Factors that facilitate and hinder the return to work after stroke: an overview of systematic reviews

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Giuseppe La Torre
Lorenza Lia
Federico Francavilla
Marta Chiappetta
Simone De Sio


return to work, stroke, systematic reviews, facilitating factors, hindering factors


Background: Stroke is one of the leading causes of death and disability in the industrialized world and a large part of stroke survivors is of working age. A very important goal for these people is to return to work after stroke as it facilitates independent living and guarantees a high level of self-esteem and life satisfaction. Aim: To find the main factors that facilitate and hinder the return to work (RTW) in people who suffered from stroke through an overview of systematic reviews. Methods: A systematic search using keywords and medical subject heading terms was conducted in January 2022, three electronic databases were searched: Medline (PubMed), Scopus and ISI Web. The articles that address the question of returning to work or maintaining employment of people of working age after stroke were included in the systematic review, as well as studies describing factors that facilitate and/or hinder RTW after stroke. Only systematic reviews written in English language were included in this overview. Results: The search revealed 180 records after removing duplicates, but only a total of 24 systematic reviews were included in the overview. This research shows that in people who have suffered from a stroke, individual abilities, socioeconomic factors, healthcare factors, and disabilities resulting from the stroke itself are the most critical factors influencing the RTW.  Conclusion: Future research should focus on cognitive disabilities, as main RTW hindering factor, and vocational rehabilitation, as the more suitable factor for improving the RTW in stroke survivors.


