ArticleFrontiers in neurology
A clinically applicable nomogram predicting non-return to work in young and middle-aged patients with acute large vessel occlusion stroke: integrating neurological function and psychosocial factors for personalized rehabilitation.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: This study was designed to identify key predictors of non-return to work (non-RTW) in young and middle-aged patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO) after endovascular therapy (EVT). Based on these predictors, we developed and validated an individualized nomogram for non-RTW risk stratification to facilitate early identification of high-risk patients and guide personalized rehabilitation for better functional recovery and less occupational loss. Methods: In this retrospective cohort study, 350 consecutive AIS-LVO patients who underwent EVT at Dongguan Hospital of Traditional Chinese Medicine (July 2018-July 2025) were included. Potential predictors were selected using least absolute shrinkage and selection operator (LASSO) regression, and independent predictors were identified via multivariable logistic regression. A nomogram was constructed and assessed for discrimination using the area under the receiver operating characteristic curve (AUC), for calibration using calibration curves and the Hosmer-Lemeshow test, and for clinical utility via decision curve analysis (DCA). Results: Six independent predictors of non-RTW were identified: instrumental activities of daily living (IADL), admission NIHSS score, Nutritional Risk Screening 2002 (NRS-2002) score, balance impairment (as measured by the Berg Balance Scale, BBS), post-stroke rehabilitation (Rehab), and anxiety-depressive state (ADS). The nomogram demonstrated robust discriminative performance (AUC = 0.858, 95% CI: 0.812-0.903). Calibration curves confirmed favorable calibration between predicted and observed probabilities. Decision curve and clinical impact analyses revealed clinically meaningful net benefit across most threshold probabilities. Conclusion: We developed and validated a clinically actionable nomogram to predict non-RTW in young and middle-aged AIS-LVO patients after EVT. This tool enables early risk stratification and personalized rehabilitation planning, promoting long-term functional and vocational recovery.
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