Study On Readiness And Maintenance For Return-to-work And Construction Of Predication Model Among Young And Middle-age Patients After Stroke

Objective1.To understand the facilitating and hindering factors of readiness and maintenance for return-to-work in young and middle-age patients after stroke.2.To investigate the status of readiness and maintenance for return-to-work and its associated factors of young and middle-age patients after stroke,construct prediction model among young and middle-age patients after stroke.MethodsAdopted a mixed research method combining qualitative research and quantitative research.The first part:Adopting semi-structured interview in qualitative research.Patients who met the inclusion and exclusion criteria in Qingdao were selected for semi-structured interviews.The interview data were summarized and refined by Coliazzi’s phenomenological procedure.The second part:The quantitative part was conducted in the form of questionnaire survey.A total sample of 475 patients were selected from two tertiary hospital in Qingdao,using convenience sampling method.The participants were investigated using“Self-made General information questionnaire”,“Readiness for Return-To-Work Scale”,“Stroke Stigma Scale”,“Medical Outcomes Study Social Support Scale”,“Stroke knowledge Questionnaire”,“Montreal Cognitive Assessment”,“Modified Barthel Index”.The data was analyzed by SPSS 25.0 software.Mean and standard deviation were used to describe measurement data and frequency and percentage were used to describe count data.Univariate analysis used the Chi-square test and Variance analysis.Logistic regression analysis was used to analyze the independent influencing factors of return-to-work readiness.Establish prediction model based on influencing factors selected according to Logistic regression analysis.Draw the receiver operating characteristic（ROC）curve to verify the predictive value of model and perform Hosmer-Lemeshow（H-L）chi square test to evaluate the model.Results1.Results of qualitative research:The driving factors:Comprehensive social support（positive family guidance,professional support,employer support,social recognition）,Knowledge of disease prevention and control（lifestyle improvement,risk factor control,condition monitoring）.The hindering factors:Stigma（labeling Self-perceived Discrimination,social isolation,physical disability shame）,Impaired body function（impaired cognitive function,restricted physical activity）.2.Results of Readiness for return-to-work:（1）The proportion of patients in’prepared for action-self evaluative’and’prepared for action-behavioral’was 77（46.6%）,which was in the stage of high preparation.（2）The protective factors of readiness for return-to-work in unreturned patients include receiving occupational rehabilitation treatment,nature of work,cognitive impairment,activities of daily living（ADL）,the number of chronic diseases,information and emotional support,and the risk factors of readiness for return-to-work in unreturned patients with social stigma,experience of discrimination and self-perceived stigma（P<0.05）.（3）The prediction model of unreturned patients is“Y=11X₁+22X₂-40X₃-9X₄+6X₅+X₆-2X₇-2X₈-X₉+3X₁₀+2X₁₁+2X₁₂+4X₁₃”(Y=Readiness for return-to-work of unreturned patient,X₁=nature of work,X₂=receive rehabilitation treatment,X₃=cognitive impairment,X₄=the number of chronic diseases,X₅=ADL,X₆=stroke knowledge level,X₇=physical disorder,X₈=social interaction,X₉=self-feeling,X₁₀=tangible support,X₁₁=informational and emotional support,X₁₂=affectionate support,X₁₃=spiritual support).The area under the ROC curve（AUC）was 0.965（95%CI:0.946-0.983）and 153 was the best critical value.Hosmer-Lemeshow test showed that the prediction model had good fitting degree（χ²=0.589,P>0.05）.3.Results of Maintenance for return-to-work:（1）There were 150 returned patients in active maintenance stage（64.10%）with high level of maintenance.（2）Gender,high education level,no multiple medication,no cognitive impairment,stroke knowledge level,information and emotional support,and mental support were protective factors of maintenance for return-to-work in returned patients.Social interactive cooperation support and physical disorder stigma were risk factors of maintenance for return-to-work in returned patients,and the difference was statistically significant（P<0.05）.（3）The prediction model of returned patients is“Y=11X₁+21X₂+57X₃-22X₄+X₅-X₆+3X₇+X₈”（Y=Maintenance for return-to-work of returned patient,X₁=educational level,X₂=gender,X₃=multiple medication,X₄=cognitive impairment,X₅=informational and emotional support,X₆=Social interactive cooperation support,X₇=spiritual support,X₈=stroke knowledge level）.The area under the ROC curve（AUC）was 0.749（95%CI:0.677-0.821）and 27 was the best critical value.Hosmer-Lemeshow test showed that the prediction model had good fitting degree（χ²=13.295,P>0.05）.ConclusionImproving the readiness and maintenance for return-to-work in young and middle-age survivors of stroke return to work is challenging.However,caregivers and clinical commissioners could play a central role.Meanwhile,patients were able to put forward concrete proposals to address the barriers identified.