Return to work after stroke: Development of a predictive model

Article (PDF Available)inArchives of Physical Medicine and Rehabilitation 71(5):285-90 · May 1990with72 Reads
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.
    • "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 [3]; and Pyun et al. [4] noted that improving QOL was the primary objective of rehabilitation in stroke patients. Hand dominance refers to a hand preference when performing a task [5]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective To evaluate the degree to which the paralysis of a dominant hand affects quality of life (QOL) in patients with subacute stroke. Methods 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). Results 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. Conclusion 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.
    Full-text · Article · Aug 2014
    • "Furthermore , it proves that the occurrence of aphasia has an influence on the direct costs of rehabilitation [4]. Language dysfunction in the post-acute or chronic phase after a stroke is the major restriction of vocational rehabilitation [5] and reduces the probability of a return to work [6]. Aphasia is associated with emotional burden [7] and limits social participation owing to impaired communication abil- ity [8], as well as with a decrease in the quality of life [9] and an increase in the mortality of stroke patients [10]. "
    [Show abstract] [Hide abstract] ABSTRACT: Aphasia is a common and severely disabling complication in stroke patients. It usually brings about lower rates of functional recovery, longer rehabilitation length of stay (LOS), and significantly poorer LOS efficiency (LOS-Eff), resulting in higher rehabilitation costs compared to patients without aphasia. It also decreases the quality of life and increases the mortality of stroke patients. The evidence currently available suggests that the effect of acupuncture combined with language training for apoplectic aphasia is statistically better than speech and language therapy (SLT) alone, but there remains a lack of high-quality randomized controlled trials. Acupuncture combined with language training is relatively low-cost and especially suitable for community-based rehabilitation for aphasia patients after stroke, taking its medical and health facilities which are always deficient in manpower and material resources into account. The aim of the present study is to develop an effective standard therapeutic program for apoplectic aphasia in communities. In a randomized controlled clinical trial with blinded assessment, 290 eligible patients with aphasia due to stroke will be randomly allocated into a control group or an experimental group. The course of this trial will comprise a 4-week intervention and a 12-week follow-up period. Five assessment points, including baseline, 2 and 4 weeks after treatment, 6 and 12 weeks after follow-up, are set to dynamically observe the changes of curative effects. Primary outcome measures are the differences in the score on both the China rehabilitation research center aphasia examination (CRRCAE) and Boston diagnostic aphasia examination - Chinese version (BDAE-C) after intervention and follow-up. The Modified Barthel Index (MBI), 36-Item Short Form Health Survey (SF-36), and results of blood oxygen level dependent-functional magnetic resonance imaging (BOLD-fMRI) examination are considered as the secondary outcome measures. Other outcomes will include rate of adverse events and economic effects. If the outcome is positive, this project will offer a low-cost appropriate technology for community health centers (CHCs) in the rehabilitation of aphasia patients after stroke, and could be implemented on a large scale, both in China and worldwide. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-13003703. Registration date: 18 October 2013.
    Full-text · Article · Jul 2014
    • "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. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective 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. Methods 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. Results 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). Conclusions 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.
    Article · May 2013
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