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Returning to work is an important goal after stroke, not only as a recovery indicator but also for facilitating independent living and improved social identity. The aim of this study was to explore the lived experiences of vocational rehabilitation and the return to work pathway after stroke. Qualitative data were collected through semi-structured interviews with purposively selected participants who had participated in a vocational rehabilitation trial. All participants were employed at the time of their stroke and were community-living. Interviews were undertaken by occupational therapists and were transcribed verbatim before data were thematically analysed using a framework approach. Sixteen participants were interviewed, seven received specialist vocational rehabilitation and nine received usual clinical rehabilitation. Three major themes were identified which highlighted the importance of tailored vocational rehabilitation to address the challenges that arise when returning to the workplace. Stroke survivors perceived the most beneficial components of the specialist vocational rehabilitation intervention to be employer liaison support, fatigue management, and support for cognition and executive processing skills. Vocational rehabilitation was perceived to provide an opportunity to influence working after stroke, although areas of unmet need were highlighted. Findings provide direction for the development of future stroke-specific vocational rehabilitation programs. Psychosocial (emotional) and cognitive (memory and planning) changes along with post-stroke fatigue were perceived to be the greatest barriers faced on returning to work and should be key areas for intervention within a vocational rehabilitation program. Vocational rehabilitation interventions should be tailored to each participant, incorporating elements perceived to be important to stroke survivors, including workplace liaison, employer communication and psychological support. Workplaces may benefit from access to information about the range of physical, cognitive and language deficits associated with stroke, and the potential impact these may have on work skills. [ABSTRACT FROM AUTHOR]

