One in four stroke patients who recover does not return to work: Singapore study

SINGAPORE – While more than 80 per cent of stroke patients here between the ages of 18 and 50 were able to return to performing daily activities without assistance, as many as one in four who recovered did not return to work, a study has found.

This points to an unmet need in stroke rehabilitation, said the researchers from the National University Health System (NUHS), noting that unemployment could lead to financial difficulties for patients.

Published in the Journal of the American Heart Association in April 2025, the study found that even though 87.8 per cent of 362 stroke patients were able to achieve good functional recovery, only 68.8 per cent returned to work.

This is similar to global trends, with the study – which also looked at more than 1,500 stroke patients under 50 from five other countries, including Malaysia, Finland and Spain – finding that only 63 per cent return to work despite almost 85 per cent recovering well.

A separate study by the same researchers found that signs of early cognitive impairment indicated which patients would not return to work.

The second study – which looked at a subset of the local stroke patients from the first study, assessed within 72 hours of admission to a hospital – was published in the Journal of Neurological Sciences in January 2026.

It found that those who scored higher on the Montreal Cognitive Assessment (MoCA), commonly used to test for dementia and mild cognitive impairment, were more likely to return to work.

This points to the need for early psycho-cognitive screening as part of an array of interventions to help younger stroke patients return to work, the researchers said.

The number of stroke cases increased from 6,100 in 2011 to more than 9,600 in 2021, according to the Singapore Stroke Registry Annual Report 2021.

The data showed that more people in their 30s and 40s suffered strokes, with a 48 per cent increase among those between the ages of 30 and 39 during that period.

Returning to work matters for younger patients as they derive a sense of purpose from being able to contribute to their families and society, said Adjunct Assistant Professor Benjamin Tan, a consultant with the neurology division of the National University Hospital’s (NUH) department of medicine.

Prof Tan, who led the research, said physical recovery alone is not enough to determine whether a patient is ready to return to work.

“Cognitive and psychological barriers are often less visible and not easily assessed, and should be systematically assessed in post-stroke patients,” he added.

NUHS aims to identify patients who may have difficulty returning to work, he said.

At NUH, one of the hospitals under the public healthcare cluster, the Early Supported Discharge (ESD) programme allows suitable stroke patients who are medically fit and have adequate home support to be discharged early and continue their rehabilitation at home.

This allows patients to regain their independence and more easily reintegrate into their routines, said Ms Wan Zhi Ying, a senior physiotherapist with NUH’s rehabilitation department.

Since its launch in 2007, the programme has benefited over 1,350 patients.

Between 2020 and 2025, more than 65 per cent of those who were employed before their stroke were able to return to the same job, or a modified version of it, after going through the programme.

In 2021, the hospital also introduced the Return to Work clinic, led by a multi-disciplinary team made up of neurologists, rehabilitation physicians and occupational therapists, among others.

Among those who benefited from the clinic was paramedic Nur Azhar Hanafiah, who suffered a stroke while attending to a patient at the site of an accident in June 2025.

The 33-year-old recalled that he realised he was experiencing stroke symptoms as he lost strength in his right hand and leg.

Though depressed by his situation, Mr Azhar was determined to recover as he was the sole breadwinner for his household, which comprises his father, who had stopped working after a heart attack several years ago, and his grandmother.

“I told myself that I have to recover quickly and get discharged,” he said, noting that he underwent daily physiotherapy for a month while warded, and subsequently weekly sessions after being discharged.

In light of his recovery progress, his employer allowed him to return to work in an administrative capacity in September, and Mr Azhar returned to on-the-ground paramedic work by end-2025.

Another stroke patient, 54-year-old senior assistant engineer Chen Chye Song, who went through the ESD programme after suffering a stroke in December 2024, noted that his employer made accommodations for him after he returned to work, such as relocating his workspace to the first floor of the Tuas facility.

Supportive employers can play an important role in ensuring stroke survivors can return to work, the researchers said.

“We encourage the patients to discuss with their employers (about returning to work), if required, and our therapists also engage employers and ask about those possibilities,” said Adjunct Assistant Professor Aftab Ahmad, who heads the neurology division at Ng Teng Fong General Hospital.