Return to work after stroke: A Swedish nationwide registry-based study

Education and Age in Return to Work After Ischemic Stroke: A Danish Nationwide Registry-based Cohort Study

OBJECTIVES

To investigate return to work and workforce detachment in ischemic stroke, including the association with age and level of education.

METHODS

Patients in the workforce aged 18 to 60 with first-time ischemic stroke between 1997 and 2017 were identified in Danish registers and followed for 5 years. The cumulative incidence of return to work and subsequent workforce detachment was computed overall and stratified according to age group and education level. Cox regression analysis was used for multivariate analysis.

RESULTS

A total of 28,325 patients were included (median age 52.3 (interquartile range (IQR) 46.1 to 56.6) and 64.3% male). After 1 year, 62.0% were in the workforce, highest in age group 18 to 30 (80.0%) and lowest in patients aged 51 to 60 (58.5%). One-year cumulative incidence of return to work overall was 73.4% (20,475), highest in the young age group (87.0%, 76.7%, 74.5%, and 71.3% for age group 18 to 30, 31 to 40, 41 to 50, and 51 to 60, respectively) and high education (80.3%, 72.1%, and 71.3% for long higher, basic or vocational education, respectively). One-year cumulative incidence of subsequent workforce detachment was 25.6% (5248), lowest in young age (22.4%, 23.1%, 24.1%, and 27.2% for age groups 18 to 30, 31 to 40, 41 to 50, and 51 to 60, respectively) and high level of education (13.0%, 28.4%, and 27.2% for long higher, basic, and vocational education, respectively). During the full follow-up, 10,855 (53.0%) left the workforce again.

CONCLUSIONS

A high proportion of patients returned to work within 1 year, but more than half left the workforce again. Young age and long education were associated with a higher incidence of return to work and lower subsequent workforce detachment.

Sickness absence and disability pension patterns before and after ischemic stroke: A Swedish longitudinal cohort study with matched references

INTRODUCTION

The aim was to determine ischemic stroke patients' sickness absence and disability pension before and after stroke, and compare these to that of matched references.

PATIENTS AND METHODS

All working-aged individuals (aged 18-61) in Sweden with incident ischemic stroke in year 2000, 2005, 2010, or 2015, respectively, and five population-based matched references to each stroke patient. Each cohort was followed 1 year prior stroke and 3 years after. We calculated rates and mean days of sickness absence and disability pension among stroke patients and references and computed trajectories of absence days with predictors of high sickness absence and disability pension.

RESULTS

Number of patients with incident ischemic stroke in 2000 (N = 2728), 2005 (N = 2738), 2010 (N = 2767), and 2015 (N = 2531). Mean stroke age was 53 years and rate of men was 64%. Mortality rate within 12 months after stroke date decreased from 8.1% in 2000 to 4.8% in 2015. Sickness absence for patients was 31.1% in the year prior their stroke, versus 13.7% for references, both groups mainly due to mental and musculoskeletal diagnoses. Factors associated with future high mean number of sickness absence and disability pension days were elementary educational level; adjusted OR (CI) 3.47(2.38-5.05), being single; 1.67(1.29-2.16), female sex 1.72(1.31-2.26), diabetes; 1.86(1.18-2.92), and aged >50; 2.25(1.69-2.98).

DISCUSSION AND CONCLUSION

Ischemic stroke patients have more absence days compared to matched references even before the stroke, mainly related to mental and musculoskeletal diagnoses. Future research should address the impact of efficient stroke treatment on sickness absence and disability pension.

Return to work after ischaemic stroke in young adults: a scoping review

OBJECTIVES

The aim of the study was to synthesize the body of knowledge on the factors that are important to the process of returning to work after ischaemic stroke in young adults under 55 years of age.

METHODS

Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA checklist for scoping reviews were used. A total of 2,249 studies were identified through a bibliographic search in six databases.

RESULTS

A total of ten studies were finally selected to respond to the research questions. Eight studies were quantitative observational studies, and two studies had a case study design. The rate of returning to work varied between the studies. The frequency of returning to work in young stroke patients, independent of the time of assessment, ranged from 42.4% to 86%. Returning to work after ischaemic stroke in young adults is a complex process and multidimensional problem which is affected by clinical variables (level of neurological deficits, cognitive ability, independency in activities of daily living, fatigue and depression, cardiovascular factors), as well as the socioeconomic and occupational status.

CONCLUSION

There is insufficient evidence concerning interventions promoting return to work. Future studies should focus on examining effective interventions to help young stroke survivors return to work.

Status and influencing factors of returning to work 6 months after discharge from hospital with severe acute pancreatitis-a cross-sectional descriptive-analytical study in China

Objective

To describe the return to work of patients with severe acute pancreatitis within 6 months after discharge, and to explore the influence of demographic, clinical, and psychosocial factors on their return to work.

Research design

Prospective 6 months follow-up study.

Setting

A third class hospital in Guizhou Province. Adult of severe acute pancreatitis(18-60years), with a job before admission, in the intensive care unit ≥ 24 h, were included.

