Return to work within a year after first stroke: blue and white collar workers comparison, predictors and causal mediation assessed during inpatient rehabilitation

Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact. 1) compare characteristics for individuals who before stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators. Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan–Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed. A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension. Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator. Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified.

当前多数研究聚焦于躯体功能与结构损伤，仅有相对较少的研究探讨其社会影响。本研究旨在达成以下4项目标：1）对比卒中前蓝领与白领劳动者的特征差异；2）明确出院后1年内与重返工作岗位相关的临床、功能及职业相关因素；3）识别康复出院时评估的特定日常生活活动（Activities of Daily Living, ADL）项目作为重返工作岗位的预测因子；4）探明重返工作岗位的因果中介变量。本研究为回顾性观察性队列研究，纳入2007年至2021年期间收入康复科的成年卒中患者，收集2008年至2022年间的基线巴塞尔指数（Barthel Index, BI）及重返工作岗位评估数据。分析采用Kaplan-Meier生存曲线及Cox比例风险模型，并通过1000次Bootstrap模拟开展因果中介分析。最终共纳入802名受试者，其中14.6%的受试者重返工作岗位，蓝领劳动者占比53.6%，白领劳动者占比46.4%。蓝领劳动者的缺血性卒中、糖尿病、血脂异常及高血压患病率显著更高。未重返工作岗位的受试者中，蓝领劳动者、优势侧脑受累、失语、巴塞尔指数评分更低以及住院时长（length of stay, LOS）更长的人群占比更高。多变量Cox比例风险分析显示，卒中发病年龄、失语、高血压及出院时总巴塞尔指数评分具有预测价值（C指数=0.74）。单变量Cox模型识别出3项与独立能力相关的巴塞尔指数独立项目：沐浴（C指数=0.58）、修饰（C指数=0.56）及进食（C指数=0.59）。巴塞尔指数改善效率（改善值/住院时长）为因果中介变量。蓝领劳动者的危险因素及共病患病率更高。本研究明确了若干新的影响因素、预测因子及重返工作岗位的中介变量。