Functional and occupational characteristics associated with very early return to work after stroke in Japan

Abstract

Objectives: To examine clinical, functional, and occupational factors associated with very early return to work after stroke, and to identify factors manageable through occupational arrangements, patient education, and other welfare programs.

Design: Prospective cohort study.

Setting: Acute care of the first stroke event in 21 acute care hospitals specializing in clinical and occupational health.

Participants: Consecutive patients with stroke in working age (N=335).

Interventions: Not applicable.

Main outcome measures: Data pertaining to demographic, clinical, functional, and occupational factors were collected from hospital records. Multiple logistic regression analysis with backward stepwise selection was used to obtain a final model to predict the likelihood of patients returning very early to work.

Results: The sample was predominantly men (80%) with a mean age ± SD of 55.2±7.2 years; 30% succeeded in very early return to work. After adjusting for age, sex, and modified Rankin scale at discharge, white-collar versus blue-collar occupation (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.00-4.21), Barthel Index at onset (OR, 1.02; 95% CI, 1.01-1.03), and employment status at discharge (OR, 17.36; 95% CI, 3.15-95.72) were selected in the final model as significant predictors of very early return to work. Patients with mild physical disability and higher cortical dysfunction found it more difficult to return to work very early compared with those without these conditions.

Conclusions: We found that patients with stroke who had mild disability at onset, were in a white collar occupation, and were employed at discharge were more likely to return to work very early, even after adjusting for functional levels at discharge. Cognitive rehabilitation is needed for those with mild physical disability and higher cortical dysfunction.