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

J Adv Nurs. 2021 Feb;77(2):653-663. doi: 10.1111/jan.14631. Epub 2020 Nov 19.


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 (β = -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.

目的: 综合汇总ICU康复者复工(RTW)的患病率和风险因素 设计: 系统评估和荟萃分析。 数据来源: 检索PUBMED、CINAHL、EMBASE和PsycINFO数据库自2000年至2020年2月期间的数据。 评估方法: 同行评审文章包含成年人ICU康复者和就业结果。两位研究员各自按照PRISMA方案对文章进行了评估。计算了复工后的合并就业率。采用了荟萃回归分析,评估残疾政策、暂时性因素以及ICU后复工之间的关系。 结果: 28份研究(N = 8,168)符合纳入标准。其中,所有研究都被评为‘低偏见风险’。通过荟萃分析,ICU复工率(95%CI)在3个月时为29% (0.20和0.42),4-6个月时为59%(0.50和0.70),7-12个月时为56%(0.50和0.62),13-24个月时为63%(0.54和0.72)、25-36个月时为58%(0.37和0.91)、37-48个月时为58%(0.42和0.81)以及49-60 个月时为44%(0.25和0.76)。时间和残疾政策支持是与ICU复工幸存者的比例有关的因素。通过荟萃回归,复工患者的比率每年上升20%(95% CI: 0.06和0.33)。然而,平均增长率每年下降4%(−0.07和 −0.1)。政策支持力度大的国家,其复工比率比政策支持力度小的国家高32%(0.08和0.24)。然而,在之后的几年中,政策支持力度大的国家,其额外个人复工比率有所降低(β = −0.060和CI: −0.1和−0.02)。 结论: ICU康复者失业是非常常见的事情。在为残疾工人提供较高支持政策的国家中,ICU住院3年后的复工比率较高。然而就3到5年以及之后的复工率而言,反而是政策支持力度低的国家就业情况比较可观。 影响: 医保政策对ICU康复者的复工率有一定影响。包括护士在内的医保提供者可作为公共提倡者,从而促进政策变更。.

Keywords: critical illness; employment; intensive care units; nursing; outcome measure; policy; return to work.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Critical Illness*
  • Employment*
  • Humans
  • Return to Work*
  • Survivors