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

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.