Copyright 2007 The Authors Journal compilation 2007 Blackwell Munksgaard
Acta Neurol Scand 2007: 115: 73–80 DOI: 10.1111/j.1600-0404.2006.00768.x
ACTA NEUROLOGICA SCANDINAVICA
Recovery after stroke: cognition, ADL function and return to work Hofgren C, Bjo¨rkdahl A, Esbjo¨rnsson E, Stibrant-Sunnerhagen K. Recovery after stroke: cognition, ADL function and return to work. Acta Neurol Scand 2007: 115: 73–80. 2007 The Authors Journal compilation 2007 Blackwell Munksgaard. Objectives – To examine the recovery of cognitive function, activities of daily living (ADL) ability and vocational situation after stroke. Materials and methods – Subjects below 65 years of age were included. Cognitive function and personal and instrumental ADL were assessed at discharge and at 1 year. Pre-stroke vocational situation was recorded at baseline and at 1 and 3 years after discharge. Results – Fifty-eight patients participated. During the first year after discharge, cognitive function and ADL ability improved. At 1 year after discharge, 83% still had cognitive dysfunction, 20% were dependent in ADL and few had returned to work. Only 20% returned to gainful employment 3 years later. Conclusions –There was a recovery of cognition and ADL function after stroke but few persons returned to work. Good neurological status was found to be a significant factor and recovery of cognitive function a near-significant factor for return to work.
Introduction
Stroke is one of the main causes of disability in the Western world. In Sweden, with nine million inhabitants, the incidence is about 30,000 per year (1), and about 20% are of working age. About half of the stroke survivors are discharged with disabling sequelae (2–4). However, the situation among younger persons in working ages suffering from a stroke is not well documented. Costs to society associated with stroke have not only to do with hospital expenditures and increased needs of social services (5, 6). Around 25% of the costs are caused by reduced production because of sick leave, early retirement and untimely death (7). Reduced cognitive function in stroke patients has been associated with reduced ability in daily life (8–10). Neglect has been reported to be associated with lower performance (11–14) but Pedersen et al. (15) found no negative prognostic influence on functional outcome. Only a few studies of good quality of return to work after stroke were found in a review article of Alexanderson et al. (16). Hindfelt and Nilsson (17)
C. Hofgren, A. Bjçrkdahl, E. Esbjçrnsson, K. StibrantSunnerhagen Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Gçteborg University, Gçteborg, Sweden
Key words: ADL; BNIS; cognition; FIM; return to work Caisa Hofgren, Institute of Clinical Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation, Guldhedsgatan 19, S-413 45 Gçteborg, Sweden Tel.: +46 31 342 32 67 Fax: +46 31 41 54 33 e-mail:
[email protected] Accepted for publication October 6, 2006
found return to work to be associated with low age, good activities of daily living (ADL) at discharge, white-collar work and right hemisphere damage (RHD). While a negative predictive factor for return to work was aphasia (18), there are reports that indicate that intensive rehabilitation of persons with aphasia can result in a return to work (19, 20). Good attentional ability, visuomotor speed and communicative ability have been found to be factors that enhance the possibility for a return to work (20). Two Swedish studies report that between 40% and 70% of stroke patients return to work (17, 21) and a French study found 73% at work after 2.5 years (22). The aims of this study were to: (i) describe the recovery of cognitive function and ADL during the first year after stroke in a population aged 18–65 years, (ii) examine the vocational status at 1 and 3 years after discharge and (iii) explore factors that could be associated with the vocational outcome after stroke: neurological deficits, general status of cognitive functions, presence of neglect and aphasia and level of dependency in ADL. 73
Hofgren et al. Materials and methods
The data were gathered during 1998–2001 at the Clinic of Rehabilitation Medicine at Sahlgrenska University Hospital, Go¨teborg, Sweden. All subjects aged
