Proportion of Non-severe Ischemic Stroke Patients Returning to Work

Authors

  • Krittin Wipahut Department of Community Medicine, Family Medicine, and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Thailand
  • Naesinee Chaiear Department of Community Medicine, Family Medicine, and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Thailand https://orcid.org/0000-0001-9295-6760
  • Sirintip Boonjaraspinyo Department of Community Medicine, Family Medicine, and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Thailand https://orcid.org/0000-0001-5380-3681
  • Kannikar Kongbunkiat Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand https://orcid.org/0000-0002-3601-0847
  • Somsak Tiamkao Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand https://orcid.org/0000-0001-5178-478X
  • Warisa Soonthornvinit Department of Community Medicine, Family Medicine, and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Thailand https://orcid.org/0009-0002-5831-9375

Keywords:

return to work, ischemic stroke, occupation, cognition, activities of daily living

Abstract

Objective To explore the proportion of non-severe ischemic stroke patients returning to work (RTW) and to examine the association of demographic, clinical, and evaluative information with RTW outcomes.

Methods This observational study included non-severe ischemic stroke patients at the stroke ward, Srinagarind Hospital, Khon Kaen, Thailand between September 2021 and November 2022. Patients included were over 18-year-old, had NIHSS scores not exceeding 14, were currently employed and wanted to RTW. Patients were assessed at the discharged time, 2-week-follow-up, and 3-month-follow-up. Bivariate analysis was conducted using either Chi-square or Fisher’s exact test.

Results Sixty-four patients were recruited of whom 4 dropped out, leaving a total of 60. The cumulative proportions of successful RTW patients at the discharged time, 2-week-follow-up, 1-month-follow-up, and 3-month-follow-up were 26.7%, 51.7%, 70%, and 76.7% (95%CI 16.8-38.8, 39.2-64.0, 57.7-80.5, 64.9-86.0), respectively.  Most patients could RTW in the first month, then the number plateaued at 3 months. More successful RTW patients included those in cognitive demand occupations, evaluated as normal to minor neurological severity, motor power graded 4-5 at discharge, passed MoCA or MMSE test, and who were rated as independent by either the mRS or the BI.  Bivariate analysis revealed statistically significant association between RTW proportion and occupation type, neurological severity, motor power, and ADL disability.

Conclusions Most non-severe ischemic stroke patients could RTW within 3 months after discharge.  Occupational type, neurological severi-ty, motor power, and ADL associated with the proportion of RTW (3-month-follow-up). RTW evaluation of non-severe stroke patients should be assessed at short intervals for 3 months after discharge. 

References

Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1736-88.

Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1204-22.

Somsak T. Incident of stroke in Thailand. Thai J Neurol. 2022;39:39-46.

George MG, Tong X, Bowman BA, Prevention S. Prevalence of cardiovascular risk factors and strokes in younger adults. JAMA Neurol. 2018;74: 695-703.

Hathidara MY, Saini V, Malik AM. Stroke in the young: a global update. Curr Neurol Neurosci Rep. 2019;19(11):91.

Talmage JB, Melhorn JM, Hyman MH. AMA guides to the evaluation of work ability and return to work. 2nd ed. Chicago: American Medical Association; 2011. p. 510.

Stinear CM, Byblow WD. Predicting and accelerating motor recovery after stroke. Curr Opin Neurol. 2014;27:624-30.

Kwakkel G, Kollen BJ. Predicting activities after stroke: what is clinically relevant? Int J Stroke. 2013;8:25-32.

Van De Port IGL, Kwakkel G, Van Wijk I, Lindeman E. Susceptibility to deterioration of mobility long-term after stroke: a prospective cohort study. Stroke. 2006;37:167-71.

Lang CE, Waddell KJ, Barth J, Holleran CL, Strube MJ, Bland MD. Upper limb performance in daily life approaches plateau around three to six weeks post-stroke. Neurorehabil Neural Repair. 2021;35: 903-14.

Lundquist CB, Nguyen BT, Hvidt TB, Stabel HH, Christensen JR, Brunner I. Changes in upper limb capacity and performance in the early and late subacute phase after stroke. J Stroke Cerebrovasc Dis. 2022;31:106590.

Girgenti SG, Brunson AO, Marsh EB. Baseline function and rehabilitation are as important as stroke severity as long-term predictors of cognitive performance post-stroke. Am J Phys Med Rehabil. 2023;102:S43-50.

Treger I, Shames J, Giaquinto S, Ring H. Return to work in stroke patients. Disabil Rehabil. 2007; 29(17):1397-403.

Hartke R, Trierweiler R, Bode R. Critical factors related to return to work after stroke: a qualitative study. Top Stroke Rehabil. 2011;18:341-51.

Ashley KD, Lee LT, Heaton K. Return to work among stroke survivors. Work Heal Saf. 2019;67:87-94.

Radford KA, McKevitt C, Clarke S, Powers K, Phillips J, Craven K, et al. Return to work after stroKE (RETAKE) Trial: Protocol for a mixed-methods process evaluation using normalisation process theory. BMJ Open. 2022 Mar 15;12(3):e053111.

Saringcarinkul T, Thimayom P. Return to work for stroke patients after treatment at prasat neurological institute. J Heal Syst Res. 2014;8(2).

Sen A, Bisquera A, Wang Y, McKevitt CJ, Rudd AG, Wolfe CD, et al. Factors, trends, and long-term outcomes for stroke patients returning to work: The South London Stroke Register. Int J Stroke. 2019;14:696-705.

