interventions to promote work participation after...

___________________________________________________________

Interuniversitaire opleiding

Master in de verzekeringsgeneeskunde en de medische expertise

Eindverhandeling _________________________________________________________________________

INTERVENTIONS TO PROMOTE WORK PARTICIPATION AFTER ISCHAEMIC STROKE:

A SYSTEMATIC REVIEW

Raf BROUNS

Promotor: Prof. dr. Jan Verlooy _________________________________________________________________________

Academiejaar 2017-2018

TABLE OF CONTENTS

Summary ................................................................................................................................... 4

Part I – Main manuscript ........................................................................................................ 6

Abstract ................................................................................................................................ 10

Introduction .......................................................................................................................... 11

Objectives ............................................................................................................................. 11

Materials and methods ......................................................................................................... 12

Criteria for considering studies in for this review ......................................................................... 12

Search methods ............................................................................................................................ 13

Data collection and analysis .......................................................................................................... 13

Results .................................................................................................................................. 14

Discussion ............................................................................................................................ 17

Conclusions .......................................................................................................................... 19

Compliance with ethical standards ....................................................................................... 20

References ............................................................................................................................ 21

Tables ................................................................................................................................... 26

Table 1: Characteristics of included studies ................................................................................. 26

Table 2: Risk of bias in included studies ....................................................................................... 28

Figures .................................................................................................................................. 30

Figure 1: PRISMA study flow diagram ........................................................................................... 30

Part II – Supplementary materials ....................................................................................... 31

Supplement 1 – Study protocol ............................................................................................ 31

Aim of the protocol ....................................................................................................................... 31

Background ................................................................................................................................... 31

Objectives ..................................................................................................................................... 33

Methods ........................................................................................................................................ 34

Discussion ..................................................................................................................................... 38

Interventions to promote work participation after ischaemic stroke Raf Brouns

3

Supplement 2 – Overview of searches per database ............................................................ 39

1 PICO search terms ...................................................................................................................... 39

2 MEDLINE (via Pubmed) .............................................................................................................. 41

3 EMBASE ...................................................................................................................................... 44

4 Web of Science .......................................................................................................................... 46

5 SCOPUS ...................................................................................................................................... 47

6 Collaborative Review Group Register ........................................................................................ 49

7 Trial registers ............................................................................................................................. 51

8 Grey literature ............................................................................................................................ 53

Supplement 3 – Form for evaluation of records ................................................................... 55

Supplement 4 – Data extraction and assessment form ......................................................... 58

Supplemental Table 1 – Excluded studies ............................................................................ 62

Acknowledgements ................................................................................................................ 63

________________________________

SUMMARY _________________________________________


5

Professional reintegration after ischaemic stroke is a major societal problem as many patients fail to return to work despite excellent functional outcome. Those not resuming professional activities are denied the positive effects that the work environment may offer, and they are at increased risk of recurrent stroke or other cardiovascular events, depression and higher mortality rates.

Contrasting sharply with the plethora of studies evaluating prognostic variables for employment after stroke, only sparse data are available on the efficacy of interventions aiming to promote work participation in ischaemic stroke survivors.

This master thesis involves the first systematic review aiming to map available literature covering interventions to promote return-to-work in patients suffering from an ischaemic stroke. We implemented the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and searched five reference databases. Prospective trial registers and grey literature were also assessed and we executed backwards and forward reference searching. The study protocol was registered in PROSPERO (CRD42017077796).

The first part of the thesis consists of a scientific paper that was submitted for publication in the Journal of Occupational Rehabilitation (Q1 journal both in the domain of Rehabilitation and in the domain of Social issues) on March 6th 2018 and is currently undergoing peer review (JOOR-D-18-00036). The second part details the methodology (e.g. study protocol, forms for data extraction) and uncovers all search syntaxes and their results per database.

Despite an extensive search and the use of permissive selection criteria, only two relevant studies were retained in this systematic literature review: a controlled before-after study showed beneficial effects of intravenous thrombolytic treatment in patients with moderate to severe acute ischaemic stroke and retrospective study with low methodological quality reported improved vocational outcome of an outpatient rehabilitation program in patients with mild to moderate ischaemic stroke.

Though return-to-work is recognized as a pivotal individual and societal objective for ischaemic stroke survivors, there currently is insufficient evidence regarding the effectiveness of interventions to promote professional reintegration in this population.

Our findings are of value despite this disconcerting conclusion, as they demonstrate an important knowledge gap regarding a highly relevant societal issue. Clearly, this is of general interest and can be expected to be recognized as such by the scientific community. Yet more, these results may serve as a springboard to initiate new research on strategies to improve return-to-work after ischaemic stroke.

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PART I MAIN MANUSCRIPT

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7

INTERVENTIONS TO PROMOTE WORK

PARTICIPATION AFTER ISCHAEMIC STROKE:

A SYSTEMATIC REVIEW

Raf Brouns1,2 MD PhD, Alexis Valenzuela Espinoza3 MSc, Lisa Goudman4-6 MSc,

Maarten Moens1,4-7 MD PhD, Jan Verlooy8 MD PhD.

1. Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan

103, 1090 Brussels, Belgium

2. Department of Neurology, ZorgSaam Hospital, Wielingenlaan 2, 4535 PA Terneuzen,

Netherlands

3. Interuniversity Center for Health Economics Research (I-CHER), Vrije Universiteit

Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium

4. Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101,

1090 Brussels, Belgium

5. Department of Manual Therapy (MANU), Vrije Universiteit Brussel (VUB),

Laarbeeklaan 103, 1090 Brussels, Belgium

6. Pain in Motion International Research Group, www.paininmotion.be

7. Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090

Brussels, Belgium

8. Department of Epidemiology and Social Medicine (ESOC), Universiteit Antwerpen,

Universiteitsplein 1, 2610 Wilrijk, Belgium


8

Address of correspondence:

Raf Brouns

Laarbeeklaan 103, 1090 Brussels, Belgium

phone : +32 474 843010

e-mail: [email protected]

Running title Interventions to promote work participation after ischaemic

stroke

Word count main text 4976

Word count abstract 196

Character count title 88

Number of references 45

Tables and figures Table 1, 2; Figure 1

Supplementary materials Study protocol; Search syntaxes; Form for evaluation of

records; Data extraction and assessment form; Supplement

Table 1.

Keywords Ischaemic stroke; Brain infarction; Return to work;

Employment; Systematic review.


9

Individual contributions to the manuscript

Raf Brouns: literature search, review design, data collection, data analysis, data

interpretation, writing of the manuscript, critical review of the manuscript.

Alexis Valenzuela Espinoza: literature search, review design, data collection, data analysis,

data interpretation, critical review of the manuscript.

Lisa Goudman: literature search, review design, data collection, data analysis, data

interpretation, critical review of the manuscript.

Maarten Moens: literature search, review design, data analysis, data interpretation, critical

review of the manuscript.

Jan Verlooy: literature search, review design, data analysis, data interpretation, critical review

of the manuscript.


10

Abstract

Purpose – Only a disappointingly low proportion of patients successfully engage in

professional activities after ischaemic stroke. This systematic review maps all contemporary

evidence regarding interventions aiming to promote return-to-work in survivors of ischaemic

stroke.

Methods – We performed a search according to Preferred Reporting Items for Systematic

Review and Meta-Analyses guidelines and searched five reference databases. Prospective

trial registers and grey literature were also assessed and we executed backwards and forward

reference searching. The study protocol was registered in PROSPERO (CRD42017077796).

Results – The search yielded 444 records of which 174 were duplicates. Backward and

forward reference searching resulted in 808 unique records. Eleven articles were retained for

full-text analysis and two met the selection criteria. A controlled before-after study showed

beneficial effects of intravenous thrombolytic treatment in patients with moderate to severe

acute ischaemic stroke. A retrospective study with low methodological quality reported

improved vocational outcome of an outpatient rehabilitation program in patients with mild to

moderate ischaemic stroke.

Conclusions – There currently is insufficient evidence regarding the effectiveness of

interventions to promote return-to-work in patients with ischaemic stroke, though intravenous

thrombolytic therapy has shown beneficial effects and there are indications that rehabilitation

programs may also be advantageous.


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Introduction

Professional reintegration after ischaemic stroke is a major societal problem as many patients

fail to return to work despite excellent functional outcome [1-5]. Those not resuming

professional activities are denied the positive effects that the work environment may offer,

such as a social context, promotion of well-being and a sense of purpose and satisfaction

[6,7]. Moreover, they are at increased risk of recurrent stroke or other cardiovascular events

[8], depression and higher mortality rates [9].

The success rate of stroke survivors to return to work varies greatly (9 to 91%) [10,11] and it

may not be justified to amalgamate patients with cerebral ischaemia and those with

intracranial haemorrhage when assessing professional activity because their therapeutic

options and prognosis, including the probability to return-to-work, differ greatly [12-20].

Contrasting sharply with the plethora of studies evaluating prognostic variables for

employment after stroke [21-25], only sparse data are available on the efficacy of

interventions aiming to promote work participation in ischaemic stroke survivors. This

knowledge gap has been recognized by the US Department of Education, which already in

2008 has selected the enhancement of functional and employment outcomes of stroke patients

as her top research priority [26]. Along the same lines, internationally accepted guidelines on

stroke management recognize the lack of good quality evidence on interventions to promote

reemployment and advocate return-to-work as a quality indicator for stroke care [27,28].

Nevertheless, there is a large unmet need regarding possible strategies to assist ischaemic

stroke patients with their professional reintegration.

Objectives

This systematic review aims to identify and evaluate the effectiveness of any intervention

reported in the literature to promote return-to-work after ischaemic stroke.


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Materials and methods

Criteria for considering studies for this review

The review was conducted in accordance with the Preferred Reporting Items for Systematic

Review guidelines [29], as detailed in the protocol (Supplement 1).

As randomised controlled trials may not often be conducted in this context, the choice was

made to also accept controlled before-after studies, prospective cohort studies, time-series,

before-after comparisons without a concurrent control group, quality of care studies, and

comparison with arbitrary controls. The intervention could be compared to 'no intervention', a

sham intervention or to any other type of intervention aiming to support a return to

professional activities. Cross-sectional studies (i.e. surveys looking at the present situation

only), prognostic studies (evaluating prognostic factors only) and case reports were not

accepted.

Only studies reporting on patients aged 18 years or older who were diagnosed with ischaemic

stroke were eligible. Publications reporting on mixed populations containing patients

diagnosed with ischaemic stroke were also taken into account provided the results of patients

with ischaemic stroke could be distilled from the data or if patients with ischaemic stroke

composed the large majority of the study population (i.e. >80% of all patients).

Any intervention aiming to support a return to professional activities was taken into account.

An intervention is defined as any kind of active manipulation of the environment, behaviour

or disease with the intention to improve or promote health.

The primary outcome parameter was the proportion of participants who successfully returned

to work after ischaemic stroke. Various definitions of return-to-work can be found in the

literature [24]. According to international standards, returning to employment, unpaid labour,

leisure, unemployment or retirement are all regarded as a vocation [30]. This complete data

set was taken into account when available, with a return to competitive employment (paid


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work) as the key parameter [24,31,32]. Secondary outcomes could involve the time interval

between stroke onset and return to professional activities, the proportion of participants who

maintained professional activities over time, the time spent off work or being on sick leave,

or the score on a validated and standardized workability scale.

