Returning to Work after Stroke: Associations with Cognitive Performance, Motivation, Perceived Working Ability and Barriers


  • Katri Saar South Savo Social and Health Care and Authority, Suojelius Oy, Espoo
  • Asko Tolvanen Department of Psychology, University of Jyväskylä, Jyväskylä
  • Erja Poutiainen Rehabilitation Foundation, Helsinki, Finland
  • Tuija Aro Department of Psychology, University of Jyväskylä, Jyväskylä



stroke, return-to-work, cognitive performance, self-perceived working ability


Objective: To investigate post-stroke return-to-work and its associations with cognitive performance, motivation, perceived working ability, and self-perceived barriers to returning to work.
Design: Prospective cohort study of a clinical sample.
Subjects and methods: Participants were 77 stroke patients younger than age 69 years. Assessment included a cognitive screening method for stroke patients (CoMet), a questionnaire regarding work-related matters, and a question regarding motivation to return to work. A predictive model of return-to-work was built, and how participants managed in their working life was examined.
Results: Cognitive performance was significantly connected with returning to work. Three of the 5 individuals who dropped out of working life had cognitive dysfunction. Cognitive performance predicted 80% of those who had not returned and 37% of those who had returned by 6 months after the initial assessment. Self-perceived working ability and barriers predicted 64% of those who had not returned and 78% of those who had returned at the 12-month follow-up.
Conclusion: Cognitive performance seems to be a crucial predictor of return-to-work post-stroke, but individuals’ own evaluations of their working capabilities are also important.

Returning to work after stroke is important for stroke patients’ participation in society. This study investigated return-to-work among stroke patients and its association with cognitive skills, motivation, and patients’ self-perceived abilities and barriers concerning returning to work. Cognitive skills were connected to returning to work and predicted returning for a 6-month period. Patients’ self-perceived abilities and barriers predicted returning to work by 12 months after stroke. These findings indicate that cognitive skills have an important role in returning to working life after stroke, but patients’ own evaluations of their capabilities are also important. This study may provide information for better rehabilitation planning after stroke and help rehabilitation professionals to consider the patients’ views of their capabilities.


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Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life-years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197-2223. DOI: DOI:

Kersten P, Low JTS, Ashburn A, George SL, McLellan DL. The unmet needs of young people who have had a stroke: results of a national UK survey. Disabil Rehabil 2002; 24: 860-866. DOI:

Hall MJ, Levant S, DeFrances CJ. Hospitalization for stroke in U.S. hospitals, 1989-2009. 2012 NCHS Data Brief 2012 May; 95: 1-8.

Lawrence M. Young adults' experience of stroke: a qualitative review of the literature. Br J Nurs 2010; 19: 241-248. DOI:

Edwards JD, Kapoor A, Linkewich E, Swartz RH. Return to work after young stroke: a systematic review. Int J Stroke 2018; 13: 243-256.

Corr S, Wilmer S. Returning to work after a stroke: an important but neglected area. Br J Occup Ther 2003; 66: 186-192. DOI:

Alaszewski A, Alaszewski H, Potter J, Penhale P. Working after a stroke: survivors' experiences and perceptions of barriers to and facilitators of the return to paid employment. Disabil Rehabil 2007; 29: 1858-1869. DOI:

Kauranen T, Turunen K, Laari S, Mustanoja S, Baumann P, Poutiainen E. The severity of cognitive deficits predicts return to work after a first-ever ischaemic stroke. J Neurol Neurosurg Psychiatry 2013; 84: 316-321. DOI:

Vestling M, Tufvesson B, Iwarsson S. Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction. J Rehabil Med 2003; 35: 127-131. DOI:

Balasooriya-Smeekens C, Bateman A, Mant J, De Simoni A. Barriers and facilitators to staying in work after stroke: insight from an online forum. BMJ Open 2016; 6: e009974. DOI:

Scott SL, Burns SP, Schwartz J, Kovic, M. Returning to work after mild stroke. Arch Phys Med Rehabil 2019; 100: 379-383. DOI:

Aarnio K, Rodríguez-Pardo J, Siegerink B, Hardt J, Broman J, Tulkki L. et al. Return to work after ischemic stroke in young adults: a registry-based follow-up study. Neurol 2018; 91: 1909-e1917. DOI:

Glozier N, Hackett ML, Parag V, Anderson CS. The influence of psychiatric morbidity on return to paid work after stroke in younger adults. Stroke 2008; 39: 1526-1532. DOI:

Trygged S, Ahacic K, Kåreholt I. Income and education as predictors of return to working life among younger stroke patients. BMC Public Health 2011; 11: 1-9. DOI:

Varona JF, Bermejo F, Guerra, JM, Molina JA. Long-term prognosis of ischemic stroke in young adults. J Neurol 2004; 251: 507-1514. DOI:

Chang WH, Sohn MK, Lee J, Kim DY, Lee SG, Chin YI et al. Return to work after stroke: The Kosco study. J Rehabil Med 2016; 48: 273-279. DOI:

Tanaka H, Toyonaga T, Hashimoto H. Functional and occupational characteristics associated with very early return to work after stroke in Japan. Arch Phys Med Rehabil 2011; 92: 743-748. DOI:

Saeki S, Ogata H, Okubo T, Takahashi K, Hoshuyama T. Return to work after stroke. Stroke 1995; 26: 399-401. DOI:

Coole C, Radford K, Grant M, Terry J. Returning to work after stroke: perspectives of employer stakeholders, a qualitative study. J Occup Rehabil 2013; 23: 406-418. DOI:

Saar K, Nyrkkö H, Tolvanen A, Kuikka P, Poutiainen E, Aro T. Validation of a new cognitive screening method for stroke patients. Behav Neurol 2019: 2943603. DOI:

Tuomi K, Ilmarinen J, Jahkola A, Katajarinne L, Tulkki A. Work Ability Index. Helsinki: Työterveyslaitos; 1998.

Edwards JD, Kapoor A, Linkewich E, Swartz RH. Return to work after young stroke: a systematic review. Int J Stroke 2018; 13: 243-256. DOI:

Lindström B, Röding J, Sundelin G. Positive attitudes and preserved high level of motor performance are important factors for return to work in younger persons after stroke: a national survey. J Rehabil Med 2009; 41: 714-718. DOI:

Hackett ML, Glozier N, Jan S, Lindley R. Returning to paid employment after stroke: the Psychosocial Outcomes In StrokE (POISE) cohort study. PloS One 2012; 7: e41795. DOI:

Palstam A, Westerlind E, Persson H. Work-related predictors for return to work after stroke. Acta Neurol Scand 2019; 139: 382-388. DOI:

Hofgren C, Björkdahl A, Esbjörnsson E, Stibrant-Sunnerhagen K. Recovery after stroke: cognition, ADL function and return to work. Acta Neurol Scand 2007; 115: 73-80. DOI:

Wolfenden B, Grace M. Returning to work after stroke: a review. Int J Rehabil Res 2009; 32: 93-97. DOI:



How to Cite

Saar, K., Tolvanen, A., Poutiainen, E., & Aro, T. (2023). Returning to Work after Stroke: Associations with Cognitive Performance, Motivation, Perceived Working Ability and Barriers. Journal of Rehabilitation Medicine, 55, jrm00365.



Original Report