Return to work after stroke: a nursing state of the science.

T here is a lack of research related to return to work (RTW) after acute ischemic stroke. Historically considered a disease of the elderly, acute ischemic stroke studies have not routinely used RTW as an outcome. Major stroke trials have not routinely collected these data as an end point. However, the mean age for acute ischemic stroke (AIS) has declined to 69 years of age, whereas the incidence in patients aged <55 years has increased to 19%. Changes in retirement age have also affected RTW as a consideration in patients with stroke. Failure to RTW after recovery from AIS has been associated with negative health outcomes such as increased cardiac disease , depression, and higher rates of mortality and social consequences such as isolation and poor coping ability. 4 RTW has not been extensively studied in the AIS population. However, with an aging, yet active population and an increased awareness of AIS in younger patients, the relevance of RTW is becoming increasingly important. According to current research, ≤50% of stroke survivors are likely to RTW if they can walk, their cognition is relatively intact, they were previously used, are younger than the mean age, and have a white-collar position. The physical, psychological, social, financial, and economic consequences associated with loss of productivity for patients with AIS and their caregivers are reported to cost billions of dollars each year. 10 With an increasing prevalence of survivors, the ability to RTW has gained significant importance as an area for further research. The purpose of this review was to provide nurses working with patients with stroke empirical evidence related to RTW outcomes. The evidence used came from current studies of AIS from January 2008 to May 2014. This time frame was used to capture the most recent evidence-based practice and research studies that would build on top of the systematic review previously done, including years 1962 to 2007. A literature search of the databases MEDLINE and Cumulative Index of Nursing and Allied Health Literature was performed using the process as defined by Whittemore and Knafl. 12 The following key words were used: employment, return to work, stroke, acute ischemic stroke, cerebral infarction, and outcomes for years 2008 to 2014. References were cross-checked from studies that were selected to find research that might fit the criteria for evaluation. Selection criteria included primary studies on RTW outcomes after acute ischemic stroke and English language. Studies …