To determine the proportion of patients with PCS who RTW and to identify significant demographic, clinical and functional predictive factors that influence successful RTW post-stroke.
This is a retrospective cohort study of patients who were admitted for PCS in an acute hospital inpatient rehabilitation unit in Singapore. A total of 73 participants were included in this study, of which 26 participants were retired prior to their stroke. Quantitative data was extracted from existing medical records, which included demographic and clinical information, and information related to functional predictive factors. Initial data analysis was used to investigate any significant relationships between the variables and RTW outcomes. Following this, multivariate logistic regression analysis was conducted to predict the probability of RTW from several significant predictor variables. Finally, using the receiver-operating characteristics (ROC) curve analysis, the optimal FIM cut-off points was determined using the least-distance analysis and the Youden index.
Out of the 47 participants who held meaningful occupations pre-stroke, 8 (17.0%) returned to work at 3-months and 21 (44.7%) returned to work at 12-months post-stroke. At both time points, the presence of other co-morbidities (3-months, p 0.05; 12-months, p = 0.04), ability to ambulate at 3-months (3-months, p 0.01; 12-months, p 0.01) and the presence of coordination impairments (3-months, p = 0.04; 12-months, p = 0.01) were significantly related to RTW. Participants who RTW had higher total, motor and cognitive admission and discharge FIM scores compared to participants who did not RTW. This study also determined FIM cut-off scores of 81.4 and 93.9 points with >75% sensitivity and specificity on admission and discharge respectively, to indicate a higher probability of successful RTW post-stroke.
Within the multi-variable logistic regression analysis for predictor variables on admission, only two independent predictor variables: a higher total FIM score on admission (OR 1.10, 95% CI 1.03-1.17) and having no other co-morbidities (OR 13.35, 95% CI 1.70-104.81) were associated with an increased probability of RTW at 12-months post-stroke.
The RTW rates are congruent with previous studies conducted in Singapore. The results of the study also suggest that intensive rehabilitation during the initial hospitalization period is likely required for an improvement in FIM scores that exceeds proportional recovery in order to achieve a higher probability of RTW post-stroke.
By identifying and evaluating the key predictive factors for RTW post-stroke, clinicians may be better equipped to provide optimized management plans for each individual patient during initial phases of rehabilitation, thereby achieving better RTW outcomes across the working stroke population.
Predictive factors
Young stroke
