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.

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.