Factors influencing return to work after stroke: the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study

Junhee Han, Hae In Lee, Yong-Il Shin, Ju Hyun Son, Soo-Yeon Kim, Deog Young Kim, Min Kyun Sohn, Jongmin Lee, Sam-Gyu Lee, Gyung-Jae Oh, Yang-Soo Lee, Min Cheol Joo, Eun Young Han, Won Hyuk Chang, Yun-Hee Kim, Junhee Han, Hae In Lee, Yong-Il Shin, Ju Hyun Son, Soo-Yeon Kim, Deog Young Kim, Min Kyun Sohn, Jongmin Lee, Sam-Gyu Lee, Gyung-Jae Oh, Yang-Soo Lee, Min Cheol Joo, Eun Young Han, Won Hyuk Chang, Yun-Hee Kim

Abstract

Objective: To investigate the rate of return to work and identify key factors associated with return to work between 3 months and 2 years after stroke.

Design: Prospective cohort study.

Setting: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) in Korea.

Participants: A total of 193 persons with first-ever stroke who reported working status at 3 months after stroke.

Outcome measures: Data on baseline characteristics were collected from medical records. Functional assessments were performed using the National Institutes of Health Stroke Scale, the modified Rankin Scale, the Fugl-Meyer Assessment, the Functional Ambulatory Category, the Korean Mini-Mental State Examination, the Korean version of the Frenchay Aphasia Screening Test, the American Speech-Language-Hearing Association National Outcomes Measurement System, the Korean-Modified Barthel Index, the Geriatric Depression Scale-Short Form and the EuroQol-5 dimensions. An enumeration survey included the Reintegration to Normal Living Index, the Psychosocial Well-being Index-Short Form (, the Family Support Index and the Caregivers Burden Index.

Results: Overall, 145 (75.1%) patients who had a stroke in the "Continuously-Employed" group and 48 (24.9%) in the "Employed-Unemployed" group returned to work between 3 months and 2 years after stroke. Multivariate logistic analysis demonstrated that in patients who had a stroke, characteristics such as age, PWI-SF Score, and caregiver characteristics, including age, sex (female) and living arrangements, were significantly associated with return to work between 3 months and 2 years after stroke.

Conclusion: Age and PWI-SF Score of patients who had a stroke, as well as the age, sex and living arrangements of caregivers, are key factors influencing the return to work after stroke.

Trial registration number: NCT03402451.

Keywords: employment; persons with stroke; return to work; vocational rehabilitation; work.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart of the study population. Baseline data were collected at 3 months after stroke. The group was divided into two groups according to working status ("Continuously-Employed" and "Employed-Unemployed"). The functional assessment and questionnaire survey were conducted between 3 months and 2 years after stroke. KOSCO, Korean Stroke Cohort for Functioning and Rehabilitation.
Figure 2
Figure 2
Proportion of patients who had a stroke who returned to work between 3 months and 2 years. The proportion of patients who had a stroke who returned to work between 3 months and 2 years after stroke is shown as a percentage (%) according to (A) Working age. (B) Sex.

