Preditores do retorno ao trabalho pós-acidente vascular encefálico em Belo Horizonte - Brasil

Abstract

The aims of this study were to estimate the proportion of individuals who return to a paid work and the predictors of return to work within six months, after a stroke in Brazil. A prospective observational study was carried out and the participants were recruited from four public hospitals, which have stroke units, of Belo Horizonte. Men or women aged 18 years were eligible to participate in the study if they had a clinical diagnosis of a recent (within 28 days) stroke, and undertook any type of paid work in the month before stroke. The outcome of interest, i.e., the dependent variable, was return to work, which was dichotomized in yes/no. The potential predictors included age (years), sex (men/women), schooling (low: none or primary only) or high ( secondary), marital status (married or not married), contribution to household income (main contributor: 50% of the household income or partial contributor: ( 50% of the household income), type of work (blue or white collar worker), depressive symptoms (depressed or not depressed), and independence (dependent or independent). Descriptive statistics and frequency analysis were used to characterize the sample and to estimate the rate of return to work. Independent t- tests or Chi-square tests were first used to identify univariate predictors of return to work depending on whether the predictor was continuous or dichotomous. The level of significance was set at p<0.10, to ensure that potential predictors were not excluded. In one year, 1,095 stroke survivors were screened. Of these, 142 were eligible and provided consent to be contacted at 3 months after their stroke. At three months, 16 participants were not contactable and 8 had died, leaving 118. Full data were available for 97 participants. Of the 118 participants who were contactable at 3 months, 45 (38%) had returned by 3 months, 52 (44%) had returned by 6 months, leaving 66 (56%) who had not returned to work. The univariate analysis revealed that making a large contribution to household income (odds ratio of 1,8; IC95% 1,1 a 3,9), being a white collar worker (odds ratio of 4,0; IC95% 1,8 a 8,57, being independent (odds ratio of 10,6; IC95% 2,9 a 38,3), and having no depression (odds ratio of 4,9; (IC95% 1,7 a 14,27). These findings demonstrated that the probability to return to work after a stroke is higher if the person is physically independente (MRS<3) at 3 months after the stroke, has a white collar job, has no depressive symptoms, and is the main provider to the household income.None of the demographic variables influenced return to work. In conclusion, the findings of the present study demonstrated that the rate of return to work was 38% at three months and 44% at six months after stroke. The level of Independence showed to be the most robust predictor for the return to paid work. Considering that this variable may be modifiable with early rehabilitation interventions, these findings could contribute to the design and implementation of health polices and guide clinical practice, in order to increase return to work. Future studies are needed to investigate whether increases in levels of Independence would result in higher return to work rates after stroke.