Job Demands Sway Speed of Return to Work After Stroke

For immediate release: February 15, 2001

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FORT LAUDERDALE, Fla. -- Job characteristics may be a key determinant in how soon an individual returns to work after having a stroke, according to research presented on February 15, 2001 at the American Stroke Association's 26th International Stroke Conference. The American Stroke Association is a division of the American Heart Association.

It was the first study to examine job characteristics and compare them with the time stroke survivors take to return to work or whether they return at all.

"The type and characteristics of the job are very important in determining who will return to work," says lead researcher Marcella A. Wozniak, M.D., Ph.D., an associate professor of neurology at the University of Maryland School of Medicine in Baltimore.

"By understanding why some individuals do not return to work, we can develop programs to help more people get back to their jobs. Similarly, we can learn to identify those who will have great difficulty resuming work."

Researchers found that both the physical and mental demands of the job were important in predicting patients' return. Individuals who were back to work within 12 months had significantly less physically and psychologically demanding jobs. They felt their jobs were very secure, felt more job satisfaction and believed they had more authority to make decisions on the job.

"Survivors who felt their job was secure returned to work significantly sooner than those who felt they were at risk of losing their job," says Wozniak. "Those with authority to make decisions about their job and with supportive co-workers and employers also tended to return to work sooner."

The results are important in light of the aging of America's workforce. Wozniak notes that the risk of stroke increases dramatically with age, that the average age of workers is increasing, and that the Social Security Administration recently has changed its policies.

"They've increased the minimum retirement age to 67 for people born after 1959," says Wozniak. "For people born between 1934 and 1959, a sliding scale to determine retirement age is in place. Therefore, more people will be working at the time of stroke and, as more effective treatments are developed, more survivors will be facing the possibility of re-employment."

The study, conducted at the University of Maryland Medical Center, recruited patients who had their first ischemic stroke (a stroke due to blood-vessel blockage) between the ages of 24 and 64 and were employed full-time outside of the home. Of 150 patients, 64 percent were male and 48 percent were black. They were all able to go home or to a rehabilitation center immediately after their stroke.

Six weeks later, study participants completed standardized questionnaires that measured their perceptions of their jobs. These questionnaires have been used in other studies examining the association of heart disease and other illnesses with employment. Patients were asked to rate their agreement or disagreement with statements about their job such as: "My job is very hectic;" "I have a lot to say about what happens on my job;" "My prospects for career development and promotions are good;" and "I can take it easy and still get my work done."

Patients were phoned at six and 12 months after the stroke to determine when they returned to work.

"Our prior analysis and work by others had found that white-collar, more educated and wealthier patients were more likely to return to work," says Wozniak. "On one level, this seems obvious because blue-collar jobs are more likely to be physically demanding. On other levels, white-collar jobs would have more cognitive demands, and educated patients with higher-paying jobs would be more likely to have disability insurance and other financial resources to retire early. These factors should make it less likely for white-collar workers to return."

Other factors that may help employees make the decision to return to work could include their perceived ability to change or modify their job environment, their assessment of how easily they could be replaced at work, how likely they feel they are to lose the job, and their social support network at work.

"How the other factors play into what is clearly a complex relationship is mostly speculation right now," says Wozniak. "It is interesting that even in people who regain their independence in daily activities, only about 60 percent return to work."

The research team plans further study of this issue.

Other researchers are Melissa McCarthy, Ph.D.; Patricia Langenberg, Ph.D.; Thomas R. Price, M.D.; and Steven J. Kittner, M.D., M.P.H.

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