Abstract
ObjectivesTo determine which early modifiable factors are associated with younger stroke survivors' ability to return to paid work in a cohort study with 12-months of follow-up conducted in 20 stroke units in the Stroke Services NSW clinical network.ParticipantsWere aged >17 and <65 years, recent (within 28 days) stroke, able to speak English sufficiently to respond to study questions, and able to provide written informed consent. Participants with language or cognitive impairment were eligible to participate if their proxy provided consent and completed assessments on the participants' behalf. The main outcome measure was return to paid work during the 12 months following stroke.ResultsOf 441 consented participants (average age 52 years, 68% male, 83% with ischemic stroke), 218 were in paid full-time and 53 in paid part-time work immediately before their stroke, of whom 202 (75%) returned to paid part- or full-time work within 12 months. Being male, female without a prior activity restricting illness, younger, independent in activities of daily living (ADL) at 28 days after stroke, and having private health insurance was associated with return to paid work, following adjustment for other illnesses and a history of depression before stroke (C statistic 0·81). Work stress and post stroke depression showed no such independent association.ConclusionsGiven that independence in ADL is the strongest predictor of return to paid work within 12 months of stroke, these data reinforce the importance of reducing stroke-related disability and increasing independence for younger stroke survivors.Trial RegistrationAustralian New Zealand Clinical Trials Registry ANZCTRN 12608000459325
Highlights
Reducing the increasing burden of stroke requires sustained, collaborative, evidence-based action [1]
Female without a prior activity restricting illness, younger, independent in activities of daily living (ADL) at 28 days after stroke, and having private health insurance was associated with return to paid work, following adjustment for other illnesses and a history of depression before stroke (C statistic 0?81)
Given that independence in ADL is the strongest predictor of return to paid work within 12 months of stroke, these data reinforce the importance of reducing stroke-related disability and increasing independence for younger stroke survivors
Summary
Reducing the increasing burden of stroke requires sustained, collaborative, evidence-based action [1]. The needs of those in paid employment at the time of their stroke are often overlooked [2]. This is surprising given that most OECD countries have seen a dramatic rise in the proportion of their working age population claiming early ill-health-retirement and associated income-replacement benefits [3], which total 3–5% of national GDP [4]. Returning to paid work is a key recovery milestone for many stroke survivors [8]. Those who return have better long-term outcomes [2,9]. Differing economic environments probably explain much of the wide variation that has been observed previously in the rate at which stroke survivors return to work, this research is characterised by a lack of consistency in study methods, e.g. a lack of standardisation in definitions of work, return to work, low power and post hoc analyses [2,10]
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