Search methods

We searched MEDLINE (PubMed interface), EMBASE, Web of Science, Scopus and the

Collaborative Review Group Register. The search for possibly relevant studies was based on

the publications' titles and abstracts. To maximize the output, we used dedicated controlled

vocabulary (MeSH for MEDLINE, EMTREE for EMBASE) and free words, including

applicable keywords, their synonyms, related terms and alternative spellings thereof. The

search syntaxis was translated for each interface (Supplement 2). The search included records

in English, French, German, Spanish and Dutch. There was no limitation regarding the date

of publication. Papers published online ahead of print were also considered.

We also consulted all relevant prospective trial registers (www.clinicaltrials.gov;

www.clinicaltrialsregister.eu; http://www.strokecenter.org/trials/; http://isrctn.com) and the

grey literature (www.opengrey.eu; https://www.ahrq.gov/). We screened the reference lists of

all relevant publications for additional papers (backward reference searching). Furthermore,

related publications were screened via exploration of all citing articles of relevant studies in

Web of Science and linkages via similar articles in MEDLINE (forward reference searching).

Data collection and analysis

For each search, we documented the type of database and interface, the date of the search, the

implemented search strategy and its results. All results were exported to Endnote (Thomson

Reuters Scientific, New York) in RIS format and deduplicated before being loaded into


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Rayyan software [33]. Review Manager 5.3 (Cochrane Collaboration) was used for

documentation of the review, data storage and analysis of the study results.

Three investigators used the Rayyan tool to independently assess the titles and abstracts of all

records identified in the searches against the inclusion and exclusion criteria. One reviewer

(RB) evaluated all records and each of the other two reviewers (AVE and LG) assessed half

of the records. To promote reliability among reviewers, collection of all pertinent information

was guided using the Form for evaluation of records (Supplement 3). Any conflicting

decisions regarding the selection of a record were resolved in discussion with a fourth

reviewer (MM). Full-text papers were acquired for all records that were deemed to be

relevant or where eligibility was unclear. All full-text papers were studied independently by

three investigators as described above and relevant data were recorded using the Data

extraction and assessment form (Supplement 4). Potential moderators and confounders of

study outcomes were assessed using the Risk Of Bias In Non-randomised Studies of

interventions tool [34].

Results

Figure 1 provides an overview of the literature search and recruitment process. The search

was executed on October 30th 2017 and yielded 444 potentially relevant records, of which

174 duplicates were removed. Based on screening of the titles and the abstracts, 259 records

were excluded because the population could not be identified as (mainly) consisting of

patients diagnosed with ischaemic stroke (n=66) and at least 18 years old (n=18). 189 studies

were excluded because they did not evaluate an intervention to promote return-to-work using

an appropriate study design and in 162 records, no relevant and well-defined outcome

parameter was reported. The inter-rater agreement was 96.2% and consensus was obtained

through discussion for the remaining records. Eleven articles met the selection criteria and


15

were retrieved for full-text evaluation. Backward and forward reference searching yielded

1123 records. After removal of 315 duplicates, 808 unique records were evaluated against the

selection criteria but none were retained for full-text evaluation. Two papers met the

predefined selection criteria for inclusion in this systematic review. Supplement Table 1 lists

the nine full-text articles that were not retained for review and the rationale therefor.

The characteristics of the included studies are detailed in Table 1. In terms of study design,

one prospective [32] and one retrospective study [31] were identified. There were no

randomised controlled trials, one controlled before-after study without randomisation [32]

and one before-after comparisons without concurrent control group [31]. The total number of

ischaemic stroke patients within the studies ranged from 172 to 276, with a total of 315

patients receiving an intervention to promote return-to-work. Both populations are

characterized by a male preponderance (>60%) and rather advanced age (mainly patients in

their fifties), yet differ substantially regarding the setting (outpatient vs. inpatient), stroke

severity, stroke latency, type of the intervention, and duration of follow-up. The

methodological quality of the study by Perna et al. is estimated to be low based on the

retrospective design, the absence of a comparator, the short duration of follow-up and the

high risk of bias. The study reported by Stefanovic et al. may have sufficient quality, though

caution is warranted given the lack of randomisation, restrictive patient selection criteria and

variability of follow-up duration. The risk of bias is assessed in Table 2. The overall risk of

bias is estimated to be high in the study by Perna et al. but low in the controlled before-after

study reported by Stefanovic et al. We did not undertake a meta-analysis given the

heterogeneity of the two identified reports regarding study design, setting, population, type of

intervention, duration of follow-up and methodological quality. In the absence of data, a

health economic evaluation was not executed either.


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The effect size of an outpatient program consisting of twice-weekly treatment for 3 months

including neuropsychological services, social work, physical therapy and speech therapy

depending on the participant's needs, is moderate for the key outcome parameter [31]. Out of

123 participants with competitive employment before ischaemic stroke, 39 were able to

return to this status (31.7%). Many others were active in modified jobs or as a homemaker,

volunteer or student. The proportion of inactive patients, however, increased from 19 to 48

for those in leisure and from 7 to 25 for nonproductive persons. The mean change in the

Mayo Portland Adaptive Inventory-4 from start to end of the program was 21 points,

corresponding with relevant improvement of disability for most patients. Yet the standard

deviation of 13 points suggests substantial variation between individuals.

Compared to controls, treatment with intravenous thrombolytics resulted in roughly a

doubling of the proportion of patients with moderate to severe ischaemic stroke who were

able to return to a full-time paid job (15.0% vs. 30.1%) [32]. The hazard ratio for returning to

a full-time job was 2.07 (95% confidence interval, 1.21-3.51) for those treated with

thrombolytics compared to patients not receiving this intervention. Using regression analysis,

intravenous thrombolysis was identified as an independent predictor for returning to a full-

time job. Notably, this effect was obtained without additional interventions and all patients

were able to maintain their professional activities. However, both in the intervention and the

control group, up to 44% of patients with excellent functional outcome failed to resume

professional activities. Patients not receiving thrombolytic therapy were more likely to

engage in part-time professional activities. The majority of patients returning to professional

activity were able to do so 3 to 12 months after the stroke.


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Discussion

This review is the first to systematically evaluate available literature covering interventions to

promote return-to-work in patients suffering from an ischaemic stroke. An extensive search

in five reference databases, multiple trail registers and grey literature using permissive

selection criteria yielded only two relevant studies. Perna et al report on a retrospective study

evaluating an outpatient program for patients with mild to moderate ischaemic stroke in the

previous 6 months, providing twice-weekly treatment for 3 months consisting of

neuropsychological services, social work, physical therapy and speech therapy [31]. This

intervention resulted in a return to competitive employment for about thirty percent of

patients after 3 months. However, these results require cautious interpretation given the low

methodological quality. The study by Stefanovic et al. is a prospective controlled before-after

study without randomisation evaluating the effect of intravenous thrombolytic therapy in

patients with moderate to severe acute ischaemic stroke [32]. Thirty percent of patients

receiving thrombolytic therapy returned to a full-time paid job, which was twice as high

compared to the patients not receiving this treatment.

The strengths of this systematic review are its execution by an independent, experienced

research team using the latest evidence and working on a prespecified protocol implementing

a robust methodology for data abstraction and quality appraisal. Further, the search strategy

did not restrict results by study design nor publication date. Non-English reports and

information were also taken from additional sources, among which grey literature search and

extensive forward and backward citation chasing.

Though not a weakness of the review methodology in se, only little relevant data covering

this domain are currently available in the literature. The significant methodological and

clinical heterogeneity of the included studies precludes quantitative analysis. The results are,

therefore, limited to a qualitative description with questionable generalisability to real-life


18

situations. Several studies were excluded from the analysis because they report on

epidemiologic data or predictive parameters regarding return-to-work, but not on the

evaluation of interventions to stimulate professional re-integration. The aggregated evaluation

of heterogeneous study populations or ambiguity regarding the stroke subtype without the

possibility to reliably extract data on ischaemic stroke patients was another frequent

exclusion criterion. It may not be excluded that some relevant information was lost in the

process. Also, it is not inconceivable that publications on the topic may be available in other

languages than English, French, German, Spanish or Dutch. Yet, it is implausible that the

number of studies reported in these languages would suffice to allow firm conclusion

drawing.

Except for the Psychosocial Outcomes In StrokE (POISE) cohort, the literature contains no

traceable data regarding the effect of intravenous thrombolytic therapy on return-to-work

after ischaemic stroke. The POISE study did not show a beneficial effect of thrombolytic

therapy, which may be attributed to the very small sample size (17 patients) [35].

There is one other systematic review evaluating return-to-work after ischaemic stroke. This

report, however, concentrates on epidemiologic information and predictive parameters for

various vocational outcomes but contains no information regarding interventions to stimulate

return-to-work [36]. Several reports evaluate return-to-work in study populations aggregating

ischaemic and haemorrhagic stroke [21-25,30,37-40] or even various forms of acute brain

injury [41-43]. Given the substantial differences in treatment options, secondary prevention,

rehabilitation, and prognosis (including return-to-work) [12-20,44], these findings may not

directly be translated to patients with ischaemic stroke. However, some reports provide

valuable information to serve as a basis for future research. Workplace interventions tailored

to the patient's functional ability and to specific professional challenges [38], resource

facilitation [41] and dedicated occupational services [42,45] showed beneficial effects in


19

these populations, whereas advances in conventional rehabilitation programs may not have

yielded such a result [39]. Nevertheless, the variability between miscellaneous vocational

interventions is high and their most effective components and optimal target population

remain to be elucidated [30]. There currently is insufficient evidence to conclude that

vocational rehabilitation would be superior to conventional rehabilitation to improve return-

to-work [40]. Multimodal, individualized and integrative approaches yet are promising as

they reckon with the person's impairments, coping and motivation, but also with job demands

and adaptability, social support and the functioning of rehabilitation services [25,43].

Conclusions

Although return-to-work is recognized as a pivotal individual and societal objective for

ischaemic stroke survivors, there currently is insufficient evidence regarding the effectiveness

of interventions to promote professional reintegration in this population. Intravenous

thrombolytic therapy has shown beneficial effects and there are indications that rehabilitation

programs may also be advantageous, especially when conventional and vocational techniques

are integrated and tailored at the individual level.

Continued research on strategies to improve return-to-work after ischaemic stroke is needed.

The inclusion of vocational outcome parameters in future studies evaluating emergency

stroke treatments, secondary prevention and rehabilitation would be a major step forward.


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Compliance with Ethical Standards

Funding: This research did not receive any specific grant from funding agencies in the public,

commercial, or not-for-profit sectors.

Conflict of Interest: The authors declare that they have no conflict of interest concerning this

publication.

Ethical approval: This article does not contain any studies with human participants or animals performed by any of the authors.


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review. Neuroepidemiology 2002;21:159-166.

