Certain young stroke survivors can’t get back to work despite recovery

Even as most young people survive ischaemic stroke and achieve functional recovery, only six out of 10 are able to resume work, as shown in a study from Singapore.

In a cohort of 562 acute ischaemic stroke survivors aged 18–50 years (mean age 45 years, 73.8 percent male, 47.0 percent Chinese), 87.8 percent regained their functional abilities, but only 68.8 percent returned to work. [J Am Heart Assoc 2025;14:e036427]

The odds of returning to work were significantly lower for participants with large-artery atherosclerosis (LAA) pathogenesis (odds ratio [OR], 0.38, 95 percent confidence interval [CI], 0.19–0.74; p=0.005), diabetes (OR, 0.49, 95 percent CI, 0.29–0.82; p=0.006), higher admission National Institutes of Health Stroke Scale (NIHSS) scores (OR, 0.74, 95 percent CI, 0.68–0.80; p<0.001), higher 90‐day modified Rankin Scale (OR, 0.28, 95 percent CI, 0.21–0.37; p<0.001), or Malay ethnicity (OR, 0.49, 95 percent CI, 0.25–0.96; p=0.035) in univariate analysis.

After adjustments for multiple covariates, male sex emerged as a significant positive predictor of return to work (adjusted OR, 2.09, 95 percent CI, 1.01–4.34; p=0.045). Meanwhile, LAA pathogenesis (adjusted OR, 0.38, 95 percent CI, 0.16–0.87; p=0.022) and higher NIHSS scores at admission (adjusted OR, 0.74, 95 percent CI, 0.68–0.80; p<0.001) remained negatively associated with the outcome.

Consistent results

A meta-analysis of six studies, including the local cohort study, showed consistent results. In the pooled population comprising 1,914 stroke survivors, 84.7 percent achieved functional recovery and 63.2 percent returned to work. In subgroup analysis by follow‐up time, the return-to-work rate was 65.0 percent for <2 years and 61.6 percent for >2 years.

In random effects meta-analysis using the DerSimonian–Laird approach, the odds of returning to work were lower among patients with diabetes (OR, 0.49, 95 percent CI, 0.35–0.71; p<0.001), those with LAA pathogenesis (OR, 0.26, 95 percent CI, 0.13–0.53; p<0.001), and those with admission NIHSS of >15 (OR, 0.13, 95 percent CI, 0.06–0.27; p<0.001).

Compared with the meta-analysis population, the Singapore cohort study population had higher prevalence of hypertension (51.2 percent vs 31.4 percent) and diabetes (21.4 percent vs 10.0 percent). The distribution of TOAST pathogeneses in the primary cohort and meta‐analysis were 18.1 percent vs 12.0 percent for LAA, 10.2 percent vs 21.1 percent for cardioembolism, and 29.6 percent vs 9.8 percent for small‐vessel disease, respectively.

Why returning to work matters

Taken together, the present data suggest that for people who had an ischaemic stroke, functional recovery does not guarantee return to work, according to the investigators.

“Only six in 10 patients meet the higher bar of physical, emotional, and cognitive function needed to return to their work or school, even in a reduced capacity. This … may be borne from various long‐term sequelae of ischaemic stroke including but not limited to fatigue, depression, and cognitive decline,” they said.

The investigators pointed out that the gap between functional recovery and return to work represents a significant barrier for poststroke rehabilitation and carries an important implication, considering the role work plays in the lives of this important and growing cohort of patients.

“Work forms a key pillar of patients’ well‐being, identity, and social participation within their communities. Due to their young age, unemployment translates into many more years of lost income, which can create financial difficulties for patients and their dependents. Work reduces the burden on social and medical services while being associated with greater social participation and better health outcomes overall,” they explained.

Understanding the rates and predictors of return-to-work outcomes can help clinicians identify and prioritize patients who are less likely to return to work after stroke, the investigators said.

“Further research is needed to better characterize the long‐term prognosis and recovery trajectories for young adult patients with stroke, allowing for better counselling and personalization of interventions. Such interventions could include cognitive rehabilitation, skills training education, workplace coaching, and/or supported employment,” they added.