References

    1. Singam A, Ytterberg C, Tham K, et al. . Participation in complex and social everyday activities six years after stroke: predictors for return to pre-stroke level. PLoS One 2015;10:e0144344 10.1371/journal.pone.0144344
    1. Westerlind E, Persson HC, Sunnerhagen KS. Return to work after a stroke in working age persons; a six-year follow up. PLoS One 2017;12:e0169759 10.1371/journal.pone.0169759
    1. Hong KS, Bang OY, Kang DW, et al. . Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the korean stroke society and clinical research center for stroke. J Stroke 2013;15:2–20. 10.5853/jos.2013.15.1.2
    1. Seo SR, Kim SY, Lee SY, et al. . The incidence of stroke by socioeconomic status, age, sex, and stroke subtype: a nationwide study in Korea. J Prev Med Public Health 2014;47:104–12. 10.3961/jpmph.2014.47.2.104
    1. Franceschini M, Massimiani MP, Paravati S, et al. . Return to work: a cut-off of FIM gain with montebello rehabilitation factor score in order to identify predictive factors in subjects with acquired brain injury. PLoS One 2016;11:e0165165 10.1371/journal.pone.0165165
    1. Hartke RJ, Trierweiler R, Bode R. Critical factors related to return to work after stroke: a qualitative study. Top Stroke Rehabil 2011;18:341–51. 10.1310/tsr1804-341
    1. Balak F, Roelen CA, Koopmans PC, et al. . Return to work after early-stage breast cancer: a cohort study into the effects of treatment and cancer-related symptoms. J Occup Rehabil 2008;18:267–72. 10.1007/s10926-008-9146-z
    1. Pryce J, Munir F, Haslam C. Cancer survivorship and work: symptoms, supervisor response, co-worker disclosure and work adjustment. J Occup Rehabil 2007;17:83–92. 10.1007/s10926-006-9040-5
    1. Maruthappu M, Shalhoub J, Tariq Z, et al. . Unemployment, government healthcare spending, and cerebrovascular mortality, worldwide 1981-2009: an ecological study. Int J Stroke 2015;10:364–71. 10.1111/ijs.12408
    1. Wozniak MA, Kittner SJ. Return to work after ischemic stroke: a methodological review. Neuroepidemiology 2002;21:159–66. 10.1159/000059516
    1. Larsen LP, Biering K, Johnsen SP, et al. . Self-rated health and return to work after first-time stroke. J Rehabil Med 2016;48:339–45. 10.2340/16501977-2061
    1. Hannerz H, Holbæk Pedersen B, Poulsen OM, et al. . A nationwide prospective cohort study on return to gainful occupation after stroke in Denmark 1996-2006. BMJ Open 2011;1:e000180 10.1136/bmjopen-2011-000180
    1. Morris R. The psychology of stroke in young adults: the roles of service provision and return to work. Stroke Res Treat 2011;2011:1–10. 10.4061/2011/534812
    1. Treger I, Shames J, Giaquinto S, et al. . Return to work in stroke patients. Disabil Rehabil 2007;29:1397–403. 10.1080/09638280701314923
    1. Busch MA, Coshall C, Heuschmann PU, et al. . Sociodemographic differences in return to work after stroke: the South London Stroke Register (SLSR). J Neurol Neurosurg Psychiatry 2009;80:888–93. 10.1136/jnnp.2008.163295
    1. Pack TG, Szirony GM. Predictors of competitive employment among persons with physical and sensory disabilities: an evidence-based model. Work 2009;33:67–79. 10.3233/WOR-2009-0845
    1. Teasell RW, McRae MP, Finestone HM. Social issues in the rehabilitation of younger stroke patients. Arch Phys Med Rehabil 2000;81:205–9. 10.1016/S0003-9993(00)90142-4
    1. Chang WH, Sohn MK, Lee J, et al. . Korean Stroke Cohort for functioning and rehabilitation (KOSCO): study rationale and protocol of a multi-centre prospective cohort study. BMC Neurol 2015;15:42 10.1186/s12883-015-0293-5
    1. Bernardini J, Callen S, Fried L, et al. . Inter-rater reliability and annual rescoring of the Charlson comorbidity index. Adv Perit Dial 2004;20:125–7.
    1. Young FB, Weir CJ, Lees KR; GAIN International Trial Steering Committee and Investigators. Comparison of the National Institutes of Health Stroke Scale with disability outcome measures in acute stroke trials. Stroke 2005;36:2187–92. 10.1161/01.STR.0000181089.41324.70
    1. Burn JP. Reliability of the modified Rankin Scale. Stroke 1992;23:438 10.1161/str.23.3.438b
    1. Fugl-Meyer AR, Jääskö L, Leyman I, et al. . The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 1975;7:13–31.
    1. Holden MK, Gill KM, Magliozzi MR, et al. . Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther 1984;64:35–40. 10.1093/ptj/64.1.35
    1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–98.
    1. Enderby PM, Wood VA, Wade DT, et al. . The Frenchay Aphasia Screening Test: a short, simple test for aphasia appropriate for non-specialists. Int Rehabil Med 1987;8:166–70. 10.3109/03790798709166209
    1. Jung SH, Lee KJ, Hong JB, et al. . Validation of clinical dysphagia scale: based on videofluoroscopic swallowing study. J Korean Acad Rehabil Med 2005;29:343–50.
    1. Lee KW, Kim SB, Lee JH, et al. . Effect of upper extremity robot-assisted exercise on spasticity in stroke patients. Ann Rehabil Med 2016;40:961–71. 10.5535/arm.2016.40.6.961
    1. Lesher EL, Berryhill JS. Validation of the Geriatric Depression Scale--Short Form among inpatients. J Clin Psychol 1994;50:256–60. 10.1002/1097-4679(199403)50:2<256::AID-JCLP2270500218>;2-E
    1. Noh JW, Kim J, Park J, et al. . Gender difference in relationship between health-related quality of life and work status. PLoS One 2015;10:e0143579 10.1371/journal.pone.0143579