37 Daniel K, Wolfe CD, Busch MA, McKevitt C: What are the social consequences of

stroke for working-aged adults? A systematic review. Stroke 2009;40:e431-e440.


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38 Ntsiea MV, Van Aswegen H, Lord S, Olorunju S S: The effect of a workplace

intervention programme on return to work after stroke: A randomised controlled trial.

Clinical rehabilitation 2015;29:663-673.

39 Saeki S, Matsushima Y, Kato N, Itoh H, Shiraishi J: Comparison of the time course of

return to work after stroke between two cohort studies in japan. Journal of UOEH

2016;38:311-315.

40 Wei XJ, Liu XF, Fong KNK: Outcomes of return-to-work after stroke rehabilitation:

A systematic review. British Journal of Occupational Therapy 2016;79:299-308.

41 Trexler LE, Trexler LC, Malec JF, Klyce D, Parrott D: Prospective randomized

controlled trial of resource facilitation on community participation and vocational outcome

following brain injury. The Journal of head trauma rehabilitation 2010;25:440-446.

42 Autret K, Zouker J, Albanese JB, Berthier T, Durufle A, Le Meur C, et al: Return to

work after brain injury: A retrospective study of 85 patients followed by an occupational

reintegration unit: Annals of physical and rehabilitation medicine, 2015, 58, pp 308-311.

43 Donker-Cools BH, Daams JG, Wind H, Frings-Dresen MH: Effective return-to-work

interventions after acquired brain injury: A systematic review. Brain injury 2016;30:113-131.

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following rehabilitation after hemorrhagic and ischemic stroke. Arch Phys Med Rehabil

2003;84:968-972.

45 Chan ML: Description of a return-to-work occupational therapy programme for stroke

rehabilitation in singapore. Occupational therapy international 2008;15:87-99.


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Tables

Table 1. Characteristics of included studies

Reference Design Setting Population Description of intervention

Outcomes Follow-up Methodological quality

Perna 2015 [31]

Single-centre retrospective study Before-after comparison without a concurrent control group

Outpatient program at the Institute for Rehabilitation and Research, Houston, Texas, USA

Diagnosis: ischaemic stroke N=172 Age: 56.8 y (12.5) * Male gender: 64.0% Stroke severity: mild to moderate Stroke latency: less than 6 months Inclusion criteria: - diagnosis - ischaemic stroke - completion of program

Program consisting of twice-weekly treatment for 3 m, including 1 h of neuropsychological services per week, 1 h of social work services per week, 2 to 4 h physical therapy per week, 2 to 4 h occupational therapy per week, and speech therapy.

1. Proportion of patients returning to professional activities (before stroke/after intervention): - Competitive employment: 123/39 - Modified job: 22/7 - School: 3/6 - Homemaker: 4/11 - Volunteer: 5/18 - Leisure: 19/48 - Nonproductive: 7/25 2. MPAI-4 (before intervention/after intervention: 46.19 (15.59) / 25.16 (15.27)*

At completion of program (3 m) No missing data

Low


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Stefanovic 2016 [32]

Single-centre controlled before-after study with measurement of outcomes in intervention and control group No randomisation

Inpatient Stroke Unit at the Neurology Clinic Belgrade, Serbia

Diagnosis: acute ischaemic stroke N: I=143, C=133 Age: I: 52 y (44-56), C: 52 y (44-56) # Male gender: I: 72.7% , C: 69.2% Stroke severity: moderate to severe Stroke latency: <24 h Inclusion criteria: - diagnosis ischaemic stroke with onset <24 h - pre-stroke functional independence - working in paid employment before stroke onset

I: intravenous thrombolytic therapy C: no intravenous thrombolytic therapy

1. Return to full-time paid job: I: 43/143 C: 20/133 2. Return to any kind of job: I: 56/143 C: 42/133

3 y# (range 1-7 y) No missing data

Sufficient

C, control; h, hours; I, Intervention; m, months; MPAI-4, Mayo Portland Adaptability Inventory-4; y, years. * Data given as mean (standard deviation); # Data given as median (interquartile range).


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Table 2. Risk of bias in included studies

Reference

Bias due to confounding of effect of intervention

Bias in selection of participants into the study

Bias in classification of interventions

Bias due to deviations from intended interventions

Bias due to missing data

Bias in measurement of outcome

Bias in selection of the reported result

Overall bias

Perna 2015 [31]

High: variability in the components of the intervention depending on participants' characteristics.

High: only participants who completed the program were included. Dropouts were excluded from analysis.

Low: intervention group is clearly defined. Information used to define intervention group was recorded at the start of the intervention. Classification of the intervention status was probably not affected by knowledge of the outcome.

Unclear: there is insufficient information available to assess potential bias due to deviations from intended interventions.

Low: outcome data were available for (nearly) all participants.

High: assessment of the MPAI-4 may have been influenced by knowledge of the intervention received. Outcome assessors were probably aware of the intervention received by participants.

Low: the reported effect is probably not the result of multiple outcome measurements, multiple analyses or evaluation of subgroups.

High

Stefanovic 2016 [32]

Low: no confounding effect of the thrombolytic

Low: intervention group and controls were adequately

Low: both groups are clearly defined using information at

Low: there are no indications of deviations from the

Low: outcome data are available for all

Low: outcome measures were probably not influenced

Low: the reported effect is probably not the result of multiple outcome

Low


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therapy to be expected.

matched and selection of patients was not influenced by other characteristics than the time delay between stroke onset and possible initiation of thrombolytic therapy.

the start of the intervention. Classification of the intervention status was not affected by knowledge of the outcome.

intended intervention. There were no important co-interventions. There are no indications that interventions were not successfully implemented for most participants.

participants. No participants were excluded due to missing data on the intervention status or on other variables.

by knowledge of the intervention. Methods of outcome assessment were comparable in both groups. There were no systematic errors in measurement of the outcome related to in the intervention received.

measurements, multiple analyses or evaluation of subgroups.

MPAI-4, Mayo Portland Adaptability Inventory-4


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Figures

Figure 1. PRISMA study flow diagram

________________________________

PART II SUPPLEMENTARY MATERIALS

_________________________________________


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Supplement1–StudyprotocolThis protocol is informed by the guidelines from the Cochrane Collaboration and the review will be executed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) prior to initiation of the systematic review (CRD42017077796 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77796).

AimoftheprotocolThis protocol aims to standardize the execution of the systematic review on ‘Interventions to promote work participation after ischaemic stroke'. By explicitly clarifying the review protocol, the authors wish to contribute to the reproducibility of the obtained results.

BackgroundStroke poses a growing health problem with devastating individual and societal impact. The risk factors, epidemiology, disease mechanisms, and prognosis differ greatly between ischaemic and haemorrhagic stroke, as do their therapeutic approaches in the acute phase, in secondary prevention and in rehabilitation. To avoid amalgamating diverse conditions, and given the much higher prevalence and lower mortality of ischaemic stroke compared to haemorrhages, we will primarily focus on ischaemic stroke. Literature shows a wide variation in the success rate of stroke survivors to return to work. Many factors have been associated with the probability of successful professional reintegration and numerous hurdles to return to work have been identified. A wide variety of interventions may influence the prognosis of patients with ischaemic stroke and the likelihood to return to professional activities. Intravenous thrombolytics, endovascular recanalization strategies and stroke unit care reduce disability and other approaches may include rehabilitation techniques, interventions aimed at social and professional reintegration (e.g. case management, patient education, promotion of self-management, changes at the workplace) or the implementation of novel technologies, such as telemedicine. Research in adjacent domains (e.g. traumatic brain injury, mental disorders) learns that return to work may be promoted by multi-component interventions, for instance encompassing health service delivery, coordination of services, work modifications, or skills training and patient coaching. Overall, there was not enough evidence to recommend single interventions such as exercise, pharmaceutical treatments, surgery, patient education or work accommodation alone to improve work participation. The lack of evidence for these strategies, however, is not synonymous with an absence of effect and further research in this field is warranted Professional reintegration after ischaemic stroke is a major societal problem since a large proportion of patients fails to return to work despite excellent functional outcome. Those not resuming professional activities are denied the positive effects that the work environment may offer, such as a social context, promotion of well-being and a sense of purpose and satisfaction Moreover, they are at increased risk of recurrent stroke or other cardiovascular. The health-economic picture is also dire: no less than 45% of stroke survivors are younger than 65 years, accounting globally for 5.2 million first strokes yearly and one-third of the


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$1.75 trillion annual costs associated with stroke in the United States alone are attributable to the inability of stroke survivors to return to work. Only sparse data are available on the efficacy of interventions aiming to promote work participation in stroke survivors. This lack of knowledge regarding work rehabilitation for stroke survivors has been recognized as an emerging concern by the US Department of Education, which has selected the enhancement of functional and employment outcomes of stroke patients as her top research priority already in 2008. Similarly, internationally accepted guidelines on stroke management recognize the lack of good quality evidence on interventions to promote return to work post-stroke and advocate the implementation of return to work as a quality indicator for stroke care. Some data is available on vocational rehabilitation in stroke, but this is limited to small studies examining the barriers and facilitators. Overall, there is a large unmet need regarding insights into the possible strategies and their effectiveness to assist patients with ischaemic stroke in overcoming obstacles to return to work.

ObjectivesThis is a systematic review in the therapeutic domain, in which the authors aim to evaluate any intervention reported in literature to promote work participation after ischaemic stroke. The effectiveness of these interventions to obtain a successful return to work will be evaluated. If data are available, health economic evaluations may also be considered. In accordance with the PICO(S) acronym, the research question can be described as follows:

Participants: survivors of ischaemic stroke aged 18 years or older Intervention: any intervention aiming to support return to professional activities Comparison: the intervention can be compared to 'no intervention', a sham

intervention or to any other type of intervention aiming to support return to professional activities

Outcomes: outcome parameters may include the proportion of participants that returned to professional activities, the time interval between stroke onset and return to professional activities, the proportion of participants who maintained professional activities over time, the time spent off work or being on sick leave, or the score on a validated and standardized work ability scale. Optionally, health economic evaluations may be included.

Study designs: all intervention studies with an adequate study design will be accepted for study in this review. Adequate designs include randomised controlled trials, controlled before-after studies, prospective cohort studies, time-series, before-after comparison without a concurrent control group, quality of care studies, comparison with arbitrary controls. (see section Study eligibility criteria for detailed description).


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MethodsStudyeligibilitycriteriaIn order to be taken into account for study in this systematic review, reports have to fulfil all the following criteria:

The study population consisting of adult patients (> 18 years of age) diagnosed with ischaemic stroke. Publications reporting on mixed populations containing patients diagnosed with ischaemic stroke may be taken into account provided the results of patients with ischaemic stroke can be distilled from the data or if patients with ischaemic stroke compose the large majority of the study population (i.e. > 80% of all patients).

Being an intervention study. An intervention is defined as any kind of active manipulation of the environment, behaviour or disease with the intention to improve or promote health.

