Fatores determinantes para o retorno ao trabalho em indivíduos pós-acidente vascular encefálico residentes em Fortaleza

Abstract

Stroke is the leading cause of death and disability in adults in Brazil. Stroke incidence in younger people, who are professionally active, is increasing. This has direct impact on individuals’ lives, including their capacities to return to a paid work. This study aimed at estimating the rate to return to a paid work six months and one year after the stroke and investigating which factors could predict this return, considering the following variables: Independence, type of work, depression, cognition, and contribution to the household income. A prospective, observational study was carried-out and the participants were recruited from one private and two public hospitals, which are reference for the treatment of stroke patients in Fortaleza, Ceará. The sample consisted of 108 patients of both sexes, who had a recent diagnosis (up to 28 days) of ischemic or hemorrhagic stroke and ages between 18 and 65 years. Data were collected by interviews and information from the medical records. Assessments were carried-out in four moments: initially within 28 days (at the hospital), and by telephone after three, six, and twelve months after the stroke. Data collection included sociodemographic, and clinical data and the application of the following scales: modified Ranking scale (mRS), Hospital Anxiety and Depression Scale (HADS), and the Brazilian version for telephone application of the Minimental State Examination (Braztel-MMSE). The outcome of interest was return to work, which was dichotomized in yes/no. Bivariate analyses, by means of chi-square test were used to investigate the following predictors: independence (mRS), type of work (white/blue collar), depression (HADS), cognition (BRAZTEL-MMSE), and contribution to household income. Then, a logistic regression analysis was performed to identify the variables that, together, could predict return to work (Odds ratios). All data were analyzed using the SPSS statistical software for windows (version 17.0). Of the 108 included participants, within 28 days 11 (10%) had returned to work, by three months 30 participants (27% from the total) and by six months 35 from the total returned to work (32%). By one year, out of the 78 participants who completed the follow-up, additional two (n=37) returned to work. Chi-square test identify statistical relevancy of independence at 28 days and white-collar job for return to work at 6 months, and, besides these, depression signs at 28 days for return to work at on year. Multiple regression analysis confirms only two factors as predictors of return to work at both six months and one year after the stroke, as follows: being independent (mRS<3) within 28 days after stroke predicted return to work by six months (OR 11.2; CI 4.1 to 30.8) and one-year follow-up (OR 11.5; CI 3.9 to 34.3) and having a white collar job predicted return to work by six-months (OR 4.2; CI 1.6 to 10.8) and one year (OR 9.5; CI 2.6 to 37.5). The return to work rate at six months of 32% was lower than that found in a previous study with similar objective in an economically more developed region of the country. Being independent at 28 days after the stroke and having white-collar job predicted return to a paid work both at six and 12 months, corroborating previous reported findings. Being able to predict return to work so early may be important for the planning and implementation of public health polices, especially in identifying modifiable factors. The rate of return to work at six months after stroke was 32%. Being independent 28 days after the stroke was the most powerful predictor of return to work by both six and 12 months after the stroke. Considering that this variable may be modified with rehabilitation interventions, these findings may contribute to guide clinical practice, so that interventions aimed at reducing disability after stroke should be considered and earlier implemented.