Study protocol to a nationwide prospective cohort study on return to gainful occupation after stroke in Denmark 1996 - 2006

Sickness absence and return to work among Japanese stroke survivors: a 365-day cohort study

OBJECTIVES

The objective of this study was to investigate the cumulative return to work (RTW) rate and to clarify the predictors of the time to full-time RTW (full RTW) and resignation among Japanese stroke survivors, within the 365-day period following their initial day of sickness absence due to stroke.

SETTING

This study was based on tertiary prevention of occupational health in large-scaled Japanese companies of various industries.

PARTICIPANTS

The participants in this study were 382 Japanese workers who experienced an episode of sickness leave due to clinically certified stroke diagnosed between 1 January 2000 and 31 December 2011. Data were obtained from an occupational health register. Participants were followed up for 365 days after the start day of the first sickness absence. The cumulative RTW rates by Kaplan-Meier estimates and predictors for time to full RTW and resignation by Cox regression were calculated.

RESULTS

A total of 382 employees had their first sickness absence due to stroke during the 12-year follow-up period. The cumulative full RTW rates at 60, 120, 180 and 365 days were 15.1%, 33.6%, 43.5% and 62.4%, respectively. Employees who took sick leave due to cerebral haemorrhage had a longer time to full RTW (HR, 0.50; 95% CI 0.36 to 0.69) than those with cerebral infarction. Older employees (over 50 years of age) demonstrated a shorter time to resignation than younger employees (HR, 3.30; 95% CI 1.17 to 9.33). Manual workers had a longer time to resignation than non-manual workers (HR, 0.24; 95% CI 0.07 to 0.78).

CONCLUSIONS

Cumulative RTW rates depended on the subtype of stroke, and older age was a predictor of resignation.

Determinants of return to work among Nigerian stroke survivors

PURPOSE

Employment, an important aspect of life, could be adversely affected by a disabling condition like stroke. This study explores the frequency and determinants of return to work (RTW) among Nigerian stroke survivors.

METHOD

One-hundred and one stroke patients attending Physiotherapy clinics at seven teaching and specialist hospital centers in north-eastern Nigeria participated in the study. Socio-demographic, clinical and RTW data were obtained from participants while the modified Rankin Scale was used to assess functional ability. Chi-square statistics and multivariable logistic regression analysis was used to identify the determinants of RTW among the participants.

RESULTS

About half of the participants (55%) had returned to work. Absence of disability [Odds Ratio (OR) = 57.7; 95% CI = 12.0-276.8) and mild disability (OR = 15.1; 95% CI = 3.9-58.3) were the significant determinants of RTW, while post-stroke duration of a year or less was associated with lower chance of returning to work (OR = 0.2; 95% CI = 0.0-0.8).

CONCLUSIONS

The prominence of functional independence among the determinants of RTW implies that rehabilitation efforts and support programmes to optimize functional ability, especially within the first year after stroke, will greatly enhance RTW among Nigerian stroke survivors.

Time trend analysis of return to work after stroke in Denmark 1996-2006

BACKGROUND

In the period 1997-2005, the Danish government initiated a series of legislative changes aimed at facilitating RTW (return to work) in the Danish population. In the present study, we investigated the odds of being gainfully occupied ca. two years after stroke as a function of onset calendar year, 1996-2006.

METHODS

All previously employed 20-57 year-old stroke patients in Denmark 1996-2006 (N = 19985) were followed prospectively through national registers. The analysis was controlled for the type of stroke and a series of demographic, structural and occupational variables.

RESULTS

The odds for RTW increased significantly during the study period (P < 0.0001). The odds at the end of the period were more than twice as high as they were at the beginning, even after post hoc control for improved survival and decreased unemployment rates. The most conspicuous increase coincided with a change in the sickness benefit act that took place in 2005.

CONCLUSION

The study provides quite strong circumstantial evidence that the legislative changes had an effect on the odds of return to work after stroke. More direct evidence is desirable, but such can only be obtained through a randomized controlled study.

A nationwide prospective cohort study on return to gainful occupation after stroke in Denmark 1996-2006

BACKGROUND

Return to work is an important outcome factor for working-age patients poststroke. Previous epidemiological studies on this topic have been small (on average 125 patients per study). Their estimated effects are therefore associated with a tremendous statistical uncertainty. The present study estimates the effect of various predictors on the odds of returning to work after stroke in the total population of 20-57-year-old previously employed hospital treated patients with stroke in Denmark 1996-2006 (N=19,985).

METHODS AND RESULTS

The patients were followed through national registers; 62% were gainfully occupied 2 years after stroke. The odds of returning to work were higher among people with intracerebral infarction, OR 1.0 (the reference group), than they were among people with subarachnoid haemorrhage, OR 0.79 (95% CI 0.71 to 0.88), and intracerebral haemorrhage, OR 0.39 (0.35 to 0.43). The odds of returning to work were lower among workers in elementary occupations OR 1.0 (reference group) than they were among workers in occupations that require skills at a basic level, OR 1.50 (1.38 to 1.64), technicians and associate professionals, OR 2.33 (2.05 to 2.65) and professionals, OR 3.04 (2.70 to 3.43). Patients in municipalities with a brain-injury rehabilitation centre did not have a better prognosis than patients in other municipalities, OR 0.91 (0.78 to 1.06). Being a woman, OR 0.79 (0.74 to 0.84), self-employed, OR 0.87 (0.78 to 0.96), or ≥ 50 years, OR 0.61 (0.57 to 0.65), was associated with an adverse prognosis.

CONCLUSION

Further research is needed to explain the gender inequality, which suggests either a potential to improve return-to-work rates among the females or a tendency among the males to return too early.