Having an adequate evaluation or study design. As randomised controlled trials may not often be conducted in this context, a wider variety of evaluation designs are accepted to increase the external validity of the review findings. The following study designs will be accepted, in order of decreasing research quality:

o A1: Randomized controlled trials that meet both following criteria: Random assignment of the study participants to intervention(s) Description of the randomisation procedure

o A2: Controlled before-after study or prospective cohort study that meets both following criteria:

Intervention and control group outcomes are measured both before and after the intervention

No randomisation procedure but deliberate assignment of the intervention to one group

o A3: Time-series that meet both following criteria: Intervention group only (no control group) Outcome measurements at least three times before and three times after

the intervention o A4: Before-after comparison without a concurrent control group, quality of

care studies, comparison with arbitrary controls that meet any of the following criteria:

Outcome measurements before and after the intervention only For patients it can be after measurement only; a measurement before

the intervention is not required (i.e. a patient series) o Cross-sectional studies (i.e. surveys looking at the present situation only),

prognostic studies (evaluating prognostic factors only) and case reports are not accepted.

Having measured successful return to professional activities as outcome parameter: o Primary outcome: proportion of participants who returned to professional

activities. According to international standards, returning to employment, unpaid labour, leisure, unemployment or retirement are all regarded as a vocation. This complete data set will be taken into account when available, with return to competitive employment (paid work) as the key parameter.


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o Secondary outcomes may involve: the time interval between stroke onset and return to professional activities, the proportion of participants who successfully maintained professional activities over time, the time spent off work or being on sick leave or the score on a validated and standardized work ability scale.

Optionally, health economic evaluations can be recorded if available in addition to the evaluation of the intervention effectiveness. Valuable parameters are costs of the intervention(s), cost-effectiveness, cost-utility or cost-benefit of the intervention(s).

SearchmethodsThe search strategy will involve searches in reference databases, prospective trial registers, hand searches of reference lists and journals, and a grey literature search. The following reference databases will be used: MEDLINE (via PubMed interface), EMBASE, Web of Science, Scopus and the Collaborative Review Group Register. The search for possibly relevant studies will be based on words appearing in the publications' titles and abstracts. All applicable keywords, their synonyms, related terms and alternative spellings thereof will be searched. For each database, the dedicated controlled vocabulary will be used (i.e.. MeSH for MEDLINE, EMTREE for EMBASE) and the search syntaxis will be translated for each interface accordingly. Consensus between all authors will be sought on the formulation of all search strategies. The search will include records in English, French, Dutch, German and Spanish. There will be no limitation regarding the data of publication. Papers published online ahead of print will also be considered. The table below lists the MeSH terms, EMTREE terms and free terms using the Population, Intervention, Comparator and Outcome (PICO) approach. No terms are listed for the Comparator as any type of comparator or no comparator will be allowed.

MeSH terms EMTREE terms Free terms

Population Brain Ischemia Brain Ischemia

“brain infarction”; “brain ischaemia”; “brain ischemia”; “cerebral ischaemia”; “cerebral ischemia”; “ischaemic brain disease”; “ischaemia cerebri”; “ischaemic cerebrovascular accident”; “ischaemic CVA”; “ischaemic encephalopathy”; “ischaemic stroke”; “ischemia cerebri”; “ischemic brain disease”; “ischemic cerebrovascular accident”; “ischemic CVA”; “ischemic encephalopathy”; “ischemic stroke”.

Intervention Rehabilitation; Physical Therapy Modalities;

Rehabilitation; Physical medicine; Vocational

“Rehabilitation”; “Intervention”; “Support”; “Promote”; “Promoting”; “Promotion”;


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Vocational Education; Workplace; Occupational Health; Remote Consultation; Telemedicine; Central Nervous System Stimulants; Human Engineering

Education; Workplace; Occupational Health; Teleconsultation; Telehealth; Central stimulant agent; Ergonomics

“Stimulate”; “Stimulation”; “Stimulus”; “Strategy”; “Strategies”; ““Recovery of function”; “Neurophysiotherapy”; “Physical therapy”; “Physiotherapy”; “Vocational”; “Education”; “Educative”; “Workplace”; “Work place”; “Work-place”; “Work location”; “Work site”; “Work-site”; “Worksite”; “Job” ;“Occupational health; “Employee health”; “Industrial health”; “Occupational safety”; “Remote consultation”; “Teleconsultation”; “Telemedicine”; “Mobile health”; “Telehealth”; “eHealth”; mHealth”; “Telecommunication”; “Online intervention”; “Central Nervous System Stimulant”; “Central stimulant”; “Analeptic”; “Human engineering”; “Ergonomic”; “Ergotherapy”; “Ergotherapeutic”; “Psychology”; “Psychologic”.

(Comparator)

Outcome Return to work; Employment; Sick leave

Return to work; Employment; Medical leave

“Return to work”; “Return-to-Work”; “RTW”; “Returning to work”; “Back to work”; Back-to-work”; “Workresumption”; “Work resumption”; “Stay at work”; “Stay-at-work”; “Staying at work”; “Employment”; “Re-employment”; “Unemployment”; “Disability pension”; “Incapacity”; “Disability leave”; “Sickness absence”; “Sick day”; “Sickness day”; “Sick leave”; “Work absence”; “Absenteeism”.

The following prospective trial registers will be consulted: www.clinicaltrials.gov, www.clinicaltrialsregister.eu, Stroke Trials Registry (http://www.strokecenter.org/trials/) and http://isrctn.com. The grey literature search will be accessed via www.opengrey.eu and the Agency for Healthcare Research and Quality (https://www.ahrq.gov/).


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We will screen the reference lists of all relevant publications for additional papers (backward reference searching). Related publications will also be screened via exploration of all citing articles of relevant studies in Web of Science and linkages via similar articles in MEDLINE (forward reference searching). Data collection and analysis For each search, we will document the type of database and interface, the date of the search, the implemented search strategy and its results. All results will be exported to Endnote (Thomson Reuters Scientific, New York) in RIS format and deduplicated before being loaded into Rayyan software. Three investigators will use the Rayyan tool to independently assess the titles and abstracts of all records identified in the database searches. One reviewer (RB) will evaluate all records and each of the other two reviewers (AVE and LG) will assess half of the record. For this, the reviewers will collect all pertinent information using the 'Form for evaluation of records'. Any conflicting decisions regarding the selection of a record will be resolved in discussion with a fourth reviewer (MM). Next, full-text papers will be obtained for all records that are deemed to be relevant or where eligibility is unclear. All full-text papers will be studied independently by three investigators as described above and data on the study population, intervention, outcome parameters, study design and potential sources of bias will be recorded using the 'Data extraction and assessment form'. Potential moderators and confounders of study outcomes will also be included in the extraction form. Disagreement between the reviewers will be resolved in concertation with the fourth reviewer. Review Manager 5.3 will be used for documentation of the review, data storage and analysis of the study results (available at http://community.cochrane.org/tools/review-production-tools/revman-5). An overview of the results will be provided using the PRISMA study flow diagram, a table listing the characteristics of excluded studies and a table listing the characteristics of included studies. Supporting information to justify all risk of bias judgements will be listed in the risk of bias table. If applicable, we will use standardised tools for bias appraisal. For randomised trials, we will implement the Cochrane Collaboration's Risk of Bias (RoB) tool 2.0 for randomised controlled trials to assess selection bias, performance bias, attrition bias, detection bias and reporting bias. With regard to assessment of blinding, we will additionally evaluate the risk of bias due to lack of blinding for participants and study personnel (performance bias) and for outcome assessment (detection bias). When assessing attrition bias, we will consider the impact of missing data separately for different outcomes. For non-randomised trials, we will implement the Risk Of Bias In Non-randomised Studies of interventions (ROBINS-I) tool. Depending on the results, the measures of treatment effect may be reported as dichotomous data and they may be analysed and compared using Risk Ratios (relative risks, odds ratios, risk differences). In case continuous data would be available, reporting of means, mean differences, changes in mean scores or weighted differences may be useful. Standardized mean differences may be reported when different studies use different scales to report the same outcome. Where a number of outcome measures are identified, the ratio of means method may be used. Meta-analyses may be undertaken if low statistical (e.g. I² < 60%), methodological, and clinical heterogeneity is observed. In that case, evaluation of heterogeneity and reporting bias may also be indicated. Similarly, subgroup analysis and sensitivity analysis may be considered, depending on the results. The evaluation will be limited to a descriptive report of


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all obtained results if the available data do not suffice for the analyses described above. If data are available, health economic assessments may be also be performed. If applicable, ongoing studies on the topic will also be described.

DiscussionThis protocol forms the basis for a systematic review of interventions to promote work participation in patients diagnosed with ischaemic stroke. Regardless of its results, adequate dissemination of the conclusions will be sought upon completion of the review. This systematic review will identify available approaches to support ischaemic stroke survivors in their search for professional reintegration. Knowledge and application of such strategies can serve as a leaping board to improve the quality of life of patients, clinicians, researchers and policymakers, and is of societal importance as it may help reduce the economic impact of this devastating condition.


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Supplement2–Overviewofsearchesperdatabase1.PICOsearchtermsPopulation

MeSH terms: Brain Ischemia EMTREE terms: Brain Ischemia Free terms: “brain infarction”; “brain ischaemia”; “brain ischemia”; “cerebral

ischaemia”; “cerebral ischemia”; “ischaemic brain disease”; “ischaemia cerebri”; “ischaemic cerebrovascular accident”; “ischaemic CVA”; “ischaemic encephalopathy”; “ischaemic stroke”; “ischemia cerebri”; “ischemic brain disease”; “ischemic cerebrovascular accident”; “ischemic CVA”; “ischemic encephalopathy”; “ischemic stroke”.

Intervention

MeSH terms: Rehabilitation; Physical Therapy Modalities; Vocational Education; Workplace; Occupational Health; Remote Consultation; Telemedicine; Central Nervous System Stimulants; Human Engineering

EMTREE terms: Rehabilitation; Physical medicine; Vocational Education; Workplace; Occupational Health; Teleconsultation; Telehealth; Central stimulant agent; Ergonomics

Free terms: “Rehabilitation”; “Intervention”; “Support”; “Promote”; “Promoting”; “Promotion”; “Stimulate”; “Stimulation”; “Stimulus”; “Strategy”; “Strategies”; “Recovery of function”; “Neurophysiotherapy”; “Physical therapy”; “Physiotherapy”; “Vocational”; “Education”; “Educative”; “Workplace”; “Work place”; “Work-place”; “Work location”; “Work site”; “Work-site”; “Worksite”; “Job” ;“Occupational health"; “Employee health”; “Industrial health”; “Occupational safety”; “Remote consultation”; “Teleconsultation”; “Telemedicine”; “Mobile health”; “Telehealth”; “eHealth”; "mHealth”; “Telecommunication”; “Online intervention”; “Central Nervous System Stimulant”; “Central stimulant”; “Analeptic”; “Human engineering”; “Ergonomic”; “Ergotherapy”; “Ergotherapeutic”; “Psychology”; “Psychologic”.