Main outcome measures

To study return to work and influencing factors one, three and six months severe acute pancreatitis patients discharge. several measurements were used, including General Health Questionnaire (Demographic, disease-related, job-related and health behavior data), Readiness for Return-To-Work Scale and the Hospital Anxiety and Depression Scale.

Results

Forty-three severe acute pancreatitis patients were included in our study, with mean age 41.53 years. Twenty-nine (67.44%) patients returned to work within 6 months, and fourteen patients did not return to work. The status of Readiness for Return-To-Work Scale: fourteen severe acute pancreatitis patients who did not return to work were mainly in the precontemplation dimension and prepared for action-self-evaluative dimension both 5 cases (35.71%), and the 29 patients who had returned to work were in the Proactive maintenance stage. The study showed that the independent risk factors for returning to work in SAP patients were chronic disease (OR, 0.095; 95% CI [0.011-0.822]; p=0.008), sepsis (OR, 0.071; 95% CI [0.015-0.339]; p=0.009), low education level (OR, 2.905; 95% CI [0.969-8.710]; p<0.001), and anxiety and depression at 6 months (OR, 1.418; 95% CI [0.996-2.019]; p=0.004).

Conclusions

In conclusion, the return to work of patients with severe acute pancreatitis needs to be improved. Chronic diseases, sepsis, low level of education and higher degree of anxiety and depression at 6 months were important factors leading to their failure to return to work.

Interventions to Support the Return to Work for Individuals with Stroke: A Systematic Review and Meta-analysis

PURPOSE

An increasing number of individuals with stroke are having difficulties in returning to work, having a significant impact on both individuals and society. The aims of this meta-analysis were to summarize the interventions to support the return to work (RTW) for individuals with stroke and to quantitatively evaluate the efficacy of each type of intervention.

METHODS

A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched until 26 June 2023, and the list of references of the initially included articles was also searched. Two researchers independently performed the search, screening, selection, and data extraction. The primary outcome was RTW rate (the RTW rate was defined as the proportion of individuals who returned to work in each group (intervention and control) at the endpoint). Pooled risk ratio (RR) was estimated using a random-effects model with 95% confidence intervals (CIs).

RESULTS

A total of 13 studies representing 4,282 individuals with stroke were included in our study. Results showed that physiological interventions could improve the RTW rate of individuals with stroke (RR: 1.19, 95% CI: 1.01 to 1.42, I2 = 72%). And receiving intravenous thrombolytic therapy was beneficial in promoting the RTW in individuals with stroke. Subgroup analysis and meta-regression analysis showed that the individuals' functional status during hospitalization was the only source of heterogeneity. Psychological interventions had little or no effect on the RTW rate of individuals with stroke (RR: 1.20, 95% CI: 0.58 to 2.51, I2 = 30%). Work-related interventions had little or no effect on the RTW rate of the individuals with stroke (RR:1.36,95%CI: 0.99 to 1.88, I2 = 73%). The subgroup analysis showed that country, age, and follow-up method were the sources of heterogeneity.

CONCLUSION

Physiological intervention promoted the RTW of individuals with stroke. But, the effect of psychological and work-related interventions in promoting the RTW of individuals with stroke was not significant. We anticipate that these findings may inform the design of future interventions. For future research, we recommend that more high-quality randomized controlled trials be conducted to further promote the RTW of individuals with stroke.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO Registration Number, CRD42023443668.

Rehabilitation with intensive attention training early after acquired brain injury promotes better long-term status on health-related quality of life, daily activities, work ability and return to work

OBJECTIVE

To describe long-term effects on activity, participation, and quality of life (i) at different post-injury starting time points of attention training and (ii) of two different types of rehabilitation with attention training in patients after stroke or traumatic brain injury; and to describe their functioning level.

DESIGN

2 years after rehabilitation intervention, comparisons were made in one cohort receiving attention training subacute (< 4 months) or post-acute (4-12 months) and in one cohort with two different training methods, a process-based and an activity-based method respectively.

PATIENTS

100 patients were recruited from our earlier RCT study. They had mild to moderate stroke or traumatic brain injury with relatively limited symptomatology, and all had moderate to severe attention impairment.

METHODS

A questionnaire-based interview: EuroQol 5 dimensions, Occupational Gaps Questionnaire, Work Ability Index, self-assessed work status, self-reported employment conditions, sick leave, and experienced cognitive limitations in work performance.

RESULTS

An advantage for patients receiving subacute attention training regarding daily activities, work ability and returning to work.

CONCLUSION

The results indicate that subacute rehabilitation with attention training (< 4 months) is preferable compared to post-acute intervention (4-12 months). There were only minor differences between the training methods.

The needs and difficulties during the return to work after a stroke: a systematic review and meta-synthesis of qualitative studies

PURPOSE

To describe which needs and difficulties are experienced by stroke patients and caregivers regarding their return to work and to synthesise the lived experiences of stroke patients and caregivers.

MATERIALS AND METHODS

A systematic review and metasynthesis was conducted on PubMed, CINAHL, Scopus, Web of Sciences and PsycInfo, in according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research. Studies eligible for the review had to fulfil the following inclusion criteria: qualitative studies, stroke patients and their caregivers in a working age (approximately from 18 to 65 years old), discharged from the hospital.

