Operational Definitions and Estimates of Return-to-Work after Stroke: A Systematic Review and Meta-Analysis

Publication date: Available online 24 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Patrick Duong, Katrine Sauvé-Schenk, Mary Y. Egan, Matthew J. Meyer, Tricia Morrison

ABSTRACT

Objective

To examine operational definitions of return-to-work (RTW) after stroke and provide more precise estimates of RTW through meta-analysis.

Data Sources

A systematic search was conducted using MEDLINE, CINAHL, PsycINFO, and SCOPUS (2005 to March 26, 2018). The search strategy involved expansion of medical subjective headings using terms related to 'stroke' and 'work'. The reference lists of review articles and included studies where checked for additional relevant studies.

Study Selection

Studies were included if they 1) quantitatively analyzed RTW outcomes or factors associated with RTW, 2) reported RTW outcomes for participants employed prior to stroke, and 3) were written in English or French. Two reviewers independently screened titles and abstracts. Of 7265 articles initially identified, 55 studies were included.

Data Extraction

Data was extracted and study quality was assessed by one reviewer and verified by a second reviewer.

Data Synthesis

Explicit and implicit operational definitions of RTW were determined and categorized. Ranges of RTW estimates were presented for study and participant characteristics. Pooled summary estimates were calculated for comparable studies by follow-up time post-stroke: 55.7% at one year (95% CI, 51.3% to 60.0%) and 67.4% at two years (95% CI, 60.4% to 74.4%). Similar summary estimates were noted when only population-based studies were considered: 56.7% at one year (95% CI, 48.3% to 65.1%) and 66.7% at two years (95% CI, 60.2% to 73.2%).

Conclusions

Operational definitions varied across studies and were often not explicitly reported. To promote comparability of RTW outcomes in future studies, we recommend working towards a universal operational definition and consistent follow-up times. The more precise estimates calculated in this review could be used as benchmarks for healthcare and social service providers.

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