Comparator

Any type of comparator or no comparator are allowed

Outcome

MeSH terms: Return to work; Employment; Sick leave EMTREE terms: Return to work; Employment; Medical leave Free terms: “Return to work”; “Return-to-Work”; “RTW”; “Returning to work”;

“Back to work”; "Back-to-work”; “Workresumption”; “Work resumption”; “Stay at work”; “Stay-at-work”; “Staying at work”; “Employment”; “Re-employment”; “Unemployment”; “Disability pension”; “Incapacity”; “Disability leave”; “Sickness absence”; “Sick day”; “Sickness day”; “Sick leave”; “Work absence”; “Absenteeism”.


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Table 1 Overview of the keywords and their combinations used in the systematic literature search

Population Intervention Outcome

MeSH terms Brain Ischemia

Rehabilitation Physical Therapy Modalities Vocational Education; Workplace Occupational Health; Remote Consultation Telemedicine Central Nervous System Stimulants Human Engineering

Return to work Employment Sick leave

EMTREE terms

Brain Ischemia

Rehabilitation Physical medicine Vocational Education Workplace Occupational Health Teleconsultation Telehealth Central stimulant agent Ergonomics

Return to work Employment Medical leave

Free terms

Brain infarction Brain ischaemia Brain ischemia Cerebral ischaemia Cerebral ischemia Ischaemic brain disease Ischaemia cerebri Ischaemic Cerebrovascular accident Ischaemic CVA Ischaemic encephalopathyIschaemic stroke Ischemia cerebri Ischemic brain disease Ischemic cerebrovascular accident Ischemic CVA Ischemic encephalopathy Ischemic stroke

Rehabilitation Intervention Support Promote Promoting Promotion Stimulate Stimulation Stimulus Strategy Strategies Recovery of function Neurophysiotherapy Physical therapy Physiotherapy Vocational Education Educative Workplace Work place Work-place Work location

Return to work Return-to-Work RTW Returning to work Back to work Back-to-work WorkresumptionWork resumptionStay at work Stay-at-work Staying at work Employment Re-employment Unemployment Disability pension Incapacity Disability leave Sickness absenceSick day Sickness day


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Work site Work-site Worksite Job Occupational health Employee health Industrial health Occupational safety Remote consultation Teleconsultation Telemedicine Mobile health Telehealth eHealth mHealth Telecommunication Online intervention Central Nervous System Stimulant Central stimulant Analeptic Human engineering Ergonomic Ergotherapy Ergotherapeutic Psychology Psychologic

Sick leave Work absence Absenteeism

Keywords in each column were linked by using the Boolean operator ‘OR’

LimitationsYearNo limitation is set

LanguageThe search is limited to publications in English, German, French, Spanish or Dutch

DemographyThe search is limited to adults

2.MEDLINE(viaPubmed)DatesearchedOctober 30th 2017

SearcherRB


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Strategy1. brain ischemia[MeSH Terms] 2. "brain infarction" OR "brain ischaemia" OR "brain ischemia" OR "cerebral

ischaemia" OR "cerebral ischemia" OR "ischaemic brain disease" OR "ischaemia cerebri" OR "ischaemic cerebrovascular accident" OR "ischaemic CVA" OR "ischaemic encephalopathy" OR "ischaemic stroke" OR "ischemia cerebri" OR "ischemic brain disease" OR "ischemic cerebrovascular accident" OR "ischemic CVA" OR "ischemic encephalopathy" OR "ischemic stroke"

3. #1 OR #2 4. Rehabilitation[MeSH Terms] OR Physical Therapy Modalities[MeSH Terms] OR

Vocational Education[MeSH Terms] OR Workplace[MeSH Terms] OR Occupational Health[MeSH Terms] OR Remote Consultation[MeSH Terms] OR Telemedicine[MeSH Terms] OR Central Nervous System Stimulants[MeSH Terms] OR Human Engineering[MeSH Terms]

5. "Rehabilitation" OR "Intervention" OR "Support" OR "Promote" OR "Promoting" OR "Promotion" OR "Stimulate" OR "Stimulating" OR "Stimulus" OR "Program" OR "Programm" OR "Strategy" OR "Strategies" OR "Recovery of function" OR "Neurophysiotherapy" OR "Physical therapy" OR "Physiotherapy" OR "Vocational education" OR "Vocational" OR "Education" OR "Educative" OR "Workplace" OR "Work place" OR "Work-place" OR "Work location" OR "Work site" OR "Work-site" OR "Worksite" OR "Job" OR "Occupational health" OR "Employee health" OR "Industrial health" OR "Occupational safety" OR "Remote consultation" OR "Teleconsultation" OR "Telemedicine" OR "Mobile health" OR "Telehealth" OR "eHealth" OR "mHealth" OR "Telecommunication" OR "Online intervention" OR "Central Nervous System Stimulant" OR "Central stimulant" OR "Analeptic" OR "Human engineering" OR "Ergonomic" OR "Ergotherapy" OR "Ergotherapeutic" OR "Psychology" OR "Psychologic"

6. #4 OR #5 7. return to work[MeSH Terms] OR employment[MeSH Terms] OR sick leave[MeSH

Terms] 8. "Return to work" OR "Return-to-Work" OR "RTW" OR "Returning to work" OR

"Back to work" OR "Back-to-work" OR "Workresumption" OR "Work resumption" OR "Stay at work" OR "Stay-at-work" OR "Staying at work" OR "Employment" OR "Re-employment" OR "Unemployment" OR "Disability pension" OR "Incapacity" OR "Disability leave" OR "Sickness absence" OR "Sick leave" OR "Sick day" OR "Sickness day" OR "Work absence" OR "Absenteeism"

9. #7 OR #8 10. English[Language] OR French[Language] OR Spanish[Language] OR

German[Language] OR Dutch[Language] 11. #3 AND #6 AND #9 AND #10 12. #11 AND Filters: Adult [MeSH Terms]


43

Syntaxis((("brain ischemia"[MeSH Terms] OR ("brain infarction"[All Fields] OR "brain ischaemia"[All Fields] OR "brain ischemia"[All Fields] OR "cerebral ischaemia"[All Fields] OR "cerebral ischemia"[All Fields] OR "ischaemic brain disease"[All Fields] OR (("ischaemia"[All Fields] OR "ischemia"[MeSH Terms] OR "ischemia"[All Fields]) AND cerebri[All Fields]) OR "ischaemic cerebrovascular accident"[All Fields] OR "ischaemic CVA"[All Fields] OR "ischaemic encephalopathy"[All Fields] OR "ischaemic stroke"[All Fields] OR (("ischaemia"[All Fields] OR "ischemia"[MeSH Terms] OR "ischemia"[All Fields]) AND cerebri[All Fields]) OR "ischemic brain disease"[All Fields] OR "ischemic cerebrovascular accident"[All Fields] OR "ischemic CVA"[All Fields] OR "ischemic encephalopathy"[All Fields] OR "ischemic stroke"[All Fields])) AND (("rehabilitation"[MeSH Terms] OR "physical therapy modalities"[MeSH Terms] OR "vocational education"[MeSH Terms] OR "workplace"[MeSH Terms] OR "occupational health"[MeSH Terms] OR "remote consultation"[MeSH Terms] OR "telemedicine"[MeSH Terms] OR "central nervous system stimulants"[MeSH Terms] OR "human engineering"[MeSH Terms]) OR ("Rehabilitation"[All Fields] OR "Intervention"[All Fields] OR "Support"[All Fields] OR "Promote"[All Fields] OR "Promoting"[All Fields] OR "Promotion"[All Fields] OR "Stimulate"[All Fields] OR "Stimulating"[All Fields] OR "Stimulus"[All Fields] OR "Program"[All Fields] OR "Programm"[All Fields] OR "Strategy"[All Fields] OR "Strategies"[All Fields] OR "Recovery of function"[All Fields] OR "Neurophysiotherapy"[All Fields] OR "Physical therapy"[All Fields] OR "Physiotherapy"[All Fields] OR "Vocational education"[All Fields] OR "Vocational"[All Fields] OR "Education"[All Fields] OR "Educative"[All Fields] OR "Workplace"[All Fields] OR "Work place"[All Fields] OR "Work-place"[All Fields] OR "Work location"[All Fields] OR "Work site"[All Fields] OR "Work-site"[All Fields] OR "Worksite"[All Fields] OR "Job"[All Fields] OR "Occupational health"[All Fields] OR "Employee health"[All Fields] OR "Industrial health"[All Fields] OR "Occupational safety"[All Fields] OR "Remote consultation"[All Fields] OR "Teleconsultation"[All Fields] OR "Telemedicine"[All Fields] OR "Mobile health"[All Fields] OR "Telehealth"[All Fields] OR "eHealth"[All Fields] OR "mHealth"[All Fields] OR "Telecommunication"[All Fields] OR "Online intervention"[All Fields] OR "Central Nervous System Stimulant"[All Fields] OR "Central stimulant"[All Fields] OR "Analeptic"[All Fields] OR "Human engineering"[All Fields] OR "Ergonomic"[All Fields] OR "Ergotherapy"[All Fields] OR "Ergotherapeutic"[All Fields] OR "Psychology"[All Fields] OR "Psychologic"[All Fields]))) AND (("return to work"[MeSH Terms] OR "employment"[MeSH Terms] OR "sick leave"[MeSH Terms]) OR ("Return to work"[All Fields] OR "Return-to-Work"[All Fields] OR "RTW"[All Fields] OR "Returning to work"[All Fields] OR "Back to work"[All Fields] OR "Back-to-work"[All Fields] OR "Work resumption"[All Fields] OR "Stay at work"[All Fields] OR "Stay-at-work"[All Fields] OR "Staying at work"[All Fields] OR "Employment"[All Fields] OR "Re-employment"[All Fields] OR "Unemployment"[All Fields] OR "Disability pension"[All Fields] OR "Incapacity"[All Fields] OR "Disability leave"[All Fields] OR "Sickness absence"[All Fields] OR "Sick leave"[All Fields] OR "Sick day"[All Fields] OR (Sickness[All Fields] AND day[All Fields]) OR "Work absence"[All Fields] OR "Absenteeism"[All Fields]))) AND (English[Language] OR French[Language] OR Spanish[Language] OR German[Language] OR dutch[Language]) AND "adult"[MeSH Terms]


44

Results1. 94774 hits 2. 86844 hits 3. 1240022 hits 4. 401059 hits 5. 11290498 hits 6. 11379457 hits 7. 78876 hits 8. 112554 hits 9. 137462 hits 10. 25045296 hits 11. 109 hits 12. 78 hits

3.EMBASEDatesearchedOctober 30th 2017

SearcherRB

Strategy1. 'brain ischemia'/exp 2. 'brain infarction' OR 'brain ischaemia' OR 'brain ischemia' OR ‘cerebral ischaemia’

OR ‘cerebral ischemia’ OR ‘ischaemic brain disease’ OR ‘ischaemia cerebri’ OR ‘ischaemic cerebrovascular accident’ OR ‘ischaemic CVA’ OR ‘ischaemic encephalopathy’ OR ‘ischaemic stroke’ OR ‘ischemia cerebri’ OR ‘ischemic brain disease’ OR ‘ischemic cerebrovascular accident’ OR ‘ischemic CVA’ OR ‘ischemic encephalopathy’ OR ‘ischemic stroke’

