Return to work after critical illness: a systematic review and meta-analysis

Area of Science:

• Critical care medicine
• Occupational health
• Rehabilitation medicine

Background:

• Survivors of critical illness frequently experience adverse outcomes post-hospitalization, including prolonged delays in returning to work.
• These employment challenges have considerable economic repercussions for individuals and society.

Purpose of the Study:

• To systematically review and perform a meta-analysis on the rates and patterns of return to work among critical illness survivors.

Main Methods:

• A comprehensive search of major databases (PubMed, Embase, PsycINFO, CINAHL, Cochrane Library) was conducted for studies published from 1970 to February 2018.
• Data from 52 studies involving 10,015 previously employed critical illness survivors were extracted and analyzed using random-effects meta-regression.

Main Results:

• Pooled return to work prevalence was 36% by 1-3 months, 60% by 12 months, and 68% by 42-60 months post-discharge.
• No significant differences in return to work were found based on diagnosis (e.g., acute respiratory distress syndrome) or geographic region, but the mode of employment evaluation (in-person, telephone, mail) showed variations.
• Post-return to work, survivors often faced job loss (20-36%), occupation changes (17-66%), or worsened employment status (5-84%).

Conclusions:

• A substantial proportion of intensive care unit survivors remain unemployed long after hospital discharge.
• Survivors who return to work frequently encounter difficulties such as job loss or altered employment conditions.
• Developing and evaluating interventions is crucial to mitigate the significant burden of employment issues faced by critical illness survivors.