Return to work after major trauma: a systematic review.

Introduction: Individuals suffering from major trauma and survive, often face diverse physical, psychