Relationship between executive functions and productivity outcomes following stroke

Abstract

Purpose. Stroke occurs in many individuals of working age and can considerably disrupt their capacity for employment and other productive activities. Few studies have examined the relationship between loss of productivity and cognitive impairment, particularly deficits in executive function. The present study examined whether performance on tests of executive function is related to employment and productivity at 12-months follow-up.

Method. Twenty-seven individuals (mean age = 47.3 years, SD = 10.7) on average 2.1 years (SD = 1.6) post-stroke were recruited from hospital and community rehabilitation services and administered a theory-driven battery of executive function tests (i.e. Health and Safety sub-test, FAS Test, Five-Point test, Key Search Test and Tinkertoy Test). A 12-month follow-up assessment of employment outcome (‘employed’ or ‘unemployed’) and productivity (measured by the Sydney Psychosocial Reintegration Scale) was conducted.

Results. A series of between-group comparisons identified that a measure of purposive behaviour and self-regulation (i.e. the Tinkertoy Test) best distinguished between the employed and unemployed groups (p < 0.01) irrespective of time since injury and neglect. Level of post-stroke productivity was significantly correlated with measures of planning (p < 0.05), self-monitoring (p < 0.01) and self-regulation (p < 0.05), as well as time since injury (p < 0.05) and functional status (p < 0.01).

Conclusions. These findings highlight the importance of routinely assessing executive functions to guide cognitive rehabilitation interventions following stroke.

Keywords:

• Stroke
• executive functions
• employment
• productivity