3. #1 OR #2 4. 'rehabilitation'/exp OR 'physical medicine'/exp OR 'vocational education'/exp OR

'workplace'/exp OR 'occupational health'/exp OR 'teleconsultation'/exp OR 'telehealth'/exp OR 'central stimulant agent'/exp OR 'ergonomics'/exp

5. 'rehabilitation' OR 'rehabilitation' OR 'intervention' OR 'support' OR 'promote' OR 'promoting' OR 'promotion' OR 'stimulate' OR 'stimulating' OR 'stimulus' OR 'program' OR 'programm' OR 'strategy' OR 'strategies' OR 'recovery of function' OR 'neurophysiotherapy' OR 'physical therapy' OR 'physiotherapy' OR 'vocational education' OR 'vocational' OR 'education' OR 'educative' OR 'workplace' OR 'work place' OR 'work-place' OR 'work location' OR 'work site' OR 'work-site' OR 'worksite' OR 'job' OR 'occupational health' OR 'employee health' OR 'industrial health' OR 'occupational safety' OR 'remote consultation' OR 'teleconsultation' OR 'telemedicine' OR 'mobile health' OR 'telehealth' OR 'ehealth' OR 'mhealth' OR 'telecommunication' OR 'online intervention' OR 'central nervous system stimulant' OR 'central stimulant' OR 'analeptic' OR 'human engineering' OR 'ergonomic' OR 'ergotherapy' OR 'ergotherapeutic' OR 'psychology' OR 'psychologic'

6. #4 OR #5 7. 'return to work'/exp OR 'employment'/exp OR 'medical leave'/exp


45

8. 'return to work' OR 'return-to-work' OR 'rtw' OR 'returning to work' OR 'back to work' OR 'back-to-work' OR 'workresumption' OR 'work resumption' OR 'stay at work' OR 'stay-at-work' OR 'staying at work' OR 'employment' OR 're-employment' OR 'unemployment' OR 'disability pension' OR 'incapacity' OR 'disability leave' OR 'sickness absence' OR 'sick leave' OR 'sick day' OR 'sickness day' OR 'work absence' OR 'absenteeism'

9. #7 OR #8 10. #3 AND #6 AND #9 11. #10 AND ([dutch]/lim OR [english]/lim OR [french]/lim OR [german]/lim OR

[spanish]/lim) AND [adult]/lim

Syntaxis('brain ischemia'/exp OR 'brain infarction' OR 'brain ischaemia' OR 'brain ischemia' OR 'cerebral ischaemia' OR 'cerebral ischemia' OR 'ischaemic brain disease' OR 'ischaemia cerebri' OR 'ischaemic cerebrovascular accident' OR 'ischaemic cva' OR 'ischaemic encephalopathy' OR 'ischaemic stroke' OR 'ischemia cerebri' OR 'ischemic brain disease' OR 'ischemic cerebrovascular accident' OR 'ischemic cva' OR 'ischemic encephalopathy' OR 'ischemic stroke') AND ('rehabilitation'/exp OR 'physical medicine'/exp OR 'vocational education'/exp OR 'workplace'/exp OR 'occupational health'/exp OR 'teleconsultation'/exp OR 'telehealth'/exp OR 'central stimulant agent'/exp OR 'ergonomics'/exp OR 'rehabilitation' OR 'intervention' OR 'support' OR 'promote' OR 'promoting' OR 'promotion' OR 'stimulate' OR 'stimulating' OR 'stimulus' OR 'program' OR 'programm' OR 'strategy' OR 'strategies' OR 'recovery of function' OR 'neurophysiotherapy' OR 'physical therapy' OR 'physiotherapy' OR 'vocational education' OR 'vocational' OR 'education' OR 'educative' OR 'workplace' OR 'work place' OR 'work-place' OR 'work location' OR 'work site' OR 'work-site' OR 'worksite' OR 'job' OR 'occupational health' OR 'employee health' OR 'industrial health' OR 'occupational safety' OR 'remote consultation' OR 'teleconsultation' OR 'telemedicine' OR 'mobile health' OR 'telehealth' OR 'ehealth' OR 'mhealth' OR 'telecommunication' OR 'online intervention' OR 'central nervous system stimulant' OR 'central stimulant' OR 'analeptic' OR 'human engineering' OR 'ergonomic' OR 'ergotherapy' OR 'ergotherapeutic' OR 'psychology' OR 'psychologic') AND ('return to work'/exp OR 'employment'/exp OR 'medical leave'/exp OR 'return to work' OR 'return-to-work' OR 'rtw' OR 'returning to work' OR 'back to work' OR 'back-to-work' OR 'workresumption' OR 'work resumption' OR 'stay at work' OR 'stay-at-work' OR 'staying at work' OR 'employment' OR 're-employment' OR 'unemployment' OR 'disability pension' OR 'incapacity' OR 'disability leave' OR 'sickness absence' OR 'sick leave' OR 'sick day' OR 'sickness day' OR 'work absence' OR 'absenteeism') AND ([dutch]/lim OR [english]/lim OR [french]/lim OR [german]/lim OR [spanish]/lim) AND [adult]/lim

Results

1. 150170 hits 2. 179581 hits 3. 205575 hits 4. 1330898 hits 5. 6448058 hits 6. 7105591 hits 7. 83611 hits


46

8. 143686 hits 9. 144821 hits 10. 221 hits 11. 117 hits

4.WebofScienceDatesearchedOctober 30th 2017

SearcherRB

Strategy1. TOPIC: (“brain infarction” OR “brain ischaemia” OR “brain ischemia” OR “cerebral

ischaemia” OR “cerebral ischemia” OR “ischaemic brain disease” OR “ischaemia cerebri” OR “ischaemic cerebrovascular accident” OR “ischaemic CVA” OR “ischaemic encephalopathy” OR “ischaemic stroke” OR “ischemia cerebri” OR “ischemic brain disease” OR “ischemic cerebrovascular accident” OR “ischemic CVA” OR “ischemic encephalopathy” OR “ischemic stroke”) Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Timespan=All years

2. TOPIC: (“Rehabilitation” OR “Intervention” OR “Support” OR “Promote” OR “Promoting” OR “Promotion” OR “Stimulate” OR “Stimulating” OR “Stimulus” OR “Program” OR “Programm” OR “Strategy” OR “Strategies” OR “Recovery of function” OR “Neurophysiotherapy” OR “Physical therapy” OR “Physiotherapy” OR “Vocational education” OR “Vocational” OR “Education” OR “Educative” OR “Workplace” OR “Work place” OR “Work-place” OR “Work location” OR “Work site” OR “Work-site” OR “Worksite” OR “Job” OR “Occupational health” OR “Employee health” OR “Industrial health” OR “Occupational safety” OR “Remote consultation” OR “Teleconsultation” OR “Telemedicine” OR “Mobile health” OR “Telehealth” OR “eHealth” OR “mHealth” OR “Telecommunication” OR “Online intervention” OR “Central Nervous System Stimulant” OR “Central stimulant” OR “Analeptic” OR “Human engineering” OR “Ergonomic” OR “Ergotherapy” OR “Ergotherapeutic” OR “Psychology” OR “Psychologic”) Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Timespan=All years

3. TOPIC: (“Return to work” OR “Return-to-Work” OR “RTW” OR “Returning to work” OR “Back to work” OR “Back-to-work” OR “Workresumption” OR “Work resumption” OR “Stay at work” OR “Stay-at-work” OR “Staying at work” OR “Employment” OR “Re-employment” OR “Unemployment” OR “Disability pension” OR “Incapacity” OR “Disability leave” OR “Sickness absence” OR “Sick leave” OR “Sick day” OR “Sickness day” OR “Work absence” OR “Absenteeism”) Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Timespan=All years

4. #1 AND #2 AND #3 Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Timespan=All years

5. #4 AND Refined by: LANGUAGES: ( ENGLISH OR SPANISH ) Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Timespan=All years


47

SyntaxisTS=((“brain infarction” OR “brain ischaemia” OR “brain ischemia” OR “cerebral ischaemia” OR “cerebral ischemia” OR “ischaemic brain disease” OR “ischaemia cerebri” OR “ischaemic cerebrovascular accident” OR “ischaemic CVA” OR “ischaemic encephalopathy” OR “ischaemic stroke” OR “ischemia cerebri” OR “ischemic brain disease” OR “ischemic cerebrovascular accident” OR “ischemic CVA” OR “ischemic encephalopathy” OR “ischemic stroke”) AND (“Rehabilitation” OR “Intervention” OR “Support” OR “Promote” OR “Promoting” OR “Promotion” OR “Stimulate” OR “Stimulating” OR “Stimulus” OR “Program” OR “Programm” OR “Strategy” OR “Strategies” OR “Recovery of function” OR “Neurophysiotherapy” OR “Physical therapy” OR “Physiotherapy” OR “Vocational education” OR “Vocational” OR “Education” OR “Educative” OR “Workplace” OR “Work place” OR “Work-place” OR “Work location” OR “Work site” OR “Work-site” OR “Worksite” OR “Job” OR “Occupational health” OR “Employee health” OR “Industrial health” OR “Occupational safety” OR “Remote consultation” OR “Teleconsultation” OR “Telemedicine” OR “Mobile health” OR “Telehealth” OR “eHealth” OR “mHealth” OR “Telecommunication” OR “Online intervention” OR “Central Nervous System Stimulant” OR “Central stimulant” OR “Analeptic” OR “Human engineering” OR “Ergonomic” OR “Ergotherapy” OR “Ergotherapeutic” OR “Psychology” OR “Psychologic”) AND (“Return to work” OR “Return-to-Work” OR “RTW” OR “Returning to work” OR “Back to work” OR “Back-to-work” OR “Workresumption” OR “Work resumption” OR “Stay at work” OR “Stay-at-work” OR “Staying at work” OR “Employment” OR “Re-employment” OR “Unemployment” OR “Disability pension” OR “Incapacity” OR “Disability leave” OR “Sickness absence” OR “Sick leave” OR “Sick day” OR “Sickness day” OR “Work absence” OR “Absenteeism”)) Refined by: LANGUAGES: ( ENGLISH OR SPANISH ) Timespan: All years. Indexes: SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI.

