Sleep quality, restless legs syndrome and daytime sleepiness in adults with 5q-spinal muscular atrophy.

Work is a central and valued occupation, and studies have shown that return to work after stroke is beneficial for health, quality of life, autonomy and perceived participation [,] and thus an important goal for rehabilitation for people in working age []. However, in some cases, returning to work after a stroke can negatively impact a person’s well-being, contributing to a gradual decline in health and reduced energy for activities outside of work [,]. Despite regaining a high level of physical recovery after a stroke, people encounter difficulties in reintegrating into the workforce and maintaining employment [,]. Post-stroke fatigue has been identified as a challenge to return-to-work for both men and women [,], and one of the most challenging impairments to manage in everyday life after a stroke []. Post-stroke fatigue is a multifaceted symptom, likely influenced by biological, psychosocial, and behavioural factors []. However, its underlying pathophysiology remains poorly understood []. Fatigue can manifest in various forms or dimensions, including cognitive (or mental), emotional, physical, and stress-related aspects [], and can impair cognitive functions such as attention and information processing speed [], which are crucial for managing daily activities. It often arises from cognitively demanding tasks or environments, and its effects become more pronounced during sustained mental effort or in the presence of intense sensory stimulation [–]. In this article, the term ‘fatigue’ refers specifically to post-stroke fatigue with no limitations regarding dimensions. Fatigue levels may fluctuate throughout the day, influenced by both diurnal rhythms and the intensity and nature of ongoing activities []. It is also a major contributor to limitations in performing complex tasks, within work and household responsibilities []. Since people of working age often engage in occupations that require cognitive skills such as information processing, multitasking, and sustained attention in social settings, it is crucial to understand how fatigue impacts everyday life, particularly in relation to achieving a sustainable return-to-work after stroke. Sustainable return-to-work is a multifaceted concept that has been primarily explored in studies focusing on mental health or musculoskeletal disorders []. While definitions vary, sustainable return-to-work generally refers to a stable and continuous reintegration into the workforce [,], supported by a holistic approach that takes into account personal, social, and organizational factors []. Beekman [] argues that return-to-work should be viewed as a process consisting of phases, transitions, and potential relapses, and that studies aiming to describe the return-to-work process often fail to capture the full complexity and diversity of return-to-work experiences, particularly the role of contextual factors []. The findings of Strømstad et al. [] support this perspective by demonstrating that barriers to return-to-work are multifaceted and extend beyond individual health limitations and performance capacity. They also encompass components described within the Model of Human Occupation (MOHO), including volition, habituation, and environmental influences. Previous studies [,] have likewise shown that factors related to these components can predict whether individuals on sick leave due to mental or somatic conditions return to work within two years, underscoring the importance of considering motivation, role patterns, routines, and contextual conditions when evaluating sustainable return-to-work. However, much of the earlier research on return-to-work after stroke has primarily focused on the binary outcome of whether individuals returned to work, while only a limited number of studies have examined the sustainability of this return over time []. Wassenius et al. [] emphasizes the importance of viewing return to work not as a singular outcome but as an interconnected part of everyday life after stroke, extending beyond the return to work. This perspective is particularly relevant given that having a stroke may lead to difficulties in managing various aspects of daily life, -making it challenging to manage work, family responsibilities, and household tasks []. However, the influence of fatigue on sustainable return-to-work and its broader impact on overall life remains insufficiently explored. Therefore, this study aims to describe how persons of working age who experience fatigue after a stroke perceive their prerequisites for sustainable return-to-work in the context of everyday life.