Return to work after stroke: Development of a predictive model
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.
Available from: Tae-du Jung
- "Social functions, such as self-management and communication, are generally reduced in stroke patients, and many reports showed results of poor quality of life (QOL) [1,2]. Several studies have found that poor daily function decreases QOL and satisfaction levels in stroke patients ; and Pyun et al.  noted that improving QOL was the primary objective of rehabilitation in stroke patients. "
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To evaluate the degree to which the paralysis of a dominant hand affects quality of life (QOL) in patients with subacute stroke.
We recruited 75 patients with subacute hemiplegic stroke. Patients were divided into two groups according to the location of the lesion and the side of the dominant hand. Group 1 consisted of patients whose strokes affected the dominant hand (i.e., right hemiplegia and right dominant hand or left hemiplegia and left dominant hand). Group 2 consisted of patients whose strokes affected the non-dominant hand (i.e., left hemiplegia and right dominant hand or right hemiplegia and left dominant hand). The primary outcome measure was the Short-Form 36-Item Health Survey (SF-36), which was used to evaluate health-related QOL. Secondary outcomes were scores on the Modified Barthel Index (MBI) and Beck Depression Inventory (BDI).
We did not find any statistically significant differences between the groups in any SF-36 domain including the summaries of physical and mental component. Similarly, the MBI and BDI scores were not significantly different between the groups.
The effect of paralysis on the dominant hand and QOL in patients with subacute stroke was not significantly different from the effect of paralysis on the non-dominant hand.
Annals of Rehabilitation Medicine 08/2014; 38(4):450-7. DOI:10.5535/arm.2014.38.4.450
Available from: PubMed Central
- "The current study also suggested that the effect of aphasia and attention dysfunction varied according to concurrent conditions of stroke patients. Patients without aphasia showed a significantly higher chance of returning to work regardless of job types, suggesting that verbal communication with worksite colleagues could influence vocational prognosis in general (Black-Schaffer and Osberg 1990). In contrast, lack of attention dysfunction and aphasia was a significant factor among younger workers, but not among older workers. "
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This study examined clinical, functional, and occupational factors associated with return to work within 18 months after stroke, specifically focusing on the impact of higher cortical dysfunction on return to work in the chronic phase.
This prospective cohort study in 21 hospitals specializing in clinical and occupational health recruited consecutive working-age inpatients receiving acute care for their first stroke (n = 351). A unified database was used to extract patient information from hospital records at the time of admission, discharge, and follow-up at 18 months post-stroke. Cox proportional hazard regression analysis was conducted to determine clinical, functional, and occupational factors influencing return to work within 18 months.
Of 351 registered stroke patients (280 males, 71 females, mean age ± SD, 55.3 ± 7.2 years) who met inclusion criteria, 250 responded to the follow-up survey and 101 were lost to follow-up. Half (51 %) succeeded in returning to work during the 18-month follow-up after stroke onset. After adjusting for age, gender, and Barthel index at initial rehabilitation, the following factors were identified as significant predictors of a return to work: white-collar versus blue-collar occupation (hazard ratio (HR) 1.5; 95 % confidence interval (CI) 1.1–2.2), no aphasia (HR 3.0; 95 % CI 1.5–5.9), no attention dysfunction (HR 2.0; 95 % CI 1.0–4.0), and walking ability (HR 3.1; 95 % CI 1.3–7.1).
This study indicated the importance of tailored rehabilitation to alleviate the impact of higher cortical dysfunction and to support return to work by stroke survivors.
International Archives of Occupational and Environmental Health 05/2013; 87(4). DOI:10.1007/s00420-013-0883-8 · 2.20 Impact Factor
Available from: sciencedirect.com
- "D'après nos résultats, le sexe ne semble pas influer sur le taux de reprise professionnelle. Cela corrobore les données de la majorité des e ´tudes précédentes     ; même si une e ´tude  a montré que les femmes auraient moins de chance de reprendre le travail que les hommes (OR = 0,45 [0,21–0,91]) et si, dans une e ´tude multicentrique prospective récente , les hommes victimes d'un AVC semblent reprendre plus tôt que les femmes. Nous n'avons pas non plus mis en e ´vidence de relation entre la reprise du travail et le niveau d'e ´tude, relation pourtant décrite par certains auteurs comme facteur prédictif positif de retour au travail     . "
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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/j.rehab.2012.01.007
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