    1. Wood-Dauphinee SL, Opzoomer MA, Williams JI, et al. . Assessment of global function: The Reintegration to Normal Living Index. Arch Phys Med Rehabil 1988;69:583–90.
    1. Kang YS, Choi SY, Ryu E. The effectiveness of a stress coping program based on mindfulness meditation on the stress, anxiety, and depression experienced by nursing students in Korea. Nurse Educ Today 2009;29:538–43. 10.1016/j.nedt.2008.12.003
    1. Cobb S. Presidential Address-1976. Social support as a moderator of life stress. Psychosom Med 1976;38:300–14.
    1. Suh MH, Oh KS. A Study of Well-being in Caregivers Caring for Chronically Ill Family Members. J Nur Acad Soc 1993;23:467–86. 10.4040/jnas.1993.23.3.467
    1. Anema JR, Schellart AJ, Cassidy JD, et al. . Can cross country differences in return-to-work after chronic occupational back pain be explained? An exploratory analysis on disability policies in a six country cohort study. J Occup Rehabil 2009;19:419–26. 10.1007/s10926-009-9202-3
    1. Saeki S, Matsushima Y, Kato N, et al. . Comparison of the time course of return to work after stroke between two cohort studies in japan. J Uoeh 2016;38:311–5. 10.7888/juoeh.38.311
    1. Steadman-Pare D, Colantonio A, Ratcliff G, et al. . Factors associated with perceived quality of life many years after traumatic brain injury. J Head Trauma Rehabil 2001;16:330–42. 10.1097/00001199-200108000-00004
    1. Eshak ES, Honjo K, Iso H, et al. . Changes in the employment status and risk of stroke and stroke types. Stroke 2017;48:1176–82. 10.1161/STROKEAHA.117.016967
    1. Kang MY, Kim HR. Association between voluntary/involuntary job loss and the development of stroke or cardiovascular disease: a prospective study of middle-aged to older workers in a rapidly developing Asian country. PLoS One 2014;9:e113495 10.1371/journal.pone.0113495
    1. Medin J, Barajas J, Ekberg K. Stroke patients' experiences of return to work. Disabil Rehabil 2006;28:1051–60. 10.1080/09638280500494819
    1. Barker-Collo S, Feigin VL, Parag V, et al. . Auckland stroke outcomes study. part 2: Cognition and functional outcomes 5 years poststroke. Neurology 2010;75:1608–16. 10.1212/WNL.0b013e3181fb44c8
    1. Jacobs BS, Boden-Albala B, Lin IF, et al. . Stroke in the young in the northern Manhattan stroke study. Stroke 2002;33:2789–93. 10.1161/01.STR.0000038988.64376.3A
    1. Lindström B, Röding J, Sundelin G. Positive attitudes and preserved high level of motor performance are important factors for return to work in younger persons after stroke: a national survey. J Rehabil Med 2009;41:714–8. 10.2340/16501977-0423
    1. Tanaka H, Toyonaga T, Hashimoto H. Functional and occupational characteristics predictive of a return to work within 18 months after stroke in Japan: implications for rehabilitation. Int Arch Occup Environ Health 2014;87:445–53. 10.1007/s00420-013-0883-8
    1. Quick HE, Moen P, Gender MP. Gender, employment, and retirement quality: a life course approach to the differential experiences of men and women. J Occup Health Psychol 1998;3:44–64. 10.1037/1076-8998.3.1.44
    1. Kobayashi T, Honjo K, Eshak ES, et al. . Work-family conflict and self-rated health among Japanese workers: How household income modifies associations. PLoS One 2017;12:e0169903 10.1371/journal.pone.0169903
    1. Passier PE, Visser-Meily JM, Rinkel GJ, et al. . Life satisfaction and return to work after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2011;20:324–9. 10.1016/j.jstrokecerebrovasdis.2010.02.001
    1. Glass TA, Matchar DB, Belyea M, et al. . Impact of social support on outcome in first stroke. Stroke 1993;24:64–70. 10.1161/01.STR.24.1.64
    1. Audhoe SS, Nieuwenhuijsen K, Hoving JL, et al. . Perspectives of unemployed workers with mental health problems: barriers to and solutions for return to work. Disabil Rehabil 2018;40:28–34. 10.1080/09638288.2016.1242170
    1. Tseng CN, Huang GS, Yu PJ, et al. . A qualitative study of family caregiver experiences of managing incontinence in stroke survivors. PLoS One 2015;10:e0129540 10.1371/journal.pone.0129540
    1. Ilse IB, Feys H, de Wit L, et al. . Stroke caregivers' strain: prevalence and determinants in the first six months after stroke. Disabil Rehabil 2008;30:523–30. 10.1080/09638280701355645
    1. Khan F, Pallant J, Brand C. Caregiver strain and factors associated with caregiver self-efficacy and quality of life in a community cohort with multiple sclerosis. Disabil Rehabil 2007;29:1241–50. 10.1080/01443610600964141
    1. Min JY, Lee KJ, Park JB, et al. . Social engagement, health, and changes in occupational status: analysis of the Korean Longitudinal Study of Ageing (KLoSA). PLoS One 2012;7:e46500 10.1371/journal.pone.0046500
    1. Kim JS, Lee EH. Cultural and noncultural predictors of health outcomes in Korean daughter and daughter-in-law caregivers. Public Health Nurs 2003;20:111–9. 10.1046/j.1525-1446.2003.20205.x
    1. Baltov P, Côte J, Truchon M, et al. . Psychosocial and socio-demographic factors associated with outcomes for patients undergoing rehabilitation for chronic whiplash associated disorders: a pilot study. Disabil Rehabil 2008;30:1947–55. 10.1080/09638280701791245
    1. Johanson S, Bejerholm U. The role of empowerment and quality of life in depression severity among unemployed people with affective disorders receiving mental healthcare. Disabil Rehabil 2017;39:1807–13. 10.1080/09638288.2016.1211758

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