Determinants of return to work after a stroke: a systematic review and meta-analysis

To identify prognostic factors for return to work after stroke.PubMed, MEDLINE, Cochrane and Embase were systematically searched.Studies had to include people of working age (<65 years old) at the time of stroke (ischemic, haemorrhagic, or subarachnoid haemorrhage). The evaluation of return to work and rate of return to work had to be mentioned. Study selection was done by 2 independent authors. In total, 1241 articles were screened, 39 met all inclusion criteria.Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author. Quality was assessed using the Scottish Intercollegiate Guidelines Network quality assessment tool.Among the 39 studies, prognostic factors for return to work were haemorrhagic stroke (odds ratio 0.53 [95% confidence interval 0.45-0.60], n=18 studies), sex (male) (1.26 [1.14-1.40], n=31), aphasia (0.37 [0.20-0.69], n=7), occupation (white collar worker) (1.84 [1.64-2.06], n=17), independence in activities of daily living (3.99 [1.73-9.23], n=7) and stroke severity (NIHSS) (1.23 [1.08-1.39], n=6).This meta-analysis highlighted positive and negative prognostic factors associated with return to work after stroke. Two categories were distinguished: modifiable and non-modifiable prognostic factors. This study provides information to help understand the issues, set appropriate objectives and implement appropriate strategies to guide people to return to work after stroke. Randomized controlled studies are needed to better evaluate work-place intervention programs as well as the effects of intravenous thrombolysis, and cognitive and neuropsychological rehabilitation on return-to-work rates after stroke. Prospero no. CRD42020161848.