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Very early cognitive screening and return to work after stroke

Journal article
Authors Emma Westerlind
Tamar Abzhandadze
Lena Rafsten
Hanna C Persson
Katharina S Sunnerhagen
Published in Topics in Stroke Rehabilitation
ISSN 1074-9357
Publication year 2019
Published at University of Gothenburg Centre for person-centred care (GPCC)
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Language en
Links dx.doi.org/10.1080/10749357.2019.16...
Keywords Stroke, Return to work, cognition disorders, rehabilitation, young stroke, ischemic-stroke, impairment, prevalence, severity, trends, moca, age, Rehabilitation
Subject categories Neurology

Abstract

Background: Stroke is a common cause of long-term disability worldwide, and an increasing number of persons affected by stroke are of working age. In addition to physical impairments, a majority of patients reportedly suffer cognitive impairments after stroke. Reduced cognitive function may hinder poststroke return to work (RTW); however, most studies of this relationship have assessed cognitive function months after the stroke. Objectives: The current study aims to investigate the degree of post-stroke RTW, and whether very early cognitive function screening can predict RTW after a stroke. Methods: This study included 145 persons treated for stroke at 18-63 years of age at a large university hospital in Sweden between 2011 and 2016. Data were retrieved from the GOTVED database. Within 36-48 h after hospital admission, cognitive function was screened using the Montreal Cognitive Assessment (MoCA). Full and partial RTW were assessed based on the Swedish Social Insurance Agency's register. Logistic regression was performed to analyze the potential predictors of RTW at 6 months and 18 months. Results: Neither global cognitive function nor executive function at 36-48 h after stroke predicted any degree of RTW at 6 or 18 months. Male sex, lower stroke severity, and not being on sick leave prior to stroke were significant predictors of RTW. Conclusions: Screening for cognitive impairments at 36-48-h post stroke is apparently too early for predicting RTW, and thus cannot be the sole basis for discharge planning after stroke. Additional research is needed to further analyze cognitive function early after stroke and RTW.

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