RESULTS

Thirty-eight studies involving stroke patients and caregivers were included in this review. For the stroke patients' group, three main themes were identified: (a) Towards the future; (b) Professional support in return to work; and (c) return to work and employment perspective, while for caregivers two main themes were: (a) daily life challenges and role overload; and (b) employment challenges.

CONCLUSIONS

Integrating public employment, social and health services, support for job placement, return to work, and social participation of stroke patients should be more supported in individual rehabilitation programs to help stroke survivors and caregivers in their return-to-work process.

Associations of effort-reward imbalance at work and quality of life among workers after stroke: a one-year longitudinal study in Thailand

Stroke incidence is increasing among working-age population, but the role of psychosocial stress in the workplace in predicting quality of life (QoL) after stroke onset is understudied. This longitudinal study aimed to investigate the relationship between work stress, measured by the effort-reward imbalance (ERI) model, and QoL over one-year period among 103 Thai workers who had experienced a stroke. The study evaluated the effort (E)-reward (R) ratio and over-commitment, the extrinsic and intrinsic components of the ERI model, before discharge; QoL was repeatedly measured at baseline, six months, and 12 months after discharge, respectively, using the Short Form Version 2 (SF-12v2) indicators of physical and mental health composite scores. Generalized estimating equations were used to examine longitudinal relationships between work stress at baseline and QoL over one year by testing the hypotheses that E-R ratio and over-commitment would have direct effects on QoL, and potential moderating effects of over-commitment on E-R ratio and QoL. The results supported the ERI model partially, as over-commitment was significantly associated with poor mental health (coefficient - 8.50; 95% CI: -13.79, -3.20) after adjusting baseline sociodemographic, behavioral, and clinical characteristics, while the E-R ratio was not significantly associated with physical or mental health; the interaction between the E-R ratio and over-commitment was also not significant. These findings suggest that more attention should be paid to workers' personal coping skills and ability to handle work-related problems and prioritize interventions that address over-commitment to promote long-term mental health among workers with stroke.

Rate of return to work in patients with stroke under the health and employment support program of Rosai hospitals in Japan

To facilitate return to work (RTW) in patients with stroke, a health and employment support (HES) program was started at Rosai hospitals in Japan. This study aimed to determine the rate of RTW in patients with stroke under this support program. We collected demographic and clinical data of patients with stroke from the implementation reports of the HES program. The program provided coordinated dual support, such as acute medical treatments, and stroke and vocational rehabilitation on the medical side, and management and support on the workplace side. The primary endpoint was RTW. Successful and unsuccessful RTW were examined using the χ2 test. The RTW rate curves were analyzed using the Kaplan-Meier method. We enrolled 483 patients; 355 (73%) and 128 (27%) patients had successful and unsuccessful RTW, respectively. Stroke types, neurological findings, and activities of daily living were significant factors for RTW. The Kaplan-Meier method revealed that left hemiplegia, right hemiplegia, and neuropsychological deficits, except for combined disability (hemiplegia with neuropsychological deficits), had similar RTW curves with an RTW rate of > 70%.

Return to work for adults following stroke: a scoping review of interventions, factors, barriers, and facilitators

OBJECTIVE

This scoping review aimed to map the literature on interventions, factors, barriers, and facilitators for return to work for adults post-stroke with or without communication disorders.

INTRODUCTION

Difficulties in returning to work can significantly impact individuals following a stroke (eg, their sense of purpose and self-esteem), not only financially, but also as they adjust to the change in their situation. Such difficulties may arise from communication disorders as well as physical impairments. Previous reviews on return to work post-stroke have focused on specific aspects, such as interventions, or barriers and facilitators, but have not provided a comprehensive map of the field. Further, no systematic or scoping reviews to date have focused on literature addressing return to work for people with communication disorders post-stroke.

INCLUSION CRITERIA

This review considered literature that reported on interventions, barriers, and facilitators for return to work for adults (aged 16 years or older) following an ischemic or hemorrhagic stroke. Records focusing on transient ischemic attacks or acquired brain injury were excluded, as were those in which a comorbidity or disability (eg, learning disability, dementia, respiratory disorder) had a significant impact on the individual's ability to work.

METHODS

This review followed the JBI scoping review methodology. Primary research of any type, systematic and non-systematic reviews, and gray literature from developed countries written in English from 2010 to the present day were identified from 7 databases, 2 gray literature repositories, JBI Evidence Synthesis , and an internet search. Records were screened for relevance to the review topic by 2 independent reviewers, and data relevant to the review questions were extracted. Findings were presented as narrative supported by tables.

