Post-Stroke Fatigue Makes Returning to Work a Complex Journey of Reinvention

For millions of stroke survivors worldwide, the moment they are declared medically stable is often treated as the finish line of rehabilitation. Yet for people of working age, a second, less visible marathon is only beginning: the effort to return to a job that may no longer fit a brain that fatigues unpredictably under cognitive load. A new study published in the Scandinavian Journal of Occupational Therapy offers one of the most detailed portraits yet of what sustainable return to work actually looks like for people living with post-stroke fatigue, and its findings challenge the simplistic binary of whether someone goes back to work at all. Instead, the research describes return to work as a long, emotionally charged process of occupational adaptation in which work ability, family roles, and identity must be renegotiated together.

The study, led by Jessica Vollertsen of Linköping University together with Mathilda Björk, Anna-Karin Norlin, and Elin Ekbladh, recruited 48 working-age individuals in Sweden who had experienced a stroke within the previous five years and who reported fatigue. All had been gainfully employed at the time of their stroke. The participants, 37 of whom were women, were interviewed using the Swedish version of the Worker Role Interview, a semi-structured assessment grounded in the Model of Human Occupation that rates sixteen psychosocial and environmental factors on a four-point scale indicating whether each item interferes with or supports return to work. A questionnaire adding demographic data, the Mental Fatigue Scale, and the Hospital Anxiety and Depression Scale completed the picture. Data were analysed with a qualitative abductive content analysis complemented by descriptive statistics, and the study was approved by the Swedish Ethical Review Authority.

The technical profile of the sample underscores why post-stroke fatigue deserves attention as an obstacle to employment. On the Mental Fatigue Scale, 89 percent of participants reported mental fatigue, most at moderate to severe levels, even though the majority did not show clinically significant depression or anxiety. At interview, 96 percent were employed, but only 15 percent were working full-time; 58 percent worked reduced part-time schedules of 25 to 75 percent, and 23 percent remained on full-time sick leave. The Worker Role Interview ratings revealed a telling pattern: the items most often rated as supportive of returning to work were enjoying work, appraising work expectations, and commitment to work, while perceptions of the work environment, expectations of job success, and pursuing interests were most often rated as interfering. In other words, motivation was rarely the problem. Capacity and context were.

The qualitative analysis produced two overarching categories. The first, re-evaluating work ability while experiencing fatigue, captures how participants confronted an altered, fluctuating capacity that often manifested through memory difficulties, impaired concentration and multitasking, and heightened stress sensitivity. This altered capacity maps onto disruptions in what occupational scientists call personal causation, the appraisal of one’s abilities and the confidence to use them effectively. Participants described learning to recognise early warning signs of fatigue, because ignoring them could trigger headaches, migraines, or exhaustion lasting from a single day to a full week. Crucially, because the impairment was largely invisible, participants struggled not to express their needs but to have them understood and regarded as legitimate by supervisors, co-workers, and external contacts such as customers. Concrete needs, like sensitivity to noise or light, were easier for employers to accommodate than task-related needs, which were frequently dismissed.

The social architecture of the workplace emerged as decisive. Supervisors who actively sought to understand the nature of fatigue were described as crucial, yet frequent leadership changes repeatedly forced participants to re-explain their condition, eroding continuity and trust. One participant recounted how a supportive supervisor had arranged adapted work tasks, only for the next supervisor to remove that possibility. Close working relationships with colleagues were especially valuable because familiar co-workers could notice subtle signs of fatigue and informally adjust workloads. Gradual return-to-work programs and work training helped participants understand their changed abilities, but several experienced an abrupt withdrawal of vocational rehabilitation support the moment they reached full-time hours. Some also reported external pressure from employers or the Social Insurance Agency to increase working hours prematurely, leading to relapses and renewed sick leave, an experience one participant described as being forced to crash three or four times to prove the limitations were real.

