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Multivariable Prediction of Return to Work at 6-Month Follow-Up in Patients With Mild to Moderate Acute Stroke

      Abstract

      Objective

      To investigate predictors of return to work (RTW) in a poststroke sample.

      Design

      Retrospective investigation of archival data from an inception cohort; acute care records and 6-month follow-up telephone interview data were obtained for analysis.

      Setting

      The Brain Recovery Core, a collaborative interinstitutional endeavor among an academic medical center, an acute care hospital, and a rehabilitation center.

      Participants

      Data from patients with stroke from the Brain Recovery Core (N=298). Excluded cases included those with nontraditional and/or nonpaid job status, no National Institute of Health Stroke Scale (NIHSS) score, and an NIHSS score >16. Our final sample included 244 individuals (age range, 25–87y).

      Interventions

      Not applicable.

      Main Outcome Measures

      Sociodemographic variables, stroke severity (NIHSS), and physical and neurocognitive measures.

      Results

      Adding predictor variables to our logistic regression model increased accuracy by approximately 18%. Greater independence in the FIM sit-to-stand movement predicted improved RTW rates (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0–3.1), whereas nonwhite race (OR, 2.52; 95% CI, 1.16–5.47) and greater impairment on the NIHSS (OR, .88; 95% CI, .77–.99) predicted attenuated RTW rates.

      Conclusions

      Valid measures of stroke severity and a clinician-rated sit-to-stand movement have utility in the acute prediction of later RTW in patients with mild to moderate stroke. Given the complexity of the RTW construct and the acute measurement of these variables, we believe that our findings can be used to inform clinical decisions and appropriately tailor rehabilitative strategies that improve quality of life for stroke survivors.

      Keywords

      List of abbreviations:

      CI (confidence interval), NIHSS (National Institute of Health Stroke Scale), OR (odds ratio), RTW (return to work)
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