RESULTS

Of the 106 sources included, 61 addressed demographic-based, socioeconomic-based, impairment-based, or recovery-based factors related to return to work. One of these 61 sources, a narrative review, focused on communication disorders. Thirty-eight sources explored barriers and facilitators for return to work from different stakeholders' perspectives; 3 of these 38 sources, including 2 qualitative studies and 1 narrative review, focused on post-stroke communication disorders. Eleven sources focused on interventions, including 7 studies (reported across 9 sources) that developed or tested return-to-work interventions. Of these primary studies, 1 randomized controlled trial and 1 retrospective cohort study were identified. The remaining intervention studies were case studies or case series. None of these intervention studies addressed communication disorders.

CONCLUSIONS

While there has been extensive research on factors, barriers, and facilitators for return to work post-stroke, there is a lack of research on interventions supporting return to work. There is also a significant gap in the evidence base on returning to work with a post-stroke communication disorder, highlighting the need for further research in this important area.

Exploring community reintegration among Nigerian stroke survivors

Background

Community reintegration is one of the ultimate goals of stroke rehabilitation. The increasing burden of stroke morbidity by other non-communicable diseases in Nigeria indicated the need for our study.

Objectives

The authors explored the factors contributing to successful community reintegration among Nigerian stroke survivors.

Method

We conducted an explorative qualitative study design to achieve this aim using in-depth semi-structured interviews with 12-purposively sampled stroke survivors.

Results

Three overarching themes emerged: restriction of participation experienced by stroke survivors, activity limitation as pointers to the quality-of-life experience of stroke survivors and enablers or barriers to community reintegration for stroke survivors. Among the core, sub-themes included incapability of returning to work, difficulty performing domestic activities, social isolation or separation, recreation and leisure time. Enablers of community reintegration included creating a positive mindset, encouragement and social support, while barriers included mobility and speech or language challenges.

Conclusion

Stroke survivors have challenges in returning to work and experience varying levels of activity limitation, which affects their quality of life with identifiable enablers or barriers to community reintegration.

Clinical implications

Stroke survivors with severe functional deficits should be monitored closely and given further rehabilitative assistance to aid functional recovery, thereby facilitating community reintegration.

The centrality of work in everyday life after stroke: A qualitative study of long-term stroke survivors

BACKGROUND

Work is an occupation of great concern for younger stroke survivors. Given the high rate of people not working after stroke, there is a need to explore work after stroke from a long-term perspective, including not just an initial return to work, but also the ability to retain employment and how this may affect everyday life after stroke. Therefore, the objective of this study was to explore experiences relating to work and to work incapacity among long-term stroke survivors.

METHOD

This study used thematic analysis on data gathered through individual semi-structured interviews with long-term stroke survivors.

RESULTS

The analysis resulted in four themes that together comprised the main theme 'The centrality of work in everyday life', containing descriptions of how everyday life was affected by aspects of work both for those who did work and those who did not return to work after stroke.

CONCLUSION AND SIGNIFICANCE

The results highlight the importance of addressing return to work not just as an isolated outcome but as part of everyday life after stroke. The results indicate a need for a more flexible approach to supporting return to work that continues past the initial return.

Factors affecting the quality of life after ischemic stroke in young adults: a scoping review

PURPOSE

To synthesize the body of knowledge on the factors influencing the quality of life (QoL) after ischemic stroke (IS) in young adults.

METHODS

Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA-ScR checklist for a scoping review was used in this paper. A total of 1197 studies were identified through a bibliographic search in Web of Science, MEDLINE, PsycInfo, ScienceDirect, Scopus, and ProQuest Science Database. Articles published between the years 2000-2021 were included.

RESULTS

A total of nine papers were finally selected to respond to the research question. Three studies were prospective longitudinal studies compared QoL between young stroke and age-matched controls from the general population. Across all the analysed studies, 14 variables potentially associated with QoL were identified. QoL in young patients is mainly affected by clinical outcomes after IS (scored by the modified Rankin scale and the Barthel index-favourable initial functional status and higher independence in ADL leads to higher QoL) and psychological factors (post-stroke fatigue and depression-higher levels of fatigue and depression lead to lower QoL). The reviewed studies emphasized the importance of functional outcomes, post-stroke depression, fatigue and anxiety and early return to work.

CONCLUSION

Further longitudinal studies are needed to identify the trajectory of post-stroke psychosocial symptoms over time and other potential predictors of unfavourable long-term QoL, thus specific young stroke rehabilitation and stroke self-management support programmes should be developed (address physical, psychological factors which influence the psychosocial adaptation post-stroke and the perception of the QoL).

Labour market participation and retirement after stroke in Denmark: registry based cohort study

OBJECTIVE

To examine labour market participation and retirement among patients with stroke and matched people in the general population according to stroke subtype.

DESIGN

Nationwide, population based, matched cohort study.

SETTING

Danish Stroke Registry, covering all Danish hospitals, and other nationwide registries (2005-18).

PARTICIPANTS

Patients (aged 18-60 years and active in the labour market) with a first time diagnosis of ischaemic stroke (n=16 577), intracerebral haemorrhage (n=2025), or subarachnoid haemorrhage (n=4305), and individuals from the general population, matched on age, sex, and calendar year (n=134 428). The median Scandinavian stroke scale score was 55.

