Hannah Roeder, MD, MPH
For working-age stroke patients, returning to work (RTW) is a yardstick for functional recovery and is associated with improved well-being. Patients who suffer large vessel occlusion (LVO) are at greater risk for persistent neurological deficits; however, in the mechanical thrombectomy era, even patients with LVO may have a favorable outcome allowing RTW. Hahn and colleagues used data from the German Stroke Registry Endovascular Treatment (GSR-ET) to explore the likelihood and predictive factors for RTW with particular attention to sex differences.
The investigators included patients in the GSR-ET who were known to be employed prior to their stroke and were less than 65 years of age (the retirement age in Germany), and excluded patients who did not receive thrombectomy or were deceased by day 90. After application of inclusion/exclusion criteria, about one-tenth of patients in the GSR-ET were eligible (606 out of 6635). Of eligible patients, 35.6% (216) were re-employed at 3 months post-stroke.
Among functional outcome parameters, the authors found that NIHSS at 24 hours following MT had the highest discriminative ability to predict RTW, explaining 43.2% of variance; however, multiple variable regression models improved explanatory power. In multiple logistic regression analysis, at 90-day follow-up, excellent functional outcome (mRS 0-1) and combined treatment with intravenous thrombolysis were positively associated with RTW, whereas female sex, higher 24-hour NIHSS after MT, and longer duration of hospital stay were independent negative predictors for RTW.
In regard to sex differences, notably, only 27.7% of included patients were female, and in univariate analysis, there was no absolute difference in the share of men versus women RTW; however, in the cohort, women were, on average, younger, less likely to smoke, and more likely to have excellent functional outcome at discharge, so in multiple logistic regression analysis, women were less likely to RTW (OR 0.52, p=0.031). The current study did not analyze the reasons for the sex disparity, but the authors proposed that income differences between men and women and greater systemic barriers facing women may contribute to the study results.
Limits to the current study include those innate to the use of a large administrative database, including not having detailed clinical information. In this case, sociodemographic and occupational factors are likely to impact whether patients are able to RTW post-stroke, but were unavailable. Additionally, patients may require more than 3 months post-stroke to be ready to RTW, but data was only available at 3 months of follow-up time.
Loss of productivity accounts for a substantial proportion of the total cost of stroke to society. As the authors state, identifying and addressing potential systemic barriers to RTW and increasing availability of targeted vocational rehabilitation have the promise to reduce disparities and improve stroke outcomes.
