Multivariable Prediction of Return to Work at Six-Month Follow-up in Mild to Moderate Acute Stroke Patients

Publication date: Available online 1 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ryan Van Patten, Zachary C. Merz, Kyler Mulhauser, Robert Fucetola
ObjectiveTo investigate predictors of return to work (RTW) in a post-stroke sample. We hypothesized that acutely measured stroke severity, occupational status, and neurocognitive abilities would predict RTW six months later.DesignA retrospective investigation of archival data from an inception cohort. Acute care records and six-month follow up telephone interview data were obtained for analysis.SettingThe Brain Recovery Core (BRC), a collaborative interinstitutional endeavor among an academic medical center, an acute care hospital, and a rehabilitation center.ParticipantsData from 298 stroke patients from the BRC. Excluded cases with nontraditional and/or nonpaid job status, no National Institute of Health Stroke Scale (NIHSS) score, and an NIHSS score of > 16. Our final sample included 244 individuals, aged 25-87.InterventionsNot applicableMain Outcome MeasuresSociodemographic variables, stroke severity (NIHSS), physical and neurocognitive measures.ResultsAdding predictor variables to our logistic regression model increased accuracy by approximately 18%. Greater independence in the Functional Independence Measure Sit-to-Stand movement predicted improved RTW rates (OR = 1.80; 95% CI = 1.0 – 3.1), while non-Caucasian race (odds ratio [OR] = 2.52; 95% confidence interval [CI] = 1.16 – 5.47) and greater impairment on the NIHSS (OR = .88; 95% CI = .77 – .99) predicted attenuated RTW rates.ConclusionsValid measures of stroke severity and a clinician-rated sit-to-stand movement have utility in the acute prediction of later RTW in mild to moderate stroke patients. Given the complexity of the RTW construct and the acute measurement of these variables, we believe that our findings can be used to a) inform clinical decisions and to b) appropriately tailor rehabilitative strategies that improve quality of life for stroke survivors.



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