MAIN OUTCOME MEASURES

Unweighted prevalences of labour market participation, receipt of sick leave benefits, receipt of disability pension, voluntary early retirement, state pension, and death were computed for each week and up to five years after stroke diagnosis. A log-linear Poisson model was used to obtain exact prevalence estimates as well as propensity score weighted prevalence differences and prevalence ratios at six months, one year, two years, and five years after stroke diagnosis.

RESULTS

Most patients (62% of those with ischaemic stroke, 69% of those with intracerebral haemorrhage, and 52% of those with subarachnoid haemorrhage) went on sick leave within three weeks of diagnosis. Prevalence of labour market participation among patients with ischaemic stroke compared with matched individuals from the general population was 56.6% versus 96.6% at six months, and 63.9% versus 91.6% at two years. Prevalence of sick leave was 39.8% versus 2.6% at six months, and 15.8% versus 3.8% at two years. Prevalence of receipt of a disability pension was 0.9% versus 0.2% at six months, and 12.2% versus 0.6% at two years. Adjusting for socioeconomic and comorbidity differences between patients and matched individuals from the general population using propensity score weighting methods had little impact on contrasts. Patients with intracerebral haemorrhage had higher prevalences of sick leave and receipt of a disability pension and thus a lower prevalence of labour market participation, while prevalences for patients with subarachnoid haemorrhage were similar in magnitude to those for patients with ischaemic stroke.

CONCLUSIONS

In a highly resourced country, about two thirds of working age adults with ischaemic stroke of primarily mild severity participated in the labour market two years after diagnosis. Sick leave and receipt of a disability pension were the most common reasons for non-participation. Patients with intracerebral haemorrhage were less likely to return to the labour market than patients with ischaemic stroke and subarachnoid haemorrhage.

Association between post-stroke psychological disorders, activity limitations and health-related quality of life in chronic stroke survivors in Benin

PURPOSE

To evaluate the association between depression/anxiety and activity limitations and health-related quality of life (HRQoL) in chronic stroke survivors in Benin.

MATERIALS AND METHODS

One hundred and seventy-six chronic stroke survivors (113 males; mean age (±SD): 56.5 (±10.5) years old) were included. We used the Barthel index (BI) to assess activity limitations. Participants were screened for depression and anxiety symptoms using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). Euroqol-5 Dimensions-3 Levels (EQ-5D-3L) including a Visual Analog Scale (EQ-VAS) was used to assess HRQoL. Multivariate linear regressions were performed to determine the impact of psychological disorders on activity limitations and HRQoL.

RESULTS

Depression (β=-0.54; p < 0.0001) and anxiety (β=-0.35; p < 0.0001) were negatively associated with activity limitations (R²=0.60). Similar patterns of association were observed with HRQoL (β≤-0.28; p < 0.0001; R² ≥0.40). Inversely, occupational status showed positive association with EQ-5D-3L summary index scores (β = 0.21; p = 0.015).

CONCLUSIONS

Depression and anxiety had a negative impact on activity limitations and HRQoL in Beninese chronic stroke survivors. This call for action to integrate psychological interventions as part of rehabilitation programs in low and middle-income countries.Implications for rehabilitationPost-stroke depression and anxiety are quite common among stroke survivors in sub-Saharan Africa.Post-stroke depression and anxiety negatively impact activities and health-related quality of life in chronic stroke survivors in sub-Saharan Africa.Managing these post-stroke psychological disorders is necessary to promote the functional recovery and social reintegration of stroke survivors in their communities.

Cognitive screen and employment long-term after infratentorial stroke

OBJECTIVES

Motor problems are well-described neurological deficits that occur commonly after an infratentorial ischemic stroke. However, the brain stem and cerebellum are also part of the neural interconnections responsible for cognition, emotions, and behavioral responses. We lack studies on long-term cognitive outcomes and patient employment after an infratentorial stroke. In the present study, we described and compared long-term poststroke cognitive outcomes and employment between patients that experienced infratentorial and supratentorial ischemic strokes.

MATERIALS AND METHODS

We included consecutive patients that experienced an acute ischemic stroke at ≤58 years of age. Patients were classified according to the stroke location. At seven years poststroke, surviving participants were assessed for neurological deficits (National Institutes of Health Stroke Scale [NIHSS]), functional outcome (modified Rankin Scale [mRS]), cognitive function Barrow Neurological Institute Screen (BNIS), and employment.

RESULTS

Among 141 participants, 25 (18%) had infratentorial and 116 (82%) had supratentorial strokes. At the 7-year poststroke follow-up, there was no significant difference in BNIS total scores; with a median of 43 (IQR 40.5-46) and 41 (IQR 38-46) in the infratentorial and supratentorial groups, respectively. This result indicated that cognitive dysfunction occurred frequently in both groups. Similar employment rates were observed in the infratentorial (48%) and supratentorial (55%) groups. Both groups had a median NIHSS score of 0 and a median mRS score of 2 at the 7-year follow-up.

CONCLUSION

Patients who survived an infratentorial or supratentorial ischemic stroke had similar rates of long-term cognitive dysfunction and difficulties in returning and/or remaining at work.