Westerlind E, Persson HC, Eriksson M, Norrving B, Sunnerhagen KS. Return to work after stroke: a Swedish nationwide registry-based study. Acta Neurol Scand. 2020;141:56-64.

Kaeobuadi W, Osothsinlp S. Return to work and associated factors of patients diagnosed with stroke in Nopparat Rajathanee Hospital. Journal of Preventive Medicine Association of Thailand. 2022;1:116-31.

Indrabhinduwat M, Tiamkao S, Chaiear N. Return to work assessment of ischemic stroke worker: a study in university hospital in north eastern of Thailand. North-Eastern Thai Journal of Neuroscience. 2019;14:31-48.

van der Kemp J, Kruithof WJ, Nijboer TCW, van Bennekom CAM, van Heugten C, Visser-Meily JMA. Return to work after mild-to-moderate stroke: work satisfaction and predictive factors. Neuropsychol Rehabil. 2019;29:638-53.

Suda S, Muraga K, Ishiwata A, Suzuki K, Sakamoto Y, Katano T. Early cognitive assessment following acute stroke: feasibility and comparison between mini-mental state examination and Montreal cognitive assessment. J Stroke Cerebrovasc Dis. 2023;29:104688.

Nascimento LR, Scianni AA, Ada L, Fantauzzi MO, Hirochi TL, Teixeira-Salmela LF. Predictors of return to work after stroke: a prospective, observational cohort study with 6 months follow-up. Disabil Rehabil. 2021;43:525-9.

Williams LS, Yilmaz EY, Lopez-Yunez AM. Retrospective assessment of initial stroke severity with the NIH stroke scale. Stroke. 2000;31:858-62.

Nasreddine Z, Phillips N, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;29:338-43.

Cumming TB, Churilov L, Linden T, Bernhardt J. Montreal cognitive assessment and mini-mental state examination are both valid cognitive tools in stroke. Acta Neurol Scand. 2013;128:122-9.

Barthel D, Mahoney F. Functional evaluation: the barthel index. Md State Med J. 1965;14:61-5.

Sulter G, Steen C, Keyser J De. Use of the barthel index and modified rankin scale in acute stroke trials. Stroke. 1999;30:1538-41.

Endo M, Sairenchi T, Kojimahara N, Haruyama Y, Sato Y, Kato R, et al. Sickness absence and return to work among Japanese stroke survivors: a 365-day cohort study. BMJ Open. 2016;6:e009682.

Wang YC, Kapellusch J, Garg A. Important factors influencing the return to work after stroke. Work. 2014;47:553-9.

Palstam A, Westerlind E, Persson HC, Sunnerhagen KS. Work-related predictors for return to work after stroke. Acta Neurol Scand. 2019;139:382-8.

Edwards JD, Kapoor A, Linkewich E, Swartz RH. Return to work after young stroke: a systematic review. Int J Stroke. 2018;13:243-56.

Bonner B, Pillai R, Sarma PS, Lipska KJ, Pandian J, Sylaja PN. Factors predictive of return to work after stroke in patients with mild-moderate disability in India. Eur J Neurol. 2016;23:548-53.

Zamboni G, Griffanti L, Jenkinson M, Mazzucco S, Li L, Küker W, et al. White matter imaging correlates of early cognitive impairment detected by the montreal cognitive assessment after transient ischemic attack and minor stroke. Stroke. 2017;48: 1539-47.

Dong Y, Kumar V, Chan BP, Venketasubramanian N, Luen H, Chee R, et al. The montreal cognitive assessment (MoCA) is superior to the mini-mental state examination (MMSE) for the detection of vascular cognitive impairment after acute stroke. J Neurol Sci. 2010;299:15-8.

Lim K, Kim J, Lee H, Yoo J. Correlation between montreal cognitive assessment and functional outcome in subacute stroke patients with cognitive dysfunction. Ann Rehabil Med. 2018;42:26-34.

Kwon S, Hartzema AG, Duncan PW, Lai SM. Disability measures in stroke: relationship among the barthel index, the functional independence measure, and the modified rankin scale. Stroke. 2004;35: 918-23.

Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified rankin scale: a systematic review. Stroke. 2009;40:3393-5.

Quinn TJ, Dawson J, Walters MR, Lees KR. Exploring the reliability of the modified Rankin scale. Stroke. 2009;40:762-6.

Huybrechts KF, Caro JJ. The barthel index and modified rankin scale as prognostic tools for long-term outcomes after stroke: a qualitative review of the literature. Curr Med Res Opin. 2007;23:1627-36.

Quinn TJ, Langhorne P, Stott DJ. Barthel index for stroke trials: development, properties, and application. Stroke. 2011;42:1146-51.

Kong KH, Lee J. Temporal recovery of activities of daily living in the first year after ischemic stroke: a prospective study of patients admitted to a rehabilitation unit. NeuroRehabilitation. 2014;35:221-6.

Ullberg T, Zia E, Petersson J, Norrving B. Changes in functional outcome over the first year after stroke: an observational study from the Swedish stroke register. Stroke. 2015;46:389-94.

Musa KI, Keegan TJ. The change of barthel index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: a random intercept model. PLoS One. 2018;13:1-13.

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Published

2023-06-30

How to Cite

1.
Wipahut K, Chaiear N, Boonjaraspinyo S, Kongbunkiat K, Tiamkao S, Soonthornvinit W. Proportion of Non-severe Ischemic Stroke Patients Returning to Work. BSCM [Internet]. 2023 Jun. 30 [cited 2024 Nov. 5];62(2):52-6. Available from: https://he01.tci-thaijo.org/index.php/CMMJ-MedCMJ/article/view/264509

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Original Article