Outcomes of return-to-work after stroke rehabilitation: A systematic review

Introduction: The purpose of this systematic review was to identify the outcomes of return-to-work for stroke survivors of working age after conventional stroke rehabilitation or vocational rehabilitation. Method: Searches were performed using three electronic databases for literature published in English in the 10-year period 2004-2014 which included a population of working age stroke survivors who had previously participated in conventional or vocational rehabilitation, and which presented the outcomes of return-to-work. Findings: The literature search yielded 10 studies that satisfied our selection criteria. Three studies involved vocational rehabilitation. Studies illustrated and compared the vocational status at or among different stages of 'pre-stroke', 'post-stroke and before rehabilitation discharge', 'rehabilitation discharge' and 'follow-up'. The employment rate at follow-up ranged from 7% to 81.1%. Conclusion: Methodological variations accounted for the wide range of return-to-work rates. There was limited evidence to support the conclusion that rehabilitation increases return-to-work rates for stroke survivors of working age, but recent studies showed that improvements in fatigue and cognitive function after stroke rehabilitation were related to good return-to-work outcomes. Either specialised vocational rehabilitation, conventional stroke rehabilitation or their combination is needed to increase return-to-work rates and improve the quality of life for stroke survivors of working age.