Sex Disparities in Re-Employment in Stroke Patients With Large Vessel Occlusion Undergoing Mechanical Thrombectomy

BACKGROUND

Strokes in the working-age population represent a relevant share of ischemic strokes and re-employment is a major factor for well-being in these patients. Income differences by sex have been suspected a barrier for women in returning to paid work following ischemic stroke. We aim to identify predictors of (not) returning to paid work in patients with large vessel occlusion treated with mechanical thrombectomy (MT) to identify potential areas of targeted vocational rehabilitation.

METHODS

From 6635 patients enrolled in the German Stroke Registry Endovascular Treatment between 2015 and 2019, data of 606 patients of the working population who survived large vessel occlusion at least 90 days past MT were compared based on employment status at day 90 follow-up. Univariate analysis, multiple logistic regression and analyses of area under the curve were performed to identify predictors of re-employment.

RESULTS

We report 35.6% of patients being re-employed 3 months following MT (median age 54.0 years; 36.1% of men, 34.5% of women [P=0.722]). We identified independent negative predictors against re-employment being female sex (odds ratio [OR], 0.427 [95% CI, 0.229-0.794]; P=0.007), higher National Institutes of Health Stroke Scale (NIHSS) score 24 hours after MT (OR, 0.775 [95% CI, 0.705-0.852]; P<0.001), large vessel occlusion due to large-artery atherosclerosis (OR, 0.558 [95% CI, 0.312-0.997]; P=0.049) and longer hospital stay (OR, 0.930 [95% CI, 0.868-0.998]; P=0.043). Positive predictors favoring re-employment were excellent functional outcome (modified Rankin Scale score of 0-1) at 90 day follow-up (OR, 11.335 [95% CI, 4.864-26.415]; P<0.001) and combined treatment with intravenous thrombolysis (OR, 1.904 [95% CI, 1.046-3.466]; P=0.035). Multiple regression modeling increased predictive power of re-employment status significantly over prediction by best single functional outcome parameter (National Institutes of Health Stroke Scale 24 hours after MT ≤5; R²: 0.582 versus 0.432; area under the receiver operating characteristic curve: 0.887 versus 0.835, P<0.001).

CONCLUSIONS

There is more to re-employment after MT than functional outcome alone. In particular, attention should be paid to possible systemic barriers deterring women from resuming paid work.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT03356392.

The Association Between Work Status and the Use of Healthcare Services Among Women in the Republic of Korea

Introduction

Previous studies on occupational health focussed predominately on the occurrence of occupational diseases. Relatively few studies have measured how employment is associated with the use of healthcare services. This study investigates the association between employment and the extent and range of healthcare use, such as medical expenditures, of women in South Korea.

Methods

We analyze data of the Korean Health Panel, an ongoing longitudinal national representative survey, from 2008 to 2017, to identify the status of economic activity of women by year and age group. We estimate the association between female employment status and medical expenditures by using random effect panel Tobit models. Furthermore, we investigate the association between employment status and the range of healthcare services in biomedicine and traditional Korean medicine (KM) by conducting conditional fixed-effects logistic regression analyses.

Results

For women aged between 25 and 65 in 2017, the majority of them were employed or self-employed. (The proportion of employment of self-employment equals 64.80%). In addition, working women spent 11.6% less on healthcare than nonworking women, and self-employment lowered the healthcare expenditure by 13.1%. Neither work nor the type of work is related to the types and range of healthcare service use. Being employed or self-employed is negatively associated with women’s expenditure on healthcare.

Conclusions

The findings show that employment is associated with less spending on healthcare. They imply that employment has a positive impact on women’s health.

Fitting the task to a person with disabilities: A case of return-to-work support for a patient due to left-sided poststroke hemiplegia using tailor-made jigs-and-tools

BACKGROUND

A 45-year-old Japanese male pharmacist developed a stroke in December 2018; hence, he had left-sided hemiplegia due to the after-effects of cerebral stroke. This paper reports the return-to-work (RTW) and after RTW support for poststroke patients from a combined ergonomic and rehabilitation perspective.

METHODS

From April 2019 to July 2020, we visited hospitals and workplaces multiple times, making various preparations for workplace accommodation and exchanging information as follows: allowing staggered working hours; securing the flow routes in the back room; equipping a cane holder on his working desk; and adjusting the position of the work tablet. In August 2020, after RTW, we conducted a brief evaluation of residual motor function and an on-site task analysis, and we subsequently made a support tool.

RESULTS

In July 2020, his RTW was eventually realized. Moreover, as a result of introducing the tailor-made support tool, the duration of certain tasks that he had been claiming to be difficult was reduced when compared to that before support-tool use, and the average task duration before and after support-tool use was 32.8 s and 10 s, respectively (reduced by approximately 69.5%).

CONCLUSION

To augment our efforts, hospital staff, support staff in his workplace, and his employer collaborated to make various workplace accommodations for the smooth realization of RTW before and after RTW. In the present case, the ergonomic and rehabilitation approach after RTW might have contributed to ease of task, work efficiency, and the potential for future job retention.