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1. Ketaki VM, Suvarna SG. Quality of Life in Patients with Stroke. J Yoga & Physio. 2017; 3(1): 555605
2. Ovbiagele B, Goldstein L, Higashida R, O et al. Forecasting the Future of Stroke in the United States: A Pol-icy Statement From the American Heart Association and American Stroke Association. Stroke. 2013; 44(8):2361-2375.
3. Rosi A, Limbucci N, Nappini S, et al. Terapia endovascolare dell’ictus ischemico acuto. G Ital Cardiol. 2019; 20(9 Suppl 1):50S-62S.
4. Ashley KD, Lee LT, Heaton K. Return to Work Among Stroke Survivors. Workplace Health & Safety. 2019; 67(2):87-94.
5. Di Meo C, Di Cioccio L. Il paziente con ictus cerebrale. Geriatria. 2010;22(3):79-86.
6. Belagaje SR. Stroke Rehabilitation. Continuum (Minneap Minn). 2017; 23(1):238–253.
7. Legg L, Langhorne P. Rehabilitation therapy services for stroke patients living at home: systematic review of randomised trials. Lancet. 2004; 363:352–355.
8. Donker-Cools BHPM, Daams JG, Wind H, Frings-Dresen MHW. Effective return-to-work interventions af-ter acquired brain injury: A systematic review. Brain Injury 2015;30(2):113-131.
9. Figueredo JM, García-Ael C, Gragnano A, Topa G. Well-Being at Work after Return to Work (RTW): A Sys-tematic Review. Int J Environ Res Public Health. 2020 Oct 15;17(20):7490.
10. Young AE, Roessler RT, Wasiak R, McPherson KM, van Poppel MN, Anema JR. A developmental concep-tualization of return to work. J Occup Rehabil. 2005 Dec;15(4):557-68.
11. Brannigan C, Galvin R, Walsh ME, et al. Barriers and facilitators associated with return to work after stroke: a qualitative meta-synthesis. Disability and Rehabilitation. 2016; 39(3):211-222.
12. Edwards JD, Kapoor A, Linkewich E, Swartz RH. Return to work after young stroke: A systematic review. International Journal of Stroke. 2017;13(3):243-256.
13. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic re-views and meta-analyses: The PRISMA statement. Int J Surg. 2010;8(5):336-41.
14. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007;7(1):10.
15. Liaset IF, Lorås H. Perceived factors in return to work after acquired brain injury: A qualitative me-ta-synthesis. Scand J Occup Ther. 2016;23(6):446-457.
16. Jellema S, van Hees S, Zajec J, van der Sande R, Nijhuis- van der Sanden MW, Steultjens EMJ. What envi-ronmental factors influence resumption of valued activities post stroke: a systematic review of qualitative and quantitative findings. Clin Rehabil. 2016; 31(7):936-947.
17. O’Keefe S, Stanley M, Adam K, Lannin NA. A Systematic Scoping Review of Work Interventions for Hospi-talised Adults with an Acquired Neurological Impairment. J Occup Rehabil. 2018;29(3):569-584.
18. Walsh ME, Galvin R, Loughnane C, Macey C, Horgan NF. Factors associated with community reintegration in the first year after stroke: a qualitative meta-synthesis. Disabil Rehabil. 2014;37(18):1599-1608.
19. Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and Functional Outcome After Aneurysmal Sub-arachnoid Hemorrhage. Stroke. 2010;41(8):e519-e536.
20. Ponchel A, Bombois S, Bordet R, Hénon H. Factors Associated with Poststroke Fatigue: A Systematic Re-view. Stroke Res Treat. 2015; 2015:1-11.
21. Dalemans RJP, De Witte LP, Wade DT, Van den Heuvel WJA. A description of social participation in work-ing‐age persons with aphasia: A review of the literature. Aphasiology. 2008; 22(10):1071-1091.
22. Turi E, Conley Y, Stanfill AG. A Literature Review of Psychosocial Comorbidities Related to Working Ca-pacity After Aneurysmal Subarachnoid Hemorrhage. J Neurosci Nurs. 2017;49(3):179-184.
23. Lawrence M. Young adults’ experience of stroke: a qualitative review of the literature. Br J Nurs. 2010;19(4):241-248.
24. Brouns R, Valenzuela Espinoza A, Goudman L, Moens M, Verlooy J. Interventions to promote work par-ticipation after ischaemic stroke: A systematic review. Clin Neurol Neurosurg. 2019;185:105458.
25. Daniel K, Wolfe CDA, Busch MA, McKevitt C. What Are the Social Consequences of Stroke for Work-ing-Aged Adults? Stroke. 2009;40(6):e431-e440.
26. Garrelfs SF, Donker-Cools BHPM, Wind H, Frings-Dresen MHW. Return-to-work in patients with ac-quired brain injury and psychiatric disorders as a comorbidity: A systematic review. Brain Injury. 2015;29(5):550-557.
27. Schwarz B, Claros-Salinas D, Streibelt M. Meta-Synthesis of Qualitative Research on Facilitators and Bar-riers of Return to Work After Stroke. J OccupRehabil. 2017;28(1):28-44.
28. Harris C. Return to Work After Stroke: A Nursing State of the Science. Stroke. 2014;45(9):e174-e176.
29. Wei X, Liu X, Fong KNK. Outcomes of return-to-work after stroke rehabilitation: A systematic review. Br J Occup Ther.2016;79(5):299-308.
30. Jellema S, van der Sande R, van Hees S, Zajec J, Steultjens EMJ, Nijhuis-van der Sanden MW. Role of Envi-ronmental Factors on Resuming Valued Activities Poststroke: A Systematic Review of Qualitative and Quantitative Findings. Arch Phys Med Rehabil. 2016; 97(6):991-1002.e1.
31. Donker-Cools BHPM, Wind H, Frings-Dresen MHW. Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury. Disabil Rehab. 2015;38(8):733-741.
32. Van Velzen JM, van Bennekom CAM, Edelaar MJA, Sluiter JK, Frings-Dresen MHW. Prognostic factors of return to work after acquired brain injury: A systematic review. Brain Injury. 2009;23(5):385-395.
33. Alves DE, Nilsen W, Fure SCR, et al. What characterises work and workplaces that retain their employees following acquired brain injury? Systematic review. Occupational and Environmental Medicine. 2020;77(2):122-130.
34. Wolfenden B, Grace M. Returning to work after stroke: a review. Int J Rehabil Res. 2009;32(2):93-97.
35. Baldwin C, Brusco NK. The Effect of Vocational Rehabilitation on Return-to-Work Rates Post Stroke: A Systematic Review. Top Stroke Rehabil . 2011;18(5):562-572.
36. Steenstra IA, Lee H, de Vroome EM, Busse JW, Hogg-Johnson SJ. Comparing current definitions of return to work: a measurement approach. J Occup Rehabil. 2012 Sep;22(3):394-400. Doi: 10.1007/s10926-011-9349-6. PMID: 22415602
37. La Torre G, Paoletti S, Petronzi F, Sestili C. L’uso del Disability Management in contesti internazionali: revisione sistematica di revisioni. G Ital Med Lav Ergon. 2021 Dec;43(4):357-368.
38. Tanzi C, Moderato L, Magnani F, et al. Cardiopulmonary exercise testing for personalized job reintegra-tion after acute cardiovascular attacks: a pilot cross-sectional study. Med Lav. 2020 Apr 30;111(2):107-115.
39. Donker-Cools BHPM, Schouten MJE, Wind H, Frings-Dresen MHW. Return to work following acquired brain injury: the views of patients and employers. Disabil Rehabil. 2018 Jan;40(2):185-19.
40. Wickizer TM, Franklin G, Fulton-Kehoe D, et al. Improving quality, preventing disability and reducing costs in workers' compensation healthcare: a population-based intervention study. Med Care. 2011 Dec;49(12):1105-11.
41. Wickizer TM, Franklin GM, Fulton-Kehoe D. Innovations in Occupational Health Care Delivery Can Pre-vent Entry into Permanent Disability: 8-Year Follow-up of the Washington State Centers for Occupational Health and Education. Med Care. 2018 Dec;56(12):1018-1023.