Results

1. 165560 hits 2. 5569504 hits 3. 106729 hits 4. 89 hits 5. 87 hits

5.ScopusDatesearchedOctober 30th 2017

SearcherRB

Strategy1. TITLE-ABS-KEY("brain infarction" OR "brain ischaemia" OR "brain ischemia" OR

"cerebral ischaemia" OR "cerebral ischemia" OR "ischaemic brain disease" OR "ischaemia cerebri" OR "ischaemic cerebrovascular accident" OR "ischaemic CVA" OR "ischaemic encephalopathy" OR "ischaemic stroke" OR "ischemia cerebri" OR


48

"ischemic brain disease" OR "ischemic cerebrovascular accident" OR "ischemic CVA" OR "ischemic encephalopathy" OR "ischemic stroke")

2. TITLE-ABS-KEY(“Rehabilitation” OR “Intervention” OR “Support” OR “Promote” OR “Promoting” OR “Promotion” OR “Stimulate” OR “Stimulating” OR “Stimulus” OR “Program” OR “Programm” OR “Strategy” OR “Strategies” OR “Recovery of function” OR “Neurophysiotherapy” OR “Physical therapy” OR “Physiotherapy” OR “Vocational education” OR “Vocational” OR “Education” OR “Educative” OR “Workplace” OR “Work place” OR “Work-place” OR “Work location” OR “Work site” OR “Work-site” OR “Worksite” OR “Job” OR “Occupational health” OR “Employee health” OR “Industrial health” OR “Occupational safety” OR “Remote consultation” OR “Teleconsultation” OR “Telemedicine” OR “Mobile health” OR “Telehealth” OR “eHealth” OR “mHealth” OR “Telecommunication” OR “Online intervention” OR “Central Nervous System Stimulant” OR “Central stimulant” OR “Analeptic” OR “Human engineering” OR “Ergonomic” OR “Ergotherapy” OR “Ergotherapeutic” OR “Psychology” OR “Psychologic”)

3. TITLE-ABS-KEY(“Return to work” OR “Return-to-Work” OR “RTW” OR “Returning to work” OR “Back to work” OR “Back-to-work” OR “Workresumption” OR “Work resumption” OR “Stay at work” OR “Stay-at-work” OR “Staying at work” OR “Employment” OR “Re-employment” OR “Unemployment” OR “Disability pension” OR “Incapacity” OR “Disability leave” OR “Sickness absence” OR “Sick leave” OR “Sick day” OR “Sickness day” OR “Work absence” OR “Absenteeism”)

4. #1 AND #2 AND #3

5. #4 AND ( LIMIT-TO ( LANGUAGE , "English" ) OR LIMIT-TO ( LANGUAGE , "Spanish" ) OR LIMIT-TO ( LANGUAGE , "Dutch" ) OR LIMIT-TO ( LANGUAGE , "German" ) )

Syntaxis( TITLE-ABS-KEY ( "brain infarction" OR "brain ischaemia" OR "brain ischemia" OR "cerebral ischaemia" OR "cerebral ischemia" OR "ischaemic brain disease" OR "ischaemia cerebri" OR "ischaemic cerebrovascular accident" OR "ischaemic CVA" OR "ischaemic encephalopathy" OR "ischaemic stroke" OR "ischemia cerebri" OR "ischemic brain disease" OR "ischemic cerebrovascular accident" OR "ischemic CVA" OR "ischemic encephalopathy" OR "ischemic stroke" ) ) AND ( TITLE-ABS-KEY ( "Rehabilitation" OR "Intervention" OR "Support" OR "Promote" OR "Promoting" OR "Promotion" OR "Stimulate" OR "Stimulating" OR "Stimulus" OR "Program" OR "Programm" OR "Strategy" OR "Strategies" OR "Recovery of function" OR "Neurophysiotherapy" OR "Physical therapy" OR "Physiotherapy" OR "Vocational education" OR "Vocational" OR "Education" OR "Educative" OR "Workplace" OR "Work place" OR "Work-place" OR "Work location" OR "Work site" OR "Work-site" OR "Worksite" OR "Job" OR "Occupational health" OR "Employee health" OR "Industrial health" OR "Occupational safety" OR "Remote consultation" OR "Teleconsultation" OR "Telemedicine" OR "Mobile health" OR "Telehealth" OR "eHealth" OR "mHealth" OR "Telecommunication" OR "Online intervention" OR "Central Nervous System Stimulant" OR "Central stimulant" OR "Analeptic" OR "Human engineering" OR "Ergonomic" OR "Ergotherapy" OR


49

"Ergotherapeutic" OR "Psychology" OR "Psychologic" ) ) AND ( TITLE-ABS-KEY ( "Return to work" OR "Return-to-Work" OR "RTW" OR "Returning to work" OR "Back to work" OR "Back-to-work" OR "Workresumption" OR "Work resumption" OR "Stay at work" OR "Stay-at-work" OR "Staying at work" OR "Employment" OR "Re-employment" OR "Unemployment" OR "Disability pension" OR "Incapacity" OR "Disability leave" OR "Sickness absence" OR "Sick leave" OR "Sick day" OR "Sickness day" OR "Work absence" OR "Absenteeism" ) ) AND ( LIMIT-TO ( LANGUAGE , "English" ) OR LIMIT-TO ( LANGUAGE , "Spanish" ) OR LIMIT-TO ( LANGUAGE , "Dutch" ) OR LIMIT-TO ( LANGUAGE , "German" ) )

Results

1. 155711 hits

2. 12205272 hits

3. 298105 hits

4. 274 hits

5. 144 hits

6.CollaborativeReviewGroupRegisterDatesearchedOctober 30th 2017

SearcherRB

Strategy1. MeSH descriptor: [Brain Ischemia] explode all trees

2. "brain infarction" or "brain ischaemia" or "brain ischemia" or "cerebral ischaemia" or "cerebral ischemia" or "ischaemic brain disease" or "ischaemia cerebri" or "ischaemic cerebrovascular accident" or "ischaemic CVA" or "ischaemic encephalopathy" or "ischaemic stroke" or "ischemia cerebri" or "ischemic brain disease" or "ischemic cerebrovascular accident" or "ischemic CVA" or "ischemic encephalopathy" or "ischemic stroke":ti,ab,kw (Word variations have been searched)

3. #1 OR #2

4. MeSH descriptor: [Rehabilitation] explode all trees

5. MeSH descriptor: [Physical Therapy Modalities] explode all trees

6. MeSH descriptor: [Vocational Education] explode all trees

7. MeSH descriptor: [Workplace] explode all trees

8. MeSH descriptor: [Occupational Health] explode all trees

9. MeSH descriptor: [Remote Consultation] explode all trees


50

10. MeSH descriptor: [Telemedicine] explode all trees

11. MeSH descriptor: [Central Nervous System Stimulants] explode all trees

12. MeSH descriptor: [Human Engineering] explode all trees

13. #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12

14. "Rehabilitation" or "Intervention" or "Support" or "Promote" or "Promoting" or "Promotion" or "Stimulate" or "Stimulating" or "Stimulus" or "Program" or "Programm" or "Strategy" or "Strategies" or "Recovery of function" or "Neurophysiotherapy" or "Physical therapy" or "Physiotherapy" or "Vocational education" or "Vocational" or "Education" or "Educative" or "Workplace" or "Work place" or "Work-place" or "Work location" or "Work site" or "Work-site" or "Worksite" or "Job" or "Occupational health" or "Employee health" or "Industrial health" or "Occupational safety" or "Remote consultation" or "Teleconsultation" or "Telemedicine" or "Mobile health" or "Telehealth" or "eHealth" or "mHealth" or "Telecommunication" or "Online intervention" or "Central Nervous System Stimulant" or "Central stimulant" or "Analeptic" or "Human engineering" or "Ergonomic" or "Ergotherapy" or "Ergotherapeutic" or "Psychology" or "Psychologic":ti,ab,kw (Word variations have been searched)

15. #13 OR #14

16. MeSH descriptor: [Return to Work] explode all trees

17. MeSH descriptor: [Employment] explode all trees

18. MeSH descriptor: [Sick Leave] explode all trees

19. #16 OR #17 OR #18

20. "Return to work" or "Return-to-Work" or "RTW" or "Returning to work" or "Back to work" or "Back-to-work" or "Workresumption" or "Work resumption" or "Stay at work" or "Stay-at-work" or "Staying at work" or "Employment" or "Re-employment" or "Unemployment" or "Disability pension" or "Incapacity" or "Disability leave" or "Sickness absence" or "Sick leave" or "Sick day" or "Sickness day" or "Work absence" or "Absenteeism":ti,ab,kw (Word variations have been searched)

21. #19 OR #20

22. #3 AND #15 AND #21

Results

1. 2889 hits

2. 9030 hits

3. 10014 hits

4. 29223 hits

5. 21613 hits


51

6. 37 hits

7. 754 hits

8. 613 hits

9. 420 hits

10. 1995 hits

11. 2047 hits

12. 2838 hits

13. 38708 hits

14. 326649 hits

15. 336888 hits

16. 145 hits

17. 1718 hits

18. 547 hits

19. 2089 hits

20. 6028 hits

21. 6643 hits

22. 11 hits

7.Trialregisterswww.clinicaltrials.govDatesearchedOctober 30th 2017

SearcherRB

StrategyCondition/disease: “brain infarction” OR “brain ischaemia” OR “brain ischemia” OR “cerebral ischaemia” OR “cerebral ischemia”OR “ischaemic cerebrovascular accident” OR “ischaemic CVA” OR “ischaemic stroke” OR “ischemic CVA” OR “ischemic stroke” Other terms: “Return to work” OR “Return-to-Work” OR “RTW” OR “Returning to work” OR “Back to work” OR “Back-to-work” OR “Work resumption” OR “Stay at work” OR “Stay-at-work” OR “Staying at work” OR “Employment” OR “Re-employment” OR “Unemployment”


52

Syntaxis “Return to work” OR “Return-to-Work” OR “RTW” OR “Returning to work” OR “Back to work” OR “Back-to-work” OR “Work resumption” OR “Stay at work” OR “Stay-at-work” OR “Staying at work” OR “Employment” OR “Re-employment” OR “Unemployment” | “brain infarction” OR “brain ischaemia” OR “brain ischemia” OR “cerebral ischaemia” OR “cerebral ischemia”OR “ischaemic cerebrovascular accident” OR “ischaemic CVA” OR “ischaemic stroke” OR “ischemic CVA” OR “ischemic stroke” Results1 hit

www.clinicaltrialsregister.euDatesearchedOctober 30th 2017

SearcherRB

Syntaxis(“Return to work” OR “Return-to-Work” OR “RTW” OR “Returning to work” OR “Back to work” OR “Back-to-work” OR “Work resumption” OR “Stay at work” OR “Stay-at-work” OR “Staying at work” OR “Employment” OR “Re-employment” OR “Unemployment”) AND (“brain infarction” OR “brain ischaemia” OR “brain ischemia” OR “cerebral ischaemia” OR “cerebral ischemia”OR “ischaemic cerebrovascular accident” OR “ischaemic CVA” OR “ischaemic stroke” OR “ischemic CVA” OR “ischemic stroke”)

Results0 hits

StrokeTrialsRegistryDatesearchedOctober 30th 2017

SearcherRB

Syntaxis(“Return to work” OR “Return-to-Work” OR “RTW” OR “Returning to work” OR “Back to work” OR “Back-to-work” OR “Work resumption” OR “Stay at work” OR “Stay-at-work” OR “Staying at work” OR “Employment” OR “Re-employment” OR “Unemployment”) AND (“brain infarction” OR “brain ischaemia” OR “brain ischemia” OR “cerebral ischaemia” OR “cerebral ischemia”OR “ischaemic cerebrovascular accident” OR “ischaemic CVA” OR “ischaemic stroke” OR “ischemic CVA” OR “ischemic stroke”)

