Job Characteristics Influence Return to Work after Ischemic Stroke
Background. Prior work has shown that few factors other than stroke severity predict return to work after ischemic stroke. Although job characteristics have been studied as determinants of return to work after myocardial infarction, there are few data on the relationship between these characteristics and return to work after stroke. Methods. A prospective study of return to work was conducted in patients with first ischemic stroke, ages 24–64, employed full-time outside of the home immediately prior to the stroke, and discharged to home or acute rehabilitation. At 6 weeks after stroke, the patients completed standardized questionnaires describing job characteristics, including the Job Content Questionnaire. At 6 and 12 months after stroke, time to return to work was determined by telephone interview. Statistical methods were univariate lifetables and a multivariate forward stepwise Cox regression model with Barthel Index, age, and the job characteristics as independent variables. Results. Of 150 stroke patients, 64% were male and 48% were African-American, with a mean age of 51. Patients employed at 12 months had significantly less demanding jobs (both physically and psychologically) and less job insecurity (all p < 0.05) and more decision authority, more job-related social support, more job satisfaction, and fewer job hazards (nonsignificant trends). The independent predictors from the Cox model, in order of entry, were psychological job demands, Barthel Index, job physical exertion, and job insecurity. Conclusion. Job characteristics were strong predictors of return to work after ischemic stroke in patients with mild to moderately severe stroke. Implications. Interventions in the work environment may have potential to promote reemployment after stroke.