Kwok Gabriel Yi Ren, Yeong Nicole, Law Michelle, Kang Zi Lun, Achar Arjun, Lim Xin Yuan, Ng Megan B J, Teo Yao-Hao, Tan Sarah M L, Ho Jamie S Y, Marmin Maznah, Hassan Fadhlina, Chia Magdalene L J, Wong Lily Y H, Sia Ching-Hui, Sharma Vijay K, Yeo Leonard L L, Ahmad Aftab, Tan Benjamin Y Q
Barts and The London School of Medicine and Dentistry, Queen Mary University of London London UK.
Yong Loo Lin School of Medicine, National University of Singapore Singapore Singapore.
J Am Heart Assoc. 2025 Apr 15;14(8):e036427. doi: 10.1161/JAHA.124.036427. Epub 2025 Apr 3.
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.
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]).
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.
全球范围内，青年缺血性卒中的发病率呈上升趋势，重返工作岗位（RTW）是一项关键的康复目标。我们旨在评估青年缺血性卒中后RTW的总体比例及相关因素。
我们对2020年至2022年期间新加坡两家三级医院所有年龄在18至50岁的缺血性卒中患者进行了一项回顾性队列研究。我们评估了患者特征与3个月RTW状态之间的关联，并通过对2000年1月至2023年11月期间PubMed、Embase、Scopus和Cochrane数据库的系统评价和荟萃分析来补充这些发现。我们汇总了RTW和功能恢复（定义为90天改良Rankin量表评分为0 - 2）的比例，并使用随机效应模型对患者特征与RTW之间的关联进行荟萃分析。在这个多中心队列中，68.8%（249/362）的青年缺血性卒中患者重返工作岗位，而87.8%（318/362）实现了功能恢复。多变量逻辑回归显示，大动脉粥样硬化发病机制、糖尿病、入院时较高的美国国立卫生研究院卒中量表评分以及较高的90天改良Rankin量表评分的患者RTW的几率显著较低。对6项队列研究中的1914例患者进行的系统评价和荟萃分析发现，大动脉粥样硬化、糖尿病以及入院时美国国立卫生研究院卒中量表评分>15的患者RTW的几率显著较低。RTW的汇总比例为63.2%（984/1574 [95% CI，56.0 - 69.9]），功能恢复的比例为84.7%（719/846 [95% CI，81.1 - 87.8]）。
基线时患有大动脉粥样硬化、糖尿病且入院时美国国立卫生研究院卒中量表评分较高的患者RTW的可能性较小。虽然较低的90天改良Rankin量表评分与RTW显著相关，但许多实现功能恢复的患者并未RTW。有必要开展设计良好的队列研究来探讨这种差异。
