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Impaired Work Productivity After Aneurysmal Subarachnoid Hemorrhage

Crago, Elizabeth A.; Price, Thomas J.; Bender, Catherine M.; Ren, Dianxu; Poloyac, Samuel M.; Sherwood, Paula R.

Journal of Neuroscience Nursing: October 2016 - Volume 48 - Issue 5 - p 260–268
doi: 10.1097/JNN.0000000000000209

ABSTRACT Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a sudden debilitating condition affecting individuals during the most productive times of their lives. Treatment advances have reduced mortality rates but increased the number of survivors facing deficits in physical and neuropsychological function. Objective: This study examined associations between neuropsychological function and work productivity after aSAH. Methods: Fifty-two patients with aSAH, employed before hemorrhage, were recruited from an ongoing National Institutes of Health study. Work Limitations Questionnaire (WLQ), neuropsychological tests (executive function, psychomotor speed, attention and mental flexibility, memory), and Patient Assessment of Own Function were completed at 3 and 12 months after aSAH. Results: Subjects in this analysis reported some level of difficulty in work productivity at 3 and 12 months (35% and 30%, respectively) after hemorrhage. Lower WLQ scores in time management and mental/interpersonal subscales were associated with poorer performance in psychomotor function (r = .5, p = .04 and r = .42, p = .09). Poorer mental flexibility and working memory correlated with time management difficulty at 3 months (r = −.4, p = .09 and r = .54, p = .02). Patients performing poorly on story recall tests were more likely to report difficulty with job physical performance (r = −.42, p = .09) and completing work effectively (r = .61, p = .009). Poorer working memory performance was associated with lower scores on mental/interpersonal WLQ subscales (r = .45, p = .05) and overall health-related work productivity loss (r = .47, p = .04). WLQ areas also correlated with participants’ perception of their neuropsychological function after aSAH. Conclusions: These results suggest that neuropsychological deficits impact work quality after hemorrhage and provide strong impetus for future studies so that domain-specific interventions can be implemented to improve outcomes that affect quality of life including work productivity.

Thomas J. Price, BS, former graduate student, School of Nursing, University of Pittsburgh, Pittsburgh, PA; and medical student, Virginia Commonwealth School of Osteopathic Medicine, Greenville, SC.

Catherine M. Bender, RN PhD, FAAN, Professor and Director of PhD program, School of Nursing, University of Pittsburgh, Pittsburgh, PA.

Dianxu Ren, PhD, Associate Professor, School of Nursing, University of Pittsburgh, Pittsburgh, PA.

Samuel M. Poloyac, PharmD PhD, Professor and Associate Dean of Graduate Studies, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA.

Paula R. Sherwood, RN PhD, FAAN, Professor, School of Nursing, University of Pittsburgh, Pittsburgh, PA.

Questions or comments about this article may be directed to Elizabeth A. Crago, RN PhD, at She is an Assistant Professor, Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA.

Work was performed at the University of Pittsburgh School of Nursing and University of Pittsburgh Medical Center Presbyterian.

Financial support: NIH-NINR R01NR004339

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this article.

© 2016 American Association of Neuroscience Nurses