Return to work after stroke: Development of a predictive model

Young Stroke Unit, New England Rehabilitation Hospital, Woburn, MA 01801.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.44). 05/1990; 71(5):285-90.
Source: PubMed

ABSTRACT Seventy-nine stroke patients who underwent a vocationally oriented, comprehensive, inpatient stroke rehabilitation program were followed up to evaluate their return to work. At follow-up, 49% had returned to work a mean of 3.1 months after rehabilitation discharge. Factors associated with success and with failure of vocational rehabilitation were then identified, and a predictive model was developed. There were positive associations between return to work and Barthel Index on admission (p = 0.0002) and discharge (p = 0.0015). Negative associations were found between return to work and aphasia (p = 0.0009), rehabilitation length of stay (p less than 0.0001), and prior alcohol consumption (p = 0.03). A step-wise multiple regression model explained 42% of the variance in return to work. Those most likely to return to work were not aphasic; they had shorter rehabilitation lengths of stay and higher Barthel Index scores on discharge; and they were lighter consumers of alcoholic beverages before their strokes. In conclusion, a set of factors predictive of return to work in younger stroke patients was identified, including, most notably, a strong negative association with aphasia and an intriguing negative association with prior alcohol consumption.

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    • "Nos résultats corroborent les données de la littérature concernant l'absence de relation entre la reprise du travail et le type ou la localisation de l'AVC [8,10,15–17,25]. En revanche, comme plusieurs auteurs l'ont déjà souligné [2] [3] [6] [7] [17] [25], nous avons montré que l'importance des séquelles fonctionnelles, Parmi les patients qui ont repris le travail, il y a eu un contact entre le service de MPR et le médecin du travail dans environ 60 % des cas et un patient sur deux seulement a bénéficié d'une visite de pré-reprise. La méthodologie de l'e ´tude ne permet pas de déterminer précisément l'impact de l'intervention du médecin du travail dans la reprise professionnelle, puisqu'il est probable que celui-ci a e ´té sollicité lorsqu'une reprise du travail semblait possible. "
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    ABSTRACT: To study work re-entry by patients having suffered a stroke at least 3 years previously. This was a retrospective survey in which a questionnaire was administered to all patients admitted after a first stroke to the "La Tour de Gassies" Centre for Physical and Rehabilitation Medicine (CPRM) in France between January 2005 and June 2007 and who were in work at the time of the incident. Fifty-six of the 72 included patients (78%) completed and returned the survey questionnaire. The mean age at the time of the stroke was 48.3±10.1. Eighteen (32.1%) of the 56 patients returned to work after their stroke (mean post-stroke time interval: 19.2±13.4 months). Negative prognostic factors for a return to work were living alone, the presence of severe functional impairment and the presence of speech disorders. Positive prognostic factors included specific, professional support and early involvement of the occupational physician. Patients who resumed driving were more likely to return to work and there was a positive correlation between the time to work re-entry and the time to resumption of driving. Close cooperation between occupational health services and CPRM appears to be necessary to speed the return to work by stroke patients.
    Annals of physical and rehabilitation medicine 02/2012; 55(2):112-27. DOI:10.1016/
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    • "These functions are necessary for adequate executive functioning; for goal-formulation, planning, performing and monitoring an activity with a persistent critical view and mental ability. Impaired language has been examined and some authors have found a negative correlation between aphasia and vocational outcome [4], while others found no association [11] [22]. Psychiatric morbidity was negatively associated with return to work in a recent study [14] and post stroke depression has been identified in around 20–50% of persons with stroke [23] [24]. "
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    ABSTRACT: There is great variability in the rate of return to work for persons who have suffered from brain injury. The aims of this study was: 1) to describe employment status of persons with stroke or traumatic brain injury, one year after the incident and 2) to investigate the impact of injury/stroke severity, length of stay, the ability to perform activities of daily living and cognitive function on return to work. Information was collected from 72 persons; 48 with a diagnosis of stroke and 24 with a traumatic brain injury. All patients had attended to a Rehabilitation Centre with inpatient and outpatient facilities. Data of the above mentioned variables was gathered retrospectively and information about employment status was retrieved from the medical records. After one year, 13 persons (approximately 18%), 5 with a stroke and 8 with a traumatic brain injury (one with mild brain injury, 9 with moderate and 3 persons with severe injuries) had returned to work. They had significantly shorter length of stay at the rehabilitation hospital and were younger than those that did not return to work. Somewhat better results at the neuropsychological screening were seen among those that returned to work, although with a significant difference only in the subscale assessing affect. Some persons with severe injury returned to work, while a majority of those with mild brain injury did not. Traumatic brain injury, younger age and less need of rehabilitation were associated with a higher rate of returning to work. Patients with stroke were older and seem to need more support in order to be successful in work return. It is of importance to reach primary rehabilitation goals, such as being ADL independent, as this was also favourable for work return. The impact of injury severity seemed complex and should to be further explored. Persons with mild brain injury should be followed-up with respect to work return. An important cognitive factor was ability to perceive and express affective responses, reflecting the need of social skills in today's work-life.
    Work 01/2010; 36(4):431-9. DOI:10.3233/WOR-2010-1039 · 0.52 Impact Factor
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    ABSTRACT: Return to work after brain injury is at high risk for failure. It is of critical interest for rehabilitation clinicians to know which key factors influence successful reintegration in working conditions. The vast majority of outcome studies focus solely on injury-related facts. Despite profound knowledge concerning the importance of individual psychological processes they are often neglected in scientific investigations. The aim of the present study was to identify the influence of those psychological processes, e.g. coping strategies, cognitive beliefs, and adaptation skills on successful return to work after neuropsychological rehabilitation. A hierarchical model is presented consisting of the components Potential , Psychic Executive , and Performance . Potential , subsuming demographic, clinical and functional data, is not supposed to directly influence Performance . Performance , the capability of a person to perform sufficiently in work, activities of daily living and therapy is presumed to be strongly determined by Psychic Executive . A cohort of 30 patients (mainly suffering from TBI and Stroke) from an outpatient clinic was comprehensively investigated. Psychic Executive at therapy onset showed a high predictive capability concerning patients Performance at the end of therapy. The self-ratings of activities of daily living turned out to be another important predictor for successful work re-entry. Due to the relatively small study sample the results can only be interpreted as temporary and heuristic. Despite this critique future outcome studies on return to work after brain injuries should urgently include psychological factors related to the rehabilitation process.
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