Results0 hits


53

http://isrctn.comDatesearchedOctober 30th 2017

SearcherRB

StrategyCondition/disease: “brain infarction” OR “brain ischaemia” OR “brain ischemia” OR “cerebral ischaemia” OR “cerebral ischemia”OR “ischaemic cerebrovascular accident” OR “ischaemic CVA” OR “ischaemic stroke” OR “ischemic CVA” OR “ischemic stroke”

Other terms: “Return to work” OR “Return-to-Work” OR “RTW” OR “Returning to work” OR “Back to work” OR “Back-to-work” OR “Work resumption” OR “Stay at work” OR “Stay-at-work” OR “Staying at work” OR “Employment” OR “Re-employment” OR “Unemployment”

Results0 hits

8.Greyliteraturewww.opengrey.euDatesearchedOctober 30th 2017

SearcherRB

Strategy(“brain infarction” OR “brain ischaemia” OR “brain ischemia” OR “cerebral ischaemia” OR “cerebral ischemia”OR “ischaemic cerebrovascular accident” OR “ischaemic CVA” OR “ischaemic stroke” OR “ischemic CVA” OR “ischemic stroke”) AND “Return to work” OR “Return-to-Work” OR “RTW” OR “Returning to work” OR “Back to work” OR “Back-to-work” OR “Work resumption” OR “Stay at work” OR “Stay-at-work” OR “Staying at work” OR “Employment” OR “Re-employment” OR “Unemployment”)

Results3 hits

AgencyforHealthcareResearchandQuality(AHRQ,https://www.ahrq.gov/)DatesearchedOctober 30th 2017

SearcherRB


54

Strategy(“brain infarction” OR “brain ischaemia” OR “brain ischemia” OR “cerebral ischaemia” OR “cerebral ischemia”OR “ischaemic cerebrovascular accident” OR “ischaemic CVA” OR “ischaemic stroke” OR “ischemic CVA” OR “ischemic stroke”) AND “Return to work”

Results3 hits

9.ForwardandbackwardreferencesearchingScreening the reference lists of all relevant publications, exploration of all citing articles (Web of Science) and linkage of related publications (MEDLINE) resulted in 1123 records, including 315 duplicates. None of the 808 unique records met the prespecified selection criteria.


55

Supplement3–Formforevaluationofrecords

Reviewer name: _______________________

Review date: __ / __ / __

Reference of report (First author, year publication): ____________________

Record selection criteria:

1. Does the publication report on patients with ischaemic stroke?

o No -> exclude

o Partially -> explain:

o Yes

2. Are the patients of aged 18 years or older?

o No -> exclude


o Unclear -> explain:

o Yes

3. Is this an interventional study (i.e. an active manipulation of the environment, behaviour or disease with the intention to improve or promote health)?

o No -> exclude



o Yes

4. What is the study design?

o Cross-sectional study (i.e. surveys looking at present situation only) -> exclude

o Prognostic study (i.e. evaluating prognostic factors only) -> exclude

o Case report -> exclude


o A1: Randomized controlled trial that meets both following criteria:


56

Random assignment of the study participants to intervention(s)

Description of the randomisation procedure




o A3: Time-series that meets both following criteria:

Intervention group only (no control group)

Outcome measurements at least three times before and three times after the intervention

o A4: Before-after comparison without a concurrent control group, quality of care studies, comparison with arbitrary controls that meets any of the following criteria:

Outcome measurements before and after the intervention only

For patients it can be after measurement only; a measurement before the intervention is not required (i.e. a patient series)

5. What is the comparison in the study?

o No comparison

o No intervention

o Sham intervention

o Other type of intervention aiming to improve return to professional activity. Specify:

6. What is (are) the relevant outcome parameter(s)?

o No relevant outcome parameter -> exclude

o Proportion of patients that returned to professional activities:

o Time interval between stroke onset and return to professional activities:

o Proportion of patients that successfully maintained professional activities over time:

o Time spent off work or being on sick leave:

o Score on a work ability scale:

o Other:


57

Remarks

Conclusion

o Include the record for analysis of full-text paper (study meets all six mandatory criteria)

o Exclude the record; reasons for exclusion are:


58

Supplement4–Dataextractionandassessmentform

Name data extractor: _______________________

Date form completed: __ / __ / __

Reference of report (First author, year publication, country): ____________________

Study population:

1. Does the publication report on patients with ischaemic stroke?

o No -> exclude


o Yes -> clarify diagnostic criteria

2. Are the patients of age 18 or older?

o No -> exclude



o Yes

Intervention

3. Is this an interventional study (i.e. an active manipulation of the environment, behaviour or disease with the intention to improve or promote health)?

o No -> exclude



o Yes -> describe the intervention:

Study type and design

4. What is the study design?


59

o Cross-sectional study (i.e. surveys looking at present situation only) -> exclude

o Prognostic study (i.e. evaluating prognostic factors only) -> exclude

o Case report -> exclude


o A1: Randomized controlled trial that meets both following criteria:

Random assignment of the study participants to intervention(s)

Description of the randomisation procedure




o A3: Time-series that meets both following criteria:

Intervention group only (no control group)

Outcome measurements at least three times before and three times after the intervention

o A4: Before-after comparison without a concurrent control group, quality of care studies, comparison with arbitrary controls that meets any of the following criteria:

Outcome measurements before and after the intervention only

For patients it can be after measurement only; a measurement before the intervention is not required (i.e. a patient series)

5. What is the comparison in the study?

o No comparison

o Sham intervention

o Other type of intervention aiming to improve return to professional activity. Specify:

6. Start and end date of the study - study duration:

7. Study population:


60

o Sample size:

o Mean age (standard deviation):

o Stroke latency:

o Residential status:

o Stroke severity:

Outcome

8. What is (are) the relevant outcome parameter(s)?

o No relevant outcome parameter -> exclude

o Outcome measured at a population level or individual level?

o Proportion of patients that returned to professional activities:

o Time interval between stroke onset and return to professional activities:

o Proportion of patients that successfully maintained professional activities over time:

o Time spent off work or being on sick leave:

o Score on a work ability scale:

o Other:

Risk of bias

9. For assessment of the risk of bias in randomised controlled trials use the RoB 2.0 tool: Higgins 2016 (https://sites.google.com/site/riskofbiastool/welcome/rob-2-0-tool )

10. For assessment of the risk of bias in non-randomised studies use the ROBINS-I tool: Sterne 2016 (https://sites.google.com/site/riskofbiastool/welcome/home )

Socio-demographic characteristics of the study population (PROGRESS)

11. Socio-demographic characteristics at baseline:

o Place:

o Race:

o Age:


61

o Occupation:

o Gender:

o Religion:

o Educational level:

o Socio-economic status:

o Social status:

12. Did the intervention include particular strategies to address diversity or disadvantage?

o No

o Yes:

Health economic evaluation

13. Was the cost of the intervention evaluated?

o No cost evaluation

o The costs of the intervention(s) are reported:

o The cost-effectiveness, cost-utility or cost-benefit of the intervention(s) are reported:

Remarks

Conclusion

o Include in review (study meets all mandatory criteria)

o Exclude from review; reasons for exclusion are:


62

SupplementTable1–Excludedstudies

Reference Full citation Primary reason for exclusion

Autret 2015

Autret K, Zouker J, Albanese JB, Berthier T, Durufle A, Le Meur C, et al. Return to work after brain injury: a retrospective study of 85 patients followed by an occupational reintegration unit. Annals of physical and rehabilitation medicine 2015;58(5):308-11

Study population

Breen 2017

Breen J, Andrusin J, Ferlito T, Hobbs S. Characteristics and estimated rehabilitation costs for stroke survivors treated in a community-based interdisciplinary outpatient rehabilitation program who return to work. Stroke 2017;48.

Study population

Daniel 2009

Daniel K, Wolfe CD, Busch MA, McKevitt C. What are the social consequences of stroke for working-aged adults? A systematic review. Stroke 2009;40(6):e431-40.

Study population

Harris 2014

Harris C. Return to work after stroke: a nursing state of the science. Stroke 2014;45(9):e174-6

Study design

Saeki 2016 Saeki S, Matsushima Y, Kato N, Itoh H, Shiraishi J. Comparison of the Time Course of Return to Work After Stroke Between Two Cohort Studies in Japan. Journal of UOEH 2016;38(4):311-5.

Study population

Treger 2007

Treger I, Shames J, Giaquinto S, Ring H. Return to work in stroke patients. Disability and rehabilitation 2007;29(17):1397-403.

Study population

Trexler 2010

Trexler LE, Trexler LC, Malec JF, Klyce D, Parrott D. Prospective randomized controlled trial of resource facilitation on community participation and vocational outcome following brain injury. The Journal of head trauma rehabilitation 2010;25(6):440-6.

Study population

Wei 2016 Wei XJ, Liu XF, Fong KNK. Outcomes of return-to-work after stroke rehabilitation: a systematic review. British Journal of Occupational Therapy 2016;79(5):299-308.

Study population

Wozniak 2002

Wozniak MA, Kittner SJ. Return to work after ischemic stroke: a methodological review. Neuroepidemiology 2002;21(4):159-66.

Study design

________________________________

ACKNOWLEDGEMENTS _________________________________________

64

The results presented in this master thesis are not accomplished by a single researcher but are the product of assiduous scientific collaboration.

Prof. Dr. Verlooy, a special word of gratitude for your contribution to this thesis. To my opinion, you have perfectly kept in balance the promotor’s roles to guide yet not force the process, to regularly and casually inquire about progress yet not suffocate or pressurize its natural course. Thank you for the privilege to freely investigate this topic and for the time to acquire insights in previously unexplored methodological techniques at my own pace.

Alexis, who dared to predict some eight years ago that Fate’s twists and turns would lead us trough the fantastic journey we experienced? Only to find ourselves saying goodbye in the surreal situation where we simultaneously write the concluding words on our theses. Surely you will agree that neither of us expected you would ever consider writing a PhD thesis, no more than we would have believed that I would consider taking the path of this postgraduate study. Most of the joy writing this thesis, I derived from receiving your practical advice, examples and well-considered opinions. They are the living proof of the exquisite progress you made, also in purely scientific domains that initially were somewhat alienating to you. I wish you all the best exploring the new challenges that are unfolding for you and I look forward to the next crossing in our paths.

Dear Lisa, you initiated me in the mysteries of ‘PRISMA guidelines’, ‘EMTREE terms’, the ‘PROSPERO register’ and the like. I have spent days reading and studying your documentation on how to correctly plan and execute a Cochrane review. Thank you for providing this information, but most of all to set the standards high regarding the methodological execution of the review. I have gathered new insights in standardized searches, statistical techniques and dedicated software programs. Your passion to always strive to fully comprehend the topic at hand and to apply the highest methodological standards is inexhaustible and surely will be the motor of many more impressive achievements to come.

Last but not least, Maarten, we go back a long way… We could reiterate the story on the showers etc. but that may not be appropriate in this context. Thank you for introducing me to this postgraduate course and for the support in the darkest hours.

All things are difficult before they are easy (Thomas Fuller)

interventions to promote work participation after...

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