Outside the workplace, the study documented how everyday life shaped work ability in a continuous feedback loop. Fatigue left no buffer for unexpected events, so a child missing the school bus or misplaced keys could drain enough mental energy to derail an entire workday. Participants engineered elaborate routines, planning clothing the night before, using calendars and reminders, and keeping their homes meticulously organised, because, as one put it, a cluttered mind requires order and tidiness around it. All participants emphasised scheduling rest and recovery into their days, whether through sleeping, lying in a dark room, pausing during walks with a carried yoga mat, or retreating discreetly to restrooms at work. Remote work arrangements, accelerated by the COVID-19 pandemic, were welcomed because eliminating commutes and using home rest areas conserved scarce energy. Yet the researchers highlight a central paradox: structure and routine are the very strategies needed to manage fatigue, but fatigue itself makes those routines difficult to establish and maintain.

The second category, redefining identity in the context of everyday life, is arguably the study’s most striking contribution. Many participants had built careers around helping others and defined themselves through high performance, making it emotionally wrenching to reconcile current limitations with previous expectations. Family members, witnessing the toll of fatigue firsthand, often questioned whether participants should work full-time at all, fearing another stroke. Energy limits strained parental roles, with one mother describing how work overload left her without the energy to cook proper meals for her children, and reshaped spousal dynamics, sometimes producing closeness through emotional support and sometimes provoking worry about how long a partner would tolerate the changes. Deliberate occupational choices, such as moving closer to work or downsizing housing, conferred a sense of control, whereas giving up cherished social and physical activities was experienced as loss and grief. One participant captured the arc from mourning to acceptance with the phrase: this is the new me, Eva 2.0.

From a clinical standpoint, the authors argue that sustainable return to work cannot be achieved through rehabilitation that treats work in isolation. Because challenges at work and at home proved to be integral to the same adaptive process rather than parallel problems, they call for person-centred rehabilitation that integrates work and everyday life, supports the reconstruction of occupational identity, and enables engagement in meaningful activities despite fatigue. The findings align with the Action Plan for Stroke in Europe 2018 to 2030 and Sweden’s integrated care reform, both of which emphasise person-centred, preventive, and long-term support. The researchers also caution that previous studies have focused overwhelmingly on the binary outcome of whether people return to work, while the sustainability of that return over time has been comparatively neglected, leaving clinicians without evidence-based guidance for the long tail of recovery.

The study has limitations worth noting. Recruitment relied solely on Facebook groups for stroke survivors, which may have excluded marginalised populations and limits generalisability, and interviews were conducted by telephone without audio recordings, restricting verbatim analysis, a constraint the authors offset by conducting 48 interviews to ensure sufficient information power. The COVID-19 pandemic also overlapped with early data collection, although recruitment continued post-pandemic. Still, the scale and depth of the qualitative dataset make this one of the richest accounts to date of how fatigue reshapes working life after stroke. The message for employers is concrete: flexible task and schedule adjustments, consistent supervisory relationships, systematic information about post-stroke fatigue, and continued individualised follow-up beyond the return to full-time hours are not accommodations of convenience but prerequisites for keeping skilled people in the workforce. For clinicians, the message is equally clear: supporting someone back to work after stroke means treating the return not as an event to be achieved, but as an ongoing negotiation between a changed self and a demanding everyday life, one in which identity, not just capacity, must be given time to heal.

Subject of Research: How post-stroke fatigue affects sustainable return to work among working-age stroke survivors

Article Title: Return to work with fatigue after stroke: A complex occupational adaptation process

Article References: Vollertsen, J., Björk, M., Norlin, A.-K., & Ekbladh, E. (2025). Return to work with fatigue after stroke: A complex occupational adaptation process. Scandinavian Journal of Occupational Therapy, 32(1), 1-13. https://doi.org/10.1080/11038128.2026.2613621

Image Credits: AI Generated

DOI: 10.1080/11038128.2026.2613621

Keywords: post-stroke fatigue, return to work, stroke rehabilitation, occupational therapy, occupational identity, Worker Role Interview, Model of Human Occupation, vocational rehabilitation, mental fatigue, workplace accommodation, everyday life, person-centred care