Understanding activity participation 3-months after stroke: a mixed methodology study

PURPOSE

To investigate stroke survivors' activity participation 3-months after stroke, reasons for activity participation and the change in reason for activity participation.

METHOD

Thirty stroke survivors were administered the Activity Card Sort-Australia concurrent with a semi-structured interview about their activity participation. Data were analyzed using descriptive statistics and spiral content analysis.

RESULTS

Participants had returned, in part, to 96% of their previous leisure, social/educational and household activities 3-months after-stroke; retaining more sedentary and home-based activities but fewer physically demanding and community-based activities. Thirteen participants described a change in their reasons for their activity participation. Personal, environmental and temporal dimensions explained these reasons for activity participation, as well as the changes in reason for activity participation. Full activity participation involved participants' orchestrating a dynamic mix of fulfilling their personal desires according to their current physical, mental and emotional capacity; their social, organizational and physical environmental demands and obligations; and their routines, available time and future plans.

CONCLUSION

Qualitative interviews extend our understanding of the process of returning to participation in life activities and occupations following stroke to reveal that it involves the stroke survivor in a dynamic adaptation process of synchronizing personal, environmental and temporal dimensions in their daily lives.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals need to recognize the unique knowledge and ability stroke survivors have to manage their capacities, activities, occupations and environments.Client-centered practice involving true collaborative partnerships are needed to ensure stroke survivors return more satisfactorily to their activities and occupations.Rehabilitation professionals need to continually consider the ongoing changing relationships that occur between the person, their capacities, social, organizational and physical environments, and the person's activity/occupational participation during recovery from stroke.Returning to full activity/occupational participation after stroke is a dynamic and continuous process.Rehabilitation needs to be provided in different forms at different stages beyond the immediate post-stroke time so that stroke survivors benefit from the "right rehabilitation" at the "right time" throughout their recovery journey.

[Factors associated with unemployment or job change due to the treatment of designated intractable diseases]

OBJECTIVES

Unemployment or job change due to treatment for a disease is affected by various factors such as disease type, degree of disability, and workplace patient support. This study aimed to clarify the factors affecting the unemployment/job-change rate among workers who had designated intractable diseases.

METHODS

A questionnaire survey was administered to 3210 designated patients with intractable diseases who underwent applications for renewal of medical care subsidies at the Hirakata City Public Health Center during fiscal year 2019 (July-December). Of these patients, 539 workers aged 20-59 years who were employed as regular workers, temporary contract worker/dispatched workers, and part-time workers when they became designated intractable diseases were subjects of the analysis. Unemployment/job-change due to the treatment for a designated intractable disease was treated as an event occurrence, while the absence of unemployment/job-change due to disease at the time of the survey were considered censored cases. The Kaplan-Meier method was used to determine the trend of the unemployment/job-change rate associated with the duration of work. The Cox proportional hazard model was used to examine the relationship between unemployment/job-change and factors such as gender, age at onset, disease groups, activities of daily living, types of employment, experienced workplace supports (e.g., reduced working hours and hourly paid leave), and existence of insoluble medical difficulties at the workplace.

RESULTS

The unemployment/job-change rate due to treatment for designated intractable disease was 19.4%. Significantly independent factors of unemployment/job-change were the following: 50s at onset (compared to those in their 30s, HR = 2.55, 95% CI (1.21-5.37)), requiring outing assistance (compared to going out alone, 2.31 (1.13-4.71)), being a temporary contract worker/dispatched worker (compared to a regular worker, 2.66 (1.20-5.89)), existence of insoluble medical difficulties at workplace (4.15 (2.43-7.09)). Experienced workplace support was not a significant factor in preventing unemployment/job-change.

CONCLUSIONS

Age at onset, degree of disability, form of employment, and existence of insoluble medical difficulties at the workplace were significantly associated with unemployment/job change due to treatment for designated intractable diseases. The relationship between workplace patient supports and unemployment/job-change was not clear, but to reduce medical difficulties in the workplace, workplace supports must be expanded. Given that workplace support is not an obligatory effort for employers, it is necessary to establish a system where employers can easily promote workplace support.

Work conditions, support, and changing personal priorities are perceived important for return to work and for stay at work after stroke - a qualitative study

PURPOSE

To explore work related and personal facilitators and barriers for return to work (RTW) and stay at work after stroke.

MATERIALS AND METHODS

Twenty individuals post-stroke (median age 52 years; seven women) were interviewed in focus groups. Data were analyzed by using qualitative content analysis.

RESULTS

An overall theme "Work conditions, support and changed personal priorities influenced RTW and stay at work after stroke" emerged and covered three categories: "Adjustments and flexibility at the work place facilitated RTW and a sustainable work situation", "Psychosocial support and knowledge about stroke consequences facilitated work and reduced stress", and "Changed view of work and other personal priorities". Physical adjustments at the work place and flexibility in the work schedule were perceived facilitators. Support from family and colleagues were important, whereas lack of knowledge of stroke disabilities at the work place was perceived a barrier. Also changed personal priorities in relation to the work and the current life situation influenced RTW in various ways.

