Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 2;13(17):2198.
doi: 10.3390/healthcare13172198.

Predictors of Return to Work After Stroke in Hungary: A Mixed-Methods Economic and Clinical Data Analysis

Arie Arizandi Kurnianto  1 , Sándor Kovács  1 , Nagy Ágnes  1
Affiliations

Predictors of Return to Work After Stroke in Hungary: A Mixed-Methods Economic and Clinical Data Analysis

Arie Arizandi Kurnianto et al. Healthcare (Basel). .

Abstract

Background: Return to work (RTW) is a fundamental aspect of recovery after stroke, importantly, for workers of working age. Evidence indicates there is little known about the clinical and systematic predictors of RTW in Hungary. We aimed to determine the independent predictors of RTW for stroke survivors using aggregate hospital data and expert opinion.

Methods: A mixed-method study using aggregated national level administrative data from the Pulvita platform (the National Health Insurance Fund of Hungary) and expert interpretation from the physicians who treat stroke survivors. The data analyzed 13,572 inpatient records for stroke hospitalizations from 2015-2024 across Hungarian counties.

Results: Stroke severity, cognitive and psychological recovery, and presence of comorbidities were important clinical predictors of RTW. Rehabilitation intensity was greater for people aged 51-65 years, and work-age men appeared to have slightly better access to rehabilitation compared to work-aged women. Patients accessed more medical rehabilitation services than they did occupational or psychosocial services. Access to rehabilitation services may have varied geographically, with patients in counties such as Budapest and Pest having better access due to higher provider availability and cross-county patient movement. In addition, economic extrapolations from the literature on post-stroke care costs may have introduced bias in estimating annual social productivity losses, reported as EUR 19,953 per patient.

Conclusions: Clinical and economic factors both impact RTW potential among stroke survivors in Hungary. Although rehabilitation intensity can indicate likelihood of RTW, the lack of a national RTW program acts as a significant barrier to RTW for stroke survivors. This study suggests a need for integrated rehabilitation and RTW systems, with associated future research linking clinical, economic, and labor market status data to develop effective and efficient policy for stroke survivors.

Keywords: economic evaluation; occupational medicine; rehabilitation; return to work; stroke.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Framework of factors influencing return to work (RTW) after stroke based on a semi-structured interview.
Figure 2
Figure 2
Distribution of patients receiving rehabilitation by county in Hungary, 2015–2024.
Figure 3
Figure 3
Mapping the number of patients who received a rehabilitation plan after stroke, by county, in Hungary.
See this image and copyright information in PMC

References

    1. Budincevic H., Tiu C., Bereczki D., Kõrv J., Tsiskaridze A., Niederkorn K., Czlonkowska A., Demarin V. Management of Ischemic Stroke in Central and Eastern Europe. Int. J. Stroke. 2015;10:125–127. doi: 10.1111/ijs.12575. - DOI - PubMed
    1. Linfante I., Wakhloo A.K. Thrombus and Stroke. CRC Press; Boca Raton, FL, USA: 2008. Acute Ischemic Stroke: Paradigm for Treatment; pp. 167–202.
    1. Corbetta M., Connor L.T. Functional MRI: Applications in Clinical Neurology and Psychiatry. CRC Press; Boca Raton, FL, USA: 2006. Neurological Recovery after Stroke; pp. 137–155.
    1. Katan M., Luft A. Global Burden of Stroke. Semin. Neurol. 2018;38:208–211. doi: 10.1055/s-0038-1649503. - DOI - PubMed
    1. Lenti L., Brainin M., Titianova E., Morovic S., Demarin V., Kalvach P., Skoloudik D., Kobayashi A., Czlonkowska A., Muresanu D.F., et al. Stroke Care in Central Eastern Europe: Current Problems and Call for Action. Int. J. Stroke. 2013;8:365–371. doi: 10.1111/j.1747-4949.2012.00845.x. - DOI - PubMed

LinkOut - more resources