与病危后的就业结果有关的因素:系统评估、荟萃分析以及荟萃回归

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.