Factors associated with employment outcome after critical illness: Systematic review, meta-analysis, and meta-regression

Aims To synthesize data on prevalence and risk factors for return to work (RTW) in ICU survivors. Design Systematic review and meta-analysis. Data sources PUBMED, CINAHL, EMBASE and PsycINFO databases were searched from 2000-Feb 2020. Review methods Peer-reviewed articles that included adult ICU survivors and employment outcomes. Two investigators independently reviewed articles following the PRISMA protocol. Pooled prevalence for RTW was calculated. Meta-regression analyses were performed to assess the association between disability policies, temporal factors and RTW following ICU. Results Twenty-eight studies (N = 8,168) met the inclusion criteria. All studies were scored as 'low risk of bias'. Using meta-analysis, the proportion (95% CI) of RTW following ICU was 29% (0.20,0.42), 59% (0.50,0.70), 56% (0.50,0.62), 63% (0.54,0.72), 58% (0.37,0.91), 58% (0.42,0.81), and 44% (0.25,0.76) at 3, 4-6, 7-12, 13-24, 25-36, 37-48, and 49-60 months, respectively. Time and disability policy support are factors associated with the proportion of ICU survivors who RTW. Through meta-regression, there is a 20% increase (95% CI: 0.06, 0.33) in the proportion of individuals who RTW per year. However, the average rate of increase slows by 4% (-0.07, -0.1) per year. In countries with high support policies, the proportion of RTW is 32% higher compared with countries with low support policies (0.08, 0.24). However, as subsequent years pass, the additional proportion of individuals RTW in high support countries declines (beta = -0.06, CI: -0.1, -0.02). Conclusions Unemployment is common in ICU survivors. Countries with policies that give higher support for disabled workers have a higher RTW proportion to 3 years following ICU admission. However, from 3-5 years, there is a shift to countries with lower support policies having better employment outcomes. Impact Health care policies have an impact on RTW rate in survivors of ICU. Healthcare providers, including nurses, can function as public advocates to facilitate policy change.

Automated summary

This study synthesized data on the prevalence and risk factors for return to work in ICU survivors, finding that employment outcomes are influenced by disability policies and temporal factors. Countries with policies that provide higher support for disabled workers have higher return to work rates in the first 3 years following ICU admission, but from 3-5 years, countries with lower support policies have better employment outcomes.