Purpose

An increasing number of individuals with stroke are having difficulties in returning to work, having a significant impact on both individuals and society. The aims of this meta-analysis were to summarize the interventions to support the return to work (RTW) for individuals with stroke and to quantitatively evaluate the efficacy of each type of intervention.

Methods

A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched until 26 June 2023, and the list of references of the initially included articles was also searched. Two researchers independently performed the search, screening, selection, and data extraction. The primary outcome was RTW rate (the RTW rate was defined as the proportion of individuals who returned to work in each group (intervention and control) at the endpoint). Pooled risk ratio (RR) was estimated using a random-effects model with 95% confidence intervals (CIs).

Results

A total of 13 studies representing 4,282 individuals with stroke were included in our study. Results showed that physiological interventions could improve the RTW rate of individuals with stroke (RR: 1.19, 95% CI: 1.01 to 1.42, I² = 72%). And receiving intravenous thrombolytic therapy was beneficial in promoting the RTW in individuals with stroke. Subgroup analysis and meta-regression analysis showed that the individuals’ functional status during hospitalization was the only source of heterogeneity. Psychological interventions had little or no effect on the RTW rate of individuals with stroke (RR: 1.20, 95% CI: 0.58 to 2.51, I² = 30%). Work-related interventions had little or no effect on the RTW rate of the individuals with stroke (RR:1.36,95%CI: 0.99 to 1.88, I² = 73%). The subgroup analysis showed that country, age, and follow-up method were the sources of heterogeneity.

Conclusion

Physiological intervention promoted the RTW of individuals with stroke. But, the effect of psychological and work-related interventions in promoting the RTW of individuals with stroke was not significant. We anticipate that these findings may inform the design of future interventions. For future research, we recommend that more high-quality randomized controlled trials be conducted to further promote the RTW of individuals with stroke.

Systematic Review Registration: PROSPERO Registration Number, CRD42023443668.

中文翻译：

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支持中风患者重返工作岗位的干预措施：系统评价和荟萃分析

目的

越来越多的中风患者难以重返工作岗位，这对个人和社会都产生了重大影响。本荟萃分析的目的是总结支持中风患者重返工作岗位 (RTW) 的干预措施，并定量评估每种干预措施的效果。

方法

根据 PRISMA 指南进行系统评价和荟萃分析。 PubMed、Embase、Cochrane Library、CINAHL 和 PsycINFO 的检索截止日期为 2023 年 6 月 26 日，并且还检索了最初收录文章的参考文献列表。两名研究人员独立进行搜索、筛选、选择和数据提取。主要结局是 RTW 率（RTW 率定义为终点时每组（干预组和对照组）返回工作岗位的个体比例）。使用具有 95% 置信区间 (CI) 的随机效应模型估计合并风险比 (RR)。

结果

我们的研究共纳入了 13 项研究，涉及 4,282 名中风患者。结果显示，生理干预可以提高脑卒中个体的RTW率（RR：1.19，95％CI：1.01至1.42，I ²  = 72％）。接受静脉溶栓治疗有利于促进卒中患者的 RTW。亚组分析和荟萃回归分析表明，患者住院期间的功能状态是异质性的唯一来源。心理干预对卒中个体的 RTW 率影响很小或没有影响（RR：1.20，95% CI：0.58 至 2.51，I ²  = 30%）。与工作相关的干预措施对卒中个体的RTW率影响很小或没有影响（RR：1.36，95％CI：0.99至1.88，I ²  = 73％）。亚组分析显示国家、年龄和随访方法是异质性的来源。

结论

生理干预可促进中风患者的 RTW。但是，心理和工作相关干预措施对促进卒中患者 RTW 的效果并不显着。我们预计这些发现可能会为未来干预措施的设计提供信息。对于未来的研究，我们建议开展更多高质量的随机对照试验，以进一步促进脑卒中个体的RTW。

系统审查注册：PROSPERO 注册号，CRD42023443668。