total score 0-100; where higher score indicates better outcome) | 6 and 12 months |
| Mental job strain | Perceived mental job strain. Single item question with ordinal 1-5 point response scale (1=not at all; 5 very much). Higher value indicates worse outcome. | 6 and 12 months |
| Perceived cognitive and emotional difficulties in general | Perceived cognitive and emotional difficulties in general measured with Check List for Cognitive and Emotional Consequences. Likert scale questions 0-2. Higher values indicate worse outcome. | 6 and 12 months |
| Modified Rankin scale | The Modified Rankin Scale (mRS) measures degree of disability/dependence after a stroke. The mRS is a 6 point disability scale with possible scores ranging from 0 to 5. Higher score indicates worse outcome. | 12 months from the stroke |
| Benefit of the job accommodations | Perceived benefit of the carried out job accommodations. Single item question with 5 point Likert scale (5=very much; 1=very little). Higher value indicates better outcome. | 6 and 12 months |
| Job burnout symptoms | Job burnout symptoms measured with Burnout Assessment Tool (BAT) 4-item version. Averaged sum score: range 1-5. Higher score indicates worse outcome. | 6 and 12 months |
| Depression symptoms | Depression symptoms measured with Patient health Questionnaire 9 question version (PHQ-9). Total score range 0-27. Higher score indicates worse outcome. | 6 and 12 months |
| General life satisfaction | Perceived general life satisfaction measured with single item question with 5 point Likert scale (5=very satisfied; 1=very dissatisfied). Higher score indicates better outcome. | 6 and 12 months |
| Daily function ability | Perceived daily ability to function measured with single item question (score range 0-10). Higher score indicates better outcome. | 6 and 12 months |
| Amount of job accommodations | Amount of the actualized job accommodations measured with single item question. Ordinal 4 item scale. (3=A lot , 2=somewhat, 1=a little, 0=not at all). Higher value indicates better outcome. | 6 and 12 months |
| Work participation | Monthly work participation percentage (%) as compared to fulltime working. Higher value indicate better outcome. | 6 and 12 months |
Self-reported level of social support measured with Oslo Social Support Scale 3-item version (OSSS-3). Sum score range 3-14. Higher score represent better outcome. |
| 6 and 12 months |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D003072 | Cognition Disorders |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |