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      Return to work after stroke: A Swedish nationwide registry‐based study

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          Abstract

          Objectives

          A substantial proportion of individuals with stroke are of working age. After stroke, it is important to return to work (RTW), both for the individual's satisfaction with life and economically for society. The current comprehensive, long‐term study aimed at investigating in what time period the RTW continues after stroke and what factors could predict RTW.

          Materials and methods

          All individuals registered in the registry Riksstroke with stroke in Sweden at ages 18‐58 years during 2011 were eligible for participation. RTW was based on sickness absence data from the Social Insurance Agency covering 1 year prestroke to 5 years post‐stroke. Time to RTW was analyzed with Kaplan‐Meier curves. Potential predictors of RTW were analyzed with Cox regression and logistic regression.

          Results

          For RTW analyses, 1695 participants were included. Almost 50% RTW within 3 months, 70% within 1 year, and 80% within 2 years post‐stroke. However, the RTW continued for several years, with a total of 85% RTW. Predictors of favorable time to RTW were male sex, ischemic stroke, and long university education compared with primary school education. Predictors of unfavorable times to RTW were higher stroke severity, defined by the level of consciousness, and older ages. Participants with self‐expectations of RTW 1 year post‐stroke had higher odds of RTW within 5 years.

          Conclusions

          The RTW continues for a longer time after stroke than previously known. Both self‐expectations and demographical, socioeconomic, stroke‐related factors were important predictors of RTW. This knowledge could assist healthcare professionals to individualize the rehabilitation post‐stroke.

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          Most cited references21

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          Twenty-four-year trends in the incidence of ischemic stroke in Sweden from 1987 to 2010.

          The incidence of stroke in Sweden increased between 1989 and 2000 among people aged ≤65 years, but more recent data on those aged >65 years are lacking.
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            Long-Term Survival and Function After Stroke

            Background and Purpose- Longitudinal long-term prognostic data after stroke based on large cohorts are sparse. We report recent survival and functional outcome data on ischemic stroke (IS) and intracerebral hemorrhage (ICH) for up to 5 years poststroke from the Swedish Stroke Register (Riksstroke). Methods- Beyond Riksstroke's regular follow-up surveys at 3 and 12 months, additional surveys were conducted in 2016 on 2 one-year cohorts with stroke 3 and 5 years earlier. Functional dependency was defined as modified Rankin Scale ≥3. Mortality data of the original cohorts were obtained from the Swedish Causes of Death Register. Multiple imputation was used to estimate functional status in nonresponders. Results- The study included 22 929 patients, 87.5% with IS and 12.5% with ICH. Loss to follow-up in the 4 surveys was 12.8% to 21.2%. Thirty-day mortality was higher for ICH than for IS (30.7% versus 11.1%; P<0.01), whereas for 30-day survivors, 5-year mortality did not differ significantly ( P=0.858). Functional outcome was less favorable for ICH at all follow-up points. At 5 years, poor outcome (death or dependency) was 79% in ICH and 70.6% in IS (including imputed data; P<0.01). Favorable outcome was less common with increasing age and in patients with prestroke functional dependency. Conclusions- Despite advances in stroke care, long-term prognosis remains a cause for concern. At 5 years after stroke over 2 in 3 patients with IS, and over 3 in 4 patients with ICH, were dead or dependent. We present robust long-term prognostic data to serve as a reference for further development of healthcare and research in stroke.
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              Return to work after young stroke: A systematic review

              Background The incidence of stroke in young adults is increasing. While many young survivors are able to achieve a good physical recovery, subtle dysfunction in other domains, such as cognition, often persists, and could affect return to work. However, reported estimates of return to work and factors affecting vocational outcome post-stroke vary greatly. Aims The aims of this systematic review were to determine the frequency of return to work at different time points after stroke and identify predictors of return to work. Summary of review Two electronic databases (Medline and Embase) were systematically searched for articles according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 6473 records were screened, 68 were assessed for eligibility, and 29 met all inclusion criteria (working-age adults with stroke, return to work evaluated as an outcome, follow-up duration reported, and publication within the past 20 years). Return to work increased with time, with median frequency increasing from 41% between 0 and 6 months, 53% at 1 year, 56% at 1.5 years to 66% between 2 and 4 years post-stroke. Greater independence in activities of daily living, fewer neurological deficits, and better cognitive ability were the most common predictors of return to work. Conclusion This review highlights the need to examine return to work in relation to time from stroke and assess cognition in working age and young stroke survivors. The full range of factors affecting return to work has not yet been explored and further evaluations of return to work interventions are warranted.
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                Author and article information

                Contributors
                emma.westerlind@neuro.gu.se
                Journal
                Acta Neurol Scand
                Acta Neurol. Scand
                10.1111/(ISSN)1600-0404
                ANE
                Acta Neurologica Scandinavica
                John Wiley and Sons Inc. (Hoboken )
                0001-6314
                1600-0404
                28 October 2019
                January 2020
                : 141
                : 1 ( doiID: 10.1111/ane.v141.1 )
                : 56-64
                Affiliations
                [ 1 ] Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
                [ 2 ] Department of Statistics USBE Umeå University Umeå Sweden
                [ 3 ] Department of Clinical Sciences Section of Neurology Lund University Skåne University Hospital Lund Sweden
                Author notes
                [*] [* ] Correspondence

                Emma Westerlind, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Rehabiliteringsmedicin, Per Dubbsgatan 14, 3 tr, 413 45 Gothenburg, Sweden.

                Email: emma.westerlind@ 123456neuro.gu.se

                Author information
                https://orcid.org/0000-0001-5410-4719
                https://orcid.org/0000-0001-8633-3292
                https://orcid.org/0000-0003-3298-1555
                https://orcid.org/0000-0002-5940-4400
                Article
                ANE13180
                10.1111/ane.13180
                6916554
                31659744
                aaa146ce-2037-41d0-9d07-00d87e3e9961
                © 2019 The Authors. Acta Neurologica Scandinavica John published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 14 July 2019
                : 03 October 2019
                : 10 October 2019
                Page count
                Figures: 3, Tables: 3, Pages: 9, Words: 6078
                Funding
                Funded by: Norrbacka‐Eugenia foundation , open-funder-registry 10.13039/501100004875;
                Funded by: Swedish Science Council
                Award ID: VR2017‐00946
                Funded by: Swedish Heart and Lung foundation
                Funded by: Promobilia , open-funder-registry 10.13039/100009389;
                Funded by: Sparbanksstiftelsen Färs & Frosta
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                January 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.3 mode:remove_FC converted:17.12.2019

                follow‐up study,rehabilitation,return to work,stroke
                follow‐up study, rehabilitation, return to work, stroke

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