Chen Nicole Yun Ching, Dong YanHong, Kua Zaylea Zhong Jie
Changi General Hospital, Singapore, Singapore.
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Front Neurol. 2023 Aug 22;14:1145705. doi: 10.3389/fneur.2023.1145705. eCollection 2023.
Return-to-work is a key rehabilitation goal for many working aged stroke survivors, promoting an overall improvement of quality of life, social integration, and emotional wellbeing. Conversely, the failure to return-to-work contributes to a loss of identity, lowered self-esteem, social isolation, poorer quality of life and health outcomes. Return-to-work programmes have largely focused on physical and vocational rehabilitation, while neglecting to include mood and fatigue management. This is despite the knowledge that stroke results in changes in physical, cognitive, and emotional functioning, which all impact one's ability to return to work. The purpose of this systematic review is to conduct a comprehensive and up-to-date search of randomised controlled trials (RCTs) of return-to-work programmes after stroke. The focus is especially on examining components of mood and fatigue if they were included, and to also report on the screening tools used to measure mood and fatigue.
Searches were performed using 7 electronic databases for RCTs published in English from inception to 4 January 2023. A narrative synthesis of intervention design and outcomes was provided.
The search yielded 5 RCTs that satisfied the selection criteria ( = 626). Three studies included components of mood and fatigue management in the intervention, of which 2 studies found a higher percentage of subjects in the intervention group returning to work compared to those in the control group. The remaining 2 studies which did not include components of mood and fatigue management did not find any significant differences in return-to-work rates between the intervention and control groups. Screening tools to assess mood or fatigue were included in 3 studies.
Overall, the findings demonstrated that mood and fatigue are poorly addressed in rehabilitation programmes aimed at improving return-to-work after stroke, despite being a significant predictor of return-to-work. There is limited and inconsistent use of mood and fatigue screening tools. The findings were generally able to provide guidance and recommendations in the development of a stroke rehabilitation programme for return-to-work, highlighting the need to include components addressing and measuring psychological support and fatigue management.
重返工作岗位是许多工作年龄段中风幸存者的关键康复目标，有助于全面提高生活质量、促进社会融入并改善情绪健康。相反，未能重返工作岗位会导致身份丧失、自尊降低、社会孤立、生活质量下降以及健康状况不佳。重返工作岗位计划主要侧重于身体和职业康复，而忽视了情绪和疲劳管理。尽管人们知道中风会导致身体、认知和情绪功能发生变化，而这些都会影响一个人重返工作岗位的能力，但情况依然如此。本系统评价的目的是对中风后重返工作岗位计划的随机对照试验（RCT）进行全面且最新的检索。重点尤其在于检查是否纳入了情绪和疲劳相关组成部分，并报告用于测量情绪和疲劳的筛查工具。
使用7个电子数据库对从数据库建立至2023年1月4日以英文发表的随机对照试验进行检索。提供了干预设计和结果的叙述性综合分析。
检索产生了5项符合入选标准的随机对照试验（n = 626）。三项研究在干预措施中纳入了情绪和疲劳管理组成部分，其中两项研究发现干预组中重返工作岗位的受试者比例高于对照组。其余两项未纳入情绪和疲劳管理组成部分的研究未发现干预组和对照组在重返工作岗位率方面有任何显著差异。三项研究纳入了评估情绪或疲劳的筛查工具。
总体而言，研究结果表明，尽管情绪和疲劳是重返工作岗位的重要预测因素，但在旨在改善中风后重返工作岗位情况的康复计划中，对其关注不足。情绪和疲劳筛查工具的使用有限且不一致。这些研究结果通常能够为制定中风后重返工作岗位的康复计划提供指导和建议，强调需要纳入解决和测量心理支持及疲劳管理的组成部分。
