Factors associated with paid employment 12 months after stroke in A Very Early Rehabilitation Trial (AVERT) - 26/07/21

Doi : 10.1016/j.rehab.2021.101565

Stephen Cain, MD ¹, Leonid Churilov, PhD ², Janice M Collier, PhD ³, Lilian B Carvalho, MD ³, Karen Borschmann, PhD ³, Marj Moodie, PhD ⁴, Vincent Thijs, MD, PhD ^1,³, Julie Bernhardt, PhD ^3,^⁎
on behalf of the
AVERT Trialist Collaboration
¹ Austin Health, Heidelberg, Victoria, Australia
² University of Melbourne, Parkville, Victoria, Australia
³ Stroke, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
⁴ Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia

^⁎Corresponding author: Julie Bernhardt, Stroke, Florey Institute of Neuroscience and Mental Health; 245 Burgundy Street, Heidelberg, Victoria 3084, AustraliaStroke, Florey Institute of Neuroscience and Mental Health245 Burgundy StreetHeidelbergVictoria3084Australia

En prensa. Manuscrito Aceptado. Disponible en línea desde el Monday 26 July 2021
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Highlights

•	This study described characteristics of working-age stroke participants and their return to work.
•	More than half (59%; <65 years old, working at time of stroke) returned to work by 12 months.
•	At 12 months, those working at the time of stroke returned to work for a median of 38 hr/week.
•	Younger stroke participants were more likely to return to work.
•	Stroke severity, 3-month modified Rankin Scale score, and prior full-time work were associated with a return to work.

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Abstract

Background

Returning to work is an important outcome for stroke survivors.

Objectives

This sub-study of a randomised controlled trial aimed to provide characteristics of working-age stroke participants and identify factors associated with return to work at 12 months.

Methods

We used paid employment data collected as part of A Very Early Rehabilitation Trial (AVERT, n=2104), an international randomised controlled trial studying the effects of very early mobilisation after stroke at 56 acute stroke units across Australia, New Zealand, the United Kingdom, Malaysia and Singapore. For the present analysis, data for trial participants < 65 years old were included if they were working at the time of stroke and had complete 12-month return-to-work data. The primary outcome was 12-month return to paid work. Univariable and multivariable logistic regression analyses were conducted to determine the association of multiple factors with return to work.

Results

In total, 376 AVERT participants met the inclusion criteria for this sub-study. By 12 months, 221 (59%) participants had returned to work at a median of 38 hr per week. Similar rates were found across geographic regions. On univariable analysis, the odds of returning to paid employment were increased with younger age (OR per year 0.95, 95%CI 0.92–0.97), no previous diabetes (0.4, 0.24–0.67), lower stroke severity (OR per National Institutes of Health Stroke Scale point 0.82, 0.78–0.86), less 3-month depressive traits (Irritability Depression Anxiety [IDA] scale) (OR per IDA point 0.87, 0.80–0.93), less 3-month disability (modified Rankin Scale), and prior full-time work (2.04, 1.23–3.38). On multivariable analysis, return to work remained associated with younger age (OR 0.94, 95%CI 0.91–0.98), lower stroke severity (0.92, 0.86–0.99), prior full-time work (2.33, 1.24–4.40), and less 3-month disability.

Conclusions

Return to work at 12 months after stroke was associated with young age, acute stroke severity, 3-month disability and full-time employment before stroke. Greater understanding of this topic could help in developing programs to support successful resumption of work post-stroke.

El texto completo de este artículo está disponible en PDF.

Keywords : Stroke, Return to work, Employment, Rehabilitation