Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐Analysis
Background Ischemic stroke incidence in young adults is increasing globally, with return to work (RTW) a key rehabilitation goal. We aimed to assess the overall proportions of and factors associated with RTW following young adult ischemic stroke. Methods and Results We performed a retrospective coho...
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Wiley
2025-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.036427 |
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| author | Gabriel Yi Ren Kwok Nicole Yeong Michelle Law Zi Lun Kang Arjun Achar Xin Yuan Lim Megan B. J. Ng Yao‐Hao Teo Sarah M. L. Tan Jamie S. Y. Ho Maznah Marmin Fadhlina Hassan Magdalene L. J. Chia Lily Y. H. Wong Ching‐Hui Sia Vijay K. Sharma Leonard L. L. Yeo Aftab Ahmad Benjamin Y. Q. Tan |
| author_facet | Gabriel Yi Ren Kwok Nicole Yeong Michelle Law Zi Lun Kang Arjun Achar Xin Yuan Lim Megan B. J. Ng Yao‐Hao Teo Sarah M. L. Tan Jamie S. Y. Ho Maznah Marmin Fadhlina Hassan Magdalene L. J. Chia Lily Y. H. Wong Ching‐Hui Sia Vijay K. Sharma Leonard L. L. Yeo Aftab Ahmad Benjamin Y. Q. Tan |
| author_sort | Gabriel Yi Ren Kwok |
| collection | DOAJ |
| description | Background Ischemic stroke incidence in young adults is increasing globally, with return to work (RTW) a key rehabilitation goal. We aimed to assess the overall proportions of and factors associated with RTW following young adult ischemic stroke. Methods and Results We performed a retrospective cohort study of all patients with ischemic stroke aged 18 to 50 years at 2 tertiary hospitals in Singapore from 2020 to 2022. We evaluated associations between patient characteristics and 3‐month RTW status, augmenting these findings with a systematic review and meta‐analysis of PubMed, Embase, Scopus, and Cochrane databases from January 2000 to November 2023. We pooled proportions for RTW and functional recovery (defined as a 90‐day modified Rankin Scale score of 0–2) and meta‐analyzed associations between patient characteristics and RTW using random‐effects models. In this multicenter cohort, 68.8% (249/362) of young patients with ischemic stroke returned to work, while 87.8% (318/362) achieved functional recovery. Multivariable logistic regression showed that patients with large‐artery atherosclerosis pathogenesis, diabetes, higher admission National Institutes of Health Stroke Scale scores, and higher 90‐day modified Rankin Scale had significantly lower odds of RTW. The systematic review and meta‐analyses of 1914 patients across 6 cohort studies identified significantly lower odds of RTW in patients with large‐artery atherosclerosis, diabetes, and admission National Institutes of Health Stroke Scale SCORE >15. The pooled proportion of RTW was 63.2% (984/1574 [95% CI, 56.0–69.9]) and functional recovery 84.7% (719/846 [95% CI, 81.1–87.8]). Conclusions Patients with large‐artery atherosclerosis, diabetes, and higher admission National Institutes of Health Stroke Scale score at baseline are less likely to RTW. While lower 90‐day modified Rankin Scale is significantly associated with RTW, many patients achieving functional recovery do not RTW. Well‐designed cohort studies are warranted to explore this disparity. |
| format | Article |
| id | doaj-art-3340497b879d4bf983e092dda1e353a1 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-3340497b879d4bf983e092dda1e353a12025-08-20T03:47:40ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-04-0114810.1161/JAHA.124.036427Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐AnalysisGabriel Yi Ren Kwok0Nicole Yeong1Michelle Law2Zi Lun Kang3Arjun Achar4Xin Yuan Lim5Megan B. J. Ng6Yao‐Hao Teo7Sarah M. L. Tan8Jamie S. Y. Ho9Maznah Marmin10Fadhlina Hassan11Magdalene L. J. Chia12Lily Y. H. Wong13Ching‐Hui Sia14Vijay K. Sharma15Leonard L. L. Yeo16Aftab Ahmad17Benjamin Y. Q. Tan18Barts and The London School of Medicine and Dentistry, Queen Mary University of London London UKYong Loo Lin School of Medicine, National University of Singapore Singapore SingaporeYong Loo Lin School of Medicine, National University of Singapore Singapore SingaporeYong Loo Lin School of Medicine, National University of Singapore Singapore SingaporeSt George’s University of London London UKYong Loo Lin School of Medicine, National University of Singapore Singapore SingaporeDivision of Neurology, Department of Medicine National