Predictive Factors for Return to Work After a First Stroke Treated at Clermont-Ferrand University Hospital in Puy de Dôme Between January 2020 and December 2024

Predictive Factors for Return to Work After a First Stroke Treated at Clermont-Ferrand University Hospital in Puy de Dôme Between January 2020 and December 2024

Stroke is a leading cause of acquired motor disability and the second most common cause of major cognitive impairment worldwide. In France, approximately 150,000 new cases occur annually, with around 31% affecting individuals of working age, making return to work (RTW) a critical public health issue. Beyond the medical burden, stroke has profound socio-economic consequences, including loss of productivity, prolonged sick leave, part-time resumption, and the need for workplace adaptations. While RTW after stroke has been investigated, major gaps remain. No standardized recommendations exist for vocational reintegration, and predictive factors are still debated. Quantitative determinants such as stroke type, severity, functional independence, and occupational characteristics have been identified, but qualitative aspects-including self-efficacy, perceived social burden, employer relationships, and motivation-are poorly documented. Moreover, cognitive deficits are often insufficiently characterized, as screening tools such as MMSE or MoCA lack the sensitivity of comprehensive neuropsychological assessments. The impact of revascularization procedures on RTW and the ability to sustain employment after initial resumption also remain unclear. Importantly, no recent data are available in the Auvergne region, despite evolving labor policies that may influence reintegration trajectories. This observational study therefore aims to identify both quantitative and qualitative predictors of RTW after ischemic or hemorrhagic stroke, describe vocational pathways in a regional cohort, and explore barriers and facilitators to long-term reintegration. Ultimately, the study seeks to provide updated evidence to guide tailored rehabilitation and socio-professional reintegration strategies, supporting sustainable RTW in working-age stroke survivors.

Inclusion Criteria:

• Patients who have suffered an ischaemic stroke according to ICD-10 (ICD-10 code: I63 (cerebral infarction) I64 (unspecified stroke), I69 (sequelae of cerebrovascular disease) or patients who have had a haemorrhagic stroke according to ICD-10 (ICD-10 code: I60, I61 and I62) between January 2020 and March 2024
• Patients of working age/under 64 years of age (legal retirement age)
• Patients with an employment contract at the time of the stroke
• Patients treated at Clermont-Ferrand University Hospital
• Post-stroke consultation recorded in the patient's medical file
• Patients affiliated with the social security system
• Patients who have not objected to participating in the study

Exclusion Criteria:

• Patients with a history of ischaemic or haemorrhagic stroke
• Patients with a history of head trauma with neurological sequelae corresponding to codes S060, S061, S062, S063, S065, S066, S067, S068 and S069
• Patients who died as a result of stroke
• Patients unable to respond to telephone questionnaires
• Patients under guardianship or trusteeship
• Patients who have suffered a transient ischaemic attack (TIA) (G459 according to ICD 10)
• Patients who were in early retirement at the time of assessment
• No information on employment after stroke in the medical file
• Patients with category 2 or 3 disability prior to stroke due to another condition
• Patients on sick leave prior to stroke due to another condition
• Patients receiving RSA income support