Registry-based studies of return to work after stroke - part of the work after stroke study (WASS)

Abstract: Objectives. Stroke is one of the most common diseases and a main cause of disability both globally and in Sweden. Even though the risk increases with older age, stroke in the younger population is increasing and a substantial part of those who suffer from stroke are at working age. Stroke in this group entails several consequences for the affected person as well as for the society as a whole. To be able to participate in work life is important from the economic perspective and seem to affect several aspects of health. National guidelines of sickness absence after stroke in Sweden suggests potential sick leave up to 2 months on full-time after stroke, however there is a lack of research investigating this topic. The aim of the thesis was to investigate in what time period people return to work (RTW) after stroke, what factors are associated with higher and faster RTW, and if RTW status affects the individual in several aspects of health post-stroke. Methods. The four individual papers mainly had long-term perspectives with follow-up times ranging between 18 months and 6 years post-stroke. They all include data pooled from different Swedish registries, and all participants had a first-time stroke during working age. Paper I and II are based on local cohorts from the Sahlgrenska University hospital in Gothenburg, Sweden, and paper III and IV on the Swedish national quality registry called Riksstroke. Working capacity prior to stroke and RTW after stroke was assessed based on sickness absence data from the Social Insurance Agency. Furthermore, questionnaire surveys, medical records, registries from the National Board of Health and Welfare, and registries from Statistics Sweden were the other data sources that were used. The statistical methods include logistic regression, Kaplan-Meier curves, Cox regression and shift analysis. All papers have ethical approval from the Regional Ethical Review Board in Gothenburg. Key results. The majority of all the participants did RTW, and most did so within the first two years after stroke. For some participants, however, the RTW process continued for several years post-stroke. A number of different factors, including demographical, stroke related, and socioeconomic factors, were important for RTW. For example, milder stroke severity, ischemic stroke compared to intracerebral haemorrhage, male sex, younger age, and higher educational level were significant determinants for RTW. In addition, those who had self-expectations of RTW were more likely to RTW compared to those who did not have expectations of RTW and the participants who were on sick leave for more than 2 weeks the year before the stroke had lower odds of RTW compared to the participants that were not on sick leave prior to stroke. The participants that did RTW had a better self-perceived health-related quality of life and general health, as well as less symptoms of depression and pain compared to the participants who did not RTW. However, the RTW-group at 1 year post-stroke had a decline in general health and increased pain between the 1 and 5 year follow-up post-stroke, which was not found in the no-RTW group. Conclusions. The process of RTW could continue for a longer time after stroke than previously described. Several different factors, both modifiable and non-modifiable, are important for RTW. RTW is perhaps not solely a facilitator of health, but should be seen as a more complex process. The present results could hopefully guide health care professionals and government authorities to further optimise and individualise the RTW process for the affected persons.

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