University of Washington School of Nursing, Seattle, WA, USA.
Oregon Health & Science University, Portland, OR, USA.
J Adv Nurs. 2021 Feb;77(2):653-663. doi: 10.1111/jan.14631. Epub 2020 Nov 19.
To synthesize data on prevalence and risk factors for return to work (RTW) in ICU survivors.
Systematic review and meta-analysis.
PUBMED, CINAHL, EMBASE and PsycINFO databases were searched from 2000-Feb 2020.
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.
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).
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.
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.
综合 ICU 幸存者重返工作岗位（RTW）的患病率和危险因素数据。
系统评价和荟萃分析。
2000 年 2 月至 2020 年 2 月期间，检索了 PUBMED、CINAHL、EMBASE 和 PsycINFO 数据库。
纳入了包含成人 ICU 幸存者和就业结果的同行评审文章。两名调查员按照 PRISMA 方案独立审查文章。计算 RTW 的汇总患病率。进行了荟萃回归分析，以评估残疾政策、时间因素与 ICU 后 RTW 之间的关系。
28 项研究（N=8168）符合纳入标准。所有研究的偏倚风险评分均为“低”。采用荟萃分析，ICU 后 RTW 的比例（95%CI）分别为 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）和 44%（0.25，0.76），分别在 3、4-6、7-12、13-24、25-36、37-48 和 49-60 个月时。时间和残疾政策支持是与 ICU 幸存者 RTW 比例相关的因素。通过荟萃回归，每年 RTW 的人数比例增加 20%（95%CI：0.06，0.33）。然而，每年的增长率平均下降 4%（-0.07，-0.1）。在残疾工人支持政策较高的国家，RTW 的比例比支持政策较低的国家高 32%（0.08，0.24）。然而，随着后续年份的推移，高支持国家 RTW 的人数比例呈下降趋势（β=-0.06，CI：-0.1，-0.02）。
失业在 ICU 幸存者中很常见。残疾工人支持政策较高的国家 ICU 入院后 RTW 比例较高，但从 3 年到 5 年，支持政策较低的国家就业结果更好。
医疗保健政策对 ICU 幸存者的 RTW 率有影响。医疗保健提供者，包括护士，可以作为公众代言人，促进政策的改变。
