National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.
BMC Public Health. 2010 Oct 19;10:623. doi: 10.1186/1471-2458-10-623.
Successful return to work is regarded as one of the most important outcome factors for working-age post stroke patients. The present study will estimate the effect of various predictors on the odds of returning to work after stroke. Nearly twenty thousand 20-57 year-old stroke patients in Denmark who were gainfully occupied prior to the stroke will be included in the study.
METHODS/DESIGN: Stroke patients will be followed prospectively through national registers. Multi-level logistic regression will be used to model the odds of being gainfully occupied ca. two years after the stroke as a function of the following predictors: Age (20-49 years, 50-57 years) gender, occupational class, self-employment (yes; no), onset calendar year (1996, 1997, ..., 2006), diagnosis (subarachnoid haemorrhage; intracerebral haemorrhage; cerebral infarction; stroke, not specified as haemorrhage or infarction) and 'type of municipality' (the variable is set to 1 if the person lived in a municipality which had a brain injury rehabilitation centre at the time of the stroke. Otherwise it is set to 0). Municipalities will be treated as the subjects while individual observations within municipalities are treated as correlated repeated measurements.
Since our follow-up is done through registers and all people in the target population are included, the study is free from sampling bias, recall bias and non-response bias. The study is also strengthened by its size. The major weakness of the study is that it does not contain any stroke severity measures. Thus, it cannot accurately predict whether a particular stroke patient will in fact return to work. The study is, however, quite useful from a public health perspective. It can be used to estimate the proportion of patients in a certain group that is expected to return to work, and thereby provide a comparison material, which e.g. municipalities can use to evaluate their success in returning their stroke patients to work.
对于工作年龄段的卒中后患者而言，成功重返工作岗位被视为最重要的预后因素之一。本研究旨在评估各种预测因素对卒中后患者重返工作岗位的可能性的影响。丹麦将纳入近 2 万名年龄在 20-57 岁之间、卒中前有全职工作的卒中患者，对其进行前瞻性随访。
方法/设计：通过国家登记处对卒中患者进行前瞻性随访。多水平逻辑回归模型将用于分析卒中后约 2 年时患者是否有全职工作的可能性，其影响因素包括：年龄（20-49 岁、50-57 岁）、性别、职业阶层、个体经营（是；否）、发病年份（1996 年、1997 年、……、2006 年）、诊断（蛛网膜下腔出血；脑实质内出血；脑梗死；未特指为出血或梗死的卒中）和“类型的自治市”（如果患者居住的自治市在卒中发生时设有脑损伤康复中心，则将该变量设为 1；否则，将其设为 0）。将自治市视为研究对象，而将自治市内的个体观测值视为相关重复测量。
由于我们的随访是通过登记处进行的，且目标人群中的所有人都被纳入研究，因此该研究不存在抽样偏差、回忆偏差和无应答偏差。研究的规模也使研究结果更为可靠。本研究的主要弱点在于其不包含任何卒中严重程度的评估指标。因此，它无法准确预测特定的卒中患者是否会真正重返工作岗位。然而，从公共卫生的角度来看，本研究还是非常有用的。它可以用来估计特定人群中预计重返工作岗位的患者比例，从而为各自治市提供一个比较材料，使其能够评估自身使卒中患者重返工作岗位的成功程度。