CONCLUSIONS

The individual's opportunities to influence the work situation is a key factor for RTW and the ability to stay at work after stroke. Adjustments, flexibility, support, knowledge of stroke, and receptivity to a changed view of work are important for a sustainable work situation.Implications for rehabilitationPhysical adjustments at the work place, a flexible work schedule and support increase the individual's possibility to RTW and maintain a sustainable work situation after stroke.Changed work and life priorities after a stroke need attention in the RTW process.Rehabilitation professionals have an important role in providing knowledge about the disabilities following stroke, and how they impact work ability. Individually tailored recommendations for work place adjustments which enable RTW and a sustainable work situation are warranted.

Stroke Severity and Maximum Inspiratory Pressure are Independently Associated with Functional Mobility in Individuals After Stroke

BACKGROUND

Clinical changes after stroke can contribute to reduced mobility and negatively affect the survival of these individuals. The objective of this study was to verify factors associated with functional mobility in stroke individuals.

METHODS

Crosssectional study carried out with stroke individuals in an outpatient clinic. Demographic and clinical data were collected and the following measures were applied: National Institute of Health Stroke Scale (NIHSS), modified Barthel Index, Trunk Impairment Scale, Functional Reach Test, Timed Up and Go Test, and the International Physical Activity Questionnaire. Respiratory muscle strength was assessed by measuring the maximum inspiratory pressure (MIP) and the maximum expiratory pressure (MEP).Variables with p < .05 in univariate logistic regression analysis were included in the multivariate logistic regression model, using the backward stepwise method.

RESULTS

53 individuals were enrolled with a mean age of 55 years (±13.43). 51% were male and the median NIHSS score was 2.25 (0-13). The final multivariate model included NIHSS (OR = 1.872; 95% CI 1.167-3.006; p = 0.009), physical therapy treatment (OR = 15.467; 95% CI 1.838-130.178; p = 0.012) and MIP (OR = 1.078; 95% CI 1.024-1.135; p = 0.004).

CONCLUSION

Stroke severity and inspiratory muscle strength were factros associated with functional mobility in individuals after stroke, regardless stroke time.

Stroke survivors' priorities for research related to life after stroke

BACKGROUND

Stroke has transitioned from an untreatable, unpreventable disease to a highly treatable and preventable disease over recent decades, and the number of stroke survivors is expected to increase. The number is also foreseen to grow larger as a result of an aging population. With an escalating number of stroke survivors, research on how to improve life after stroke is needed.

AIMS

The primary aim was to determine which area of research related to life after stroke that stroke patients and their informal carers prioritized as being relevant and valuable.

METHODS

A cross-sectional study of all patients who had completed the 12 months of follow-up in the EFFECTS trial. In the questionnaire the stroke patients and their informal carers were asked to prioritize areas of research they considered important and valuable with respect to their life after stroke.

RESULTS

Of the 731 patients who were still alive after the 12 months-follow-up, 589 responded. The most prioritized areas of research were Balance and walking difficulties (290 (49%) responders) and Post-stroke fatigue (173 (29%) responders). Women answered the undefined alternative "other" more often than men (43 women (11%) versus 11 men (6%), p = .04). Younger patients prioritized Post-stroke fatigue to a higher extent (88 (45%) versus (22%), p < .001), and elderly prioritized Balance and walking difficulties (214 (54%) versus 76 (40%), p = .002) and Speech difficulties (38 (10%) versus 9 (5%), p = .045).

CONCLUSIONS

Life after stroke is perceived differentely with aging. Future research should address strategies to face challenges such as imbalance and walking difficulties and post-stroke-fatigue.

Return to work after stroke: A Swedish nationwide registry-based study

OBJECTIVES

A substantial proportion of individuals with stroke are of working age. After stroke, it is important to return to work (RTW), both for the individual's satisfaction with life and economically for society. The current comprehensive, long-term study aimed at investigating in what time period the RTW continues after stroke and what factors could predict RTW.

MATERIALS AND METHODS

All individuals registered in the registry Riksstroke with stroke in Sweden at ages 18-58 years during 2011 were eligible for participation. RTW was based on sickness absence data from the Social Insurance Agency covering 1 year prestroke to 5 years post-stroke. Time to RTW was analyzed with Kaplan-Meier curves. Potential predictors of RTW were analyzed with Cox regression and logistic regression.

RESULTS

For RTW analyses, 1695 participants were included. Almost 50% RTW within 3 months, 70% within 1 year, and 80% within 2 years post-stroke. However, the RTW continued for several years, with a total of 85% RTW. Predictors of favorable time to RTW were male sex, ischemic stroke, and long university education compared with primary school education. Predictors of unfavorable times to RTW were higher stroke severity, defined by the level of consciousness, and older ages. Participants with self-expectations of RTW 1 year post-stroke had higher odds of RTW within 5 years.

CONCLUSIONS

The RTW continues for a longer time after stroke than previously known. Both self-expectations and demographical, socioeconomic, stroke-related factors were important predictors of RTW. This knowledge could assist healthcare professionals to individualize the rehabilitation post-stroke.