Introduction: Returning to work is a goal for many people after brain injury. The failure to return to work after injury brings both economic and personal (quality of life) costs to those living with stroke or brain injury, their families, and society. This study explored the barriers to providing work‐focused interventions during hospital‐based rehabilitation and co‐created solutions with rehabilitation providers to increase the provision of work‐focused intervention during inpatient rehabilitation. Methods: This study used an Intervention Mapping approach (a six‐step protocol that guides the design of complex interventions) based on an action research methodology. Focus group data, in addition to best evidence from systematic reviews, practice guidelines and key articles were combined with theoretical models for changing behaviour and clinician experience. This was then systematically operationalised into an intervention process using consensus among clinicians. The process was further refined through piloting and feedback from key stakeholders, and group consensus on the final process. Results: A detailed five phase return to work intervention process for inpatient rehabilitation was developed. The key features of the process include; having one key allied health clinician to coordinate the process, choosing assessments based on pre‐injury work demands, emphasising the importance of core work skills and considering the most appropriate service for referral at the conclusion of rehabilitation. Conclusion: We used a systematic approach, guided by the intervention mapping approach and behaviour change theory to tailor existing workfocused interventions to the inpatient setting. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the relationship between the provision of an interdisciplinary return to work or study (RTW/S) program for persons with acquired brain injury (ABI) and work/study status, and their health and well-being outcomes. A prospective longitudinal research design was utilised. Nineteen adults with an ABI engaged in an individualised, interdisciplinary RTW/S rehabilitation program. Data was collected on work/study status and the Quality of Life (SF-12?) measure at baseline, program completion, and 3-months post program completion. Immediately after and 3 months' post intervention, 74% of participants had RTW/S in either full-time or a reduced capacity; one quarter were unemployed or no longer studying. Work/study status at the 3-month post intervention time point did not correlate with the SF-12 although self-reported quality of life did increase following the work/study intervention. Involvement in an interdisciplinary RTW/S rehabilitation program demonstrates promise, and is associated with returning successfully to work/study and improved health and well-being after an ABI. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusion WHAT THIS PAPER ADDS What is already known on the subject What this study adds What are the clinical implications of this work? People with communication disability after stroke experience low rates of return to vocational roles. Vocational rehabilitation is recommended; however, there are no clear guidelines informing vocational rehabilitation for people with communication disability. Understanding the needs and experiences of this population is critical to improving vocational stroke rehabilitation outcomes.This study aimed to: (1) investigate the experience of vocational rehabilitation for people with communication disability after stroke, (2) identify gaps and, (3) provide preliminary recommendations for tailored service delivery.Seven participants with an identified communication impairment following stroke were recruited from a larger clinical trial of early vocational rehabilitation (20% of total sample, n = 34). To address the study aims, a qualitative design was employed. Semi‐structured, in‐depth interviews were conducted and analysed using thematic analysis. Data were integrated with demographic and intervention audit data to contextualise participant experiences, identify vocational rehabilitation gaps and inform preliminary recommendations.Participants were five men and two women aged 24–69 years whose communication profiles included difficulties with auditory comprehension and information processing, reading comprehension, thinking, executive function and self‐regulation, as well as difficulties with verbal and written expression. Vocational rehabilitation was perceived as beneficial but participants identified gaps including limited access to psychological and peer‐based support during early rehabilitation, limitations to accessing specialist vocational rehabilitation programs, barriers to accessing ongoing rehabilitation after resumption of vocational activity, and limited preparedness for the degree of impact that their communication changes had on execution of vocational roles and responsibilities.Vocational environments are communicatively demanding and people living with acquired communication difficulties face a range of vocation‐related participation barriers even when communication difficulties are mild. Greater emphasis on evaluating the vocational communication environment and targeted communication training and preparation for colleagues within the workplace is recommended to reduce barriers faced. Interdisciplinary rehabilitation, inclusive of psychological care, may support working‐age stroke survivors to recognise and acknowledge changes in their communication function, lead to improved engagement in the rehabilitation process, and ensure early identification of factors likely to influence successful return‐to‐vocational activity. Stroke is common amongst people of working age yet fewer than half of stroke survivors will return to pre‐stroke vocational roles. Communication difficulties affect anywhere between 24% and 45% of people after stroke and include changes to language abilities, motor speech, vision, hearing and cognition. This group experiences much lower rates of return to vocational roles when compared to people with stroke who do not have a concomitant communication difficulty. Vocational rehabilitation is recommended. However, currently there is limited evidence to inform vocational rehabilitation guidelines for people with stroke and communication difficulties. Achieving a successful return to vocational activity is associated with improved life satisfaction for people with communication difficulties after stroke and is a key research priority for this population. This study investigated the experiences of people with communication difficulty after stroke who reported a goal of returning to pre‐stroke vocational activity. Data associated with types of interventions received, the experiences and perceptions of vocational rehabilitation, and experiences of returning to vocational activity were analysed to identify core rehabilitation needs and develop preliminary recommendations to inform future vocational rehabilitation guidelines for this population. The present study provides preliminary evidence that people experiencing communication difficulties after stroke require a more integrated rehabilitation pathway. During early stages of vocational rehabilitation psychological and peer‐based support is indicated to support adjustment to changed communication function and to enable productive goal setting and engagement in rehabilitation. Clinicians need to complete a detailed analysis of the vocational communication environment and consider the communication activities involved in the individual's future vocational duties in order to plan meaningful rehabilitation. A multidisciplinary approach is required and additional training for clinicians is indicated to support clinicians to work collaboratively within the vocational setting. [ABSTRACT FROM AUTHOR]

Infertility is a widespread issue which is estimated to affect up to 17.5% of the global population. Evidence suggests that the most common causes of female infertility are ovulation disorders (e.g., polycystic ovary syndrome). That said, lifestyle factors such as dietary patterns, stress, alcohol consumption, smoking, and obesity are key determinants which have been shown to impact female physiology and significantly decrease the chances of conception. Obesity has been widely recognized as a significant factor that negatively impacts ovarian stimulation in women and is associated with several reproductive disorders, including anovulation, subfertility, and infertility. Despite improvements in fertility treatments, obesity remains a challenge particularly for fertility clinics because of the poorer pregnancy outcomes observed within the population. In this article, we will explore the effects of weight loss on female fertility and review the various strategies that have been shown to be effective in reducing obesity and improving reproductive outcomes.

Obesity is a well-established risk factor for infertility. Consequentially, women living with obesity may require fertility treatment to support them to conceive. Due to evidence suggesting obesity is also linked with poorer outcomes following in vitro fertilisation (IVF), local commissioning guidelines on assisted conception recommend a BMI of <30kg/m 2 before IVF can commence. However, it is currently unclear if these guidelines are evidence based. This commentary aims to critically appraise a recent systematic review by Sermondade et al, 2019 and expand upon the implications of the findings for clinical practice.