University Hospital Singapore SingaporeYong Loo Lin School of Medicine, National University of Singapore Singapore SingaporeDivision of Neurology, Department of Medicine National University Hospital Singapore SingaporeDivision of Neurology, Department of Medicine National University Hospital Singapore SingaporeDivision of Neurology, Department of Medicine Ng Teng Fong General Hospital Singapore SingaporeDivision of Neurology, Department of Medicine Ng Teng Fong General Hospital Singapore SingaporeDivision of Neurology, Department of Medicine Ng Teng Fong General Hospital Singapore SingaporeDivision of Neurology, Department of Medicine National University Hospital Singapore SingaporeYong Loo Lin School of Medicine, National University of Singapore Singapore SingaporeYong Loo Lin School of Medicine, National University of Singapore Singapore SingaporeYong Loo Lin School of Medicine, National University of Singapore Singapore SingaporeDivision of Neurology, Department of Medicine Ng Teng Fong General Hospital Singapore SingaporeYong Loo Lin School of Medicine, National University of Singapore Singapore SingaporeBackground Ischemic stroke incidence in young adults is increasing globally, with return to work (RTW) a key rehabilitation goal. We aimed to assess the overall proportions of and factors associated with RTW following young adult ischemic stroke. Methods and Results We performed a retrospective cohort study of all patients with ischemic stroke aged 18 to 50 years at 2 tertiary hospitals in Singapore from 2020 to 2022. We evaluated associations between patient characteristics and 3‐month RTW status, augmenting these findings with a systematic review and meta‐analysis of PubMed, Embase, Scopus, and Cochrane databases from January 2000 to November 2023. We pooled proportions for RTW and functional recovery (defined as a 90‐day modified Rankin Scale score of 0–2) and meta‐analyzed associations between patient characteristics and RTW using random‐effects models. In this multicenter cohort, 68.8% (249/362) of young patients with ischemic stroke returned to work, while 87.8% (318/362) achieved functional recovery. Multivariable logistic regression showed that patients with large‐artery atherosclerosis pathogenesis, diabetes, higher admission National Institutes of Health Stroke Scale scores, and higher 90‐day modified Rankin Scale had significantly lower odds of RTW. The systematic review and meta‐analyses of 1914 patients across 6 cohort studies identified significantly lower odds of RTW in patients with large‐artery atherosclerosis, diabetes, and admission National Institutes of Health Stroke Scale SCORE >15. The pooled proportion of RTW was 63.2% (984/1574 [95% CI, 56.0–69.9]) and functional recovery 84.7% (719/846 [95% CI, 81.1–87.8]). Conclusions Patients with large‐artery atherosclerosis, diabetes, and higher admission National Institutes of Health Stroke Scale score at baseline are less likely to RTW. While lower 90‐day modified Rankin Scale is significantly associated with RTW, many patients achieving functional recovery do not RTW. Well‐designed cohort studies are warranted to explore this disparity.https://www.ahajournals.org/doi/10.1161/JAHA.124.036427occupationprognosisstrokeworkyoung |
| spellingShingle | Gabriel Yi Ren Kwok Nicole Yeong Michelle Law Zi Lun Kang Arjun Achar Xin Yuan Lim Megan B. J. Ng Yao‐Hao Teo Sarah M. L. Tan Jamie S. Y. Ho Maznah Marmin Fadhlina Hassan Magdalene L. J. Chia Lily Y. H. Wong Ching‐Hui Sia Vijay K. Sharma Leonard L. L. Yeo Aftab Ahmad Benjamin Y. Q. Tan Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease occupation prognosis stroke work young |
| title | Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐Analysis |
| title_full | Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐Analysis |
| title_fullStr | Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐Analysis |
| title_full_unstemmed | Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐Analysis |
| title_short | Return to Work After Ischemic Stroke in Young Adults: A Multicenter Cohort Study, Systematic Review, and Meta‐Analysis |
| title_sort | return to work after ischemic stroke in young adults a multicenter cohort study systematic review and meta analysis |
| topic | occupation prognosis stroke work young |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036427 |
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