# Factors associated with return to work in young and middle-aged stroke survivors: a prospective cohort study with a focus on psychological resilience

## TL;DR

This study identifies factors influencing return to work after stroke, emphasizing the role of psychological resilience in young and middle-aged survivors.

## Contribution

The study highlights psychological resilience as a novel independent predictor of return to work in stroke survivors.

## Key findings

- Higher psychological resilience and higher income increase the likelihood of returning to work.
- Older age and greater stroke severity reduce the chances of returning to work.
- A model including psychological factors outperforms traditional clinical models in predicting return to work.

## Abstract

Return to work (RTW) is a core indicator for evaluating social functional recovery in young and middle-aged stroke survivors, holding significant importance for individuals, families, and society. However, RTW is influenced by multiple factors, and its predictive models remain underdeveloped, particularly regarding the independent contribution of psychosocial factors such as psychological resilience.

To explore the multidimensional factors affecting RTW in young and middle-aged stroke survivors and to clarify the predictive value of psychological resilience.

This prospective cohort study enrolled 253 young and middle-aged stroke survivors (aged 18–59 years) from Fuyang People’s Hospital (January 2022–December 2024). Baseline assessments included demographic characteristics, clinical severity [National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS)], psychological resilience [10-item Connor-Davidson Resilience Scale (CD-RISC-10)], and physiological indicators. Return to work (RTW) status was assessed at 6 months post-stroke. Multivariable logistic regression identified independent factors associated with RTW, with results reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC).

At 6 months post-stroke, 131 participants (51.8%) had returned to work. In multivariable analysis, higher psychological resilience (aOR per 1-point increase: 1.149; 95% CI: 1.088–1.213; p < 0.001) and monthly income ≥8,000 CNY (aOR: 2.568; 95% CI: 1.376–4.793; p = 0.003) were independently associated with higher RTW likelihood, while older age (aOR per 1-year: 0.949; 95% CI: 0.917–0.982; p = 0.003) and higher NIHSS scores (aOR per 1-point: 0.818; 95% CI: 0.734–0.912; p < 0.001) were negatively associated. A comprehensive model incorporating clinical, socioeconomic, and psychological factors demonstrated excellent discrimination (AUC = 0.873; 95% CI: 0.830–0.916), significantly outperforming models containing only clinical (AUC = 0.781; p < 0.001) or clinical-socioeconomic (AUC = 0.826; p = 0.013) variables.

The RTW status of young and middle-aged stroke survivors is jointly influenced by multiple factors, including age, severity of neurological deficits, economic income, and psychological resilience. Psychological resilience is a key protective predictive factor independent of traditional variables. Clinical rehabilitation assessment and intervention should integrate the evaluation of psychosocial resources, and implement early interventions for individuals with low psychological resilience to optimize their socio-occupational rehabilitation outcomes.