Wilfried Schupp

Fachklinik Herzogenaurach, Friedrich-Alexander University Erlangen-Nuremberg, Germany

Title: Return to Work (RTW) after Stroke

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Biography

Wilfried Schupp, MD, Medical Head at Fachklinik Herzogenaurach, is working on neurorehabilitation since 1987 as approved neurologist, psychiatrist, physiatrist and geriatrist.  Since 1997 he became affiliated with Friedrich Alexander University Erlangen-Nuremberg as a lecturer and researcher. He has been appointed as a member of Advisory Boards and of Managing Groups at different legal and statutory Bavarian and German institutions and at  national scientific neurorehabilitation and social medicine societies. He had been a Delegate to the EAN Assembly from 2015 - 2018, and is still a member of EAN scientific panel Neurorehabilitation. His scientific work started with clinical approaches to neurorehabilitation problems in stroke, TBI, and others, even rare neuromuscular diseases. He published some important basic papers on organization and delivery of neurorehabilitation treatment and services in Germany.

Abstract

About 1/4 till 1/3 of stroke survivors worldwide stay in worklife. But only about 50% will return to work afterwards. In Germany, we had established a guideline „Stroke and RTW“ since 2012 together with the statutory Federal Pension Insurances Institutes (DRV), which is now to be revised.

The research on this topic has increased in industrialised and emerging countries. About 50 reviews and meta-analyses can be found in PubMed or EMBASE within the last ten years. They reflect prognostic indicators, medical or vocational rehabilitation measurements, structured qualitative interviews with stroke survivors or employers.

Age and gender have no prognostic power for RTW besides a small positive trend for men, nor do initial severity or localisation of stroke. Cognitive impairments and aphasia indicate poorer RTW chances than sensorimotor deficits. Fatigue and affective or behavioral disorders variably decrease RTW rates, The most evidenced prognostic factor is a high level of ADL scores (Barthel-Index or FIM) after a first stroke rehabilitation procedure. Case management can increase, length of sick leave after stroke decrease. Higher education and job level, an existing employment and bigger employers improve. Stroke survivors need motivation and adaptive power for RTW. The impact of specific vocational rehab remains unclear.

Based on these facts, after any initial stroke rehabilitation programme reimbursed by DRV a social medical prognostic experts‘ opinion must be given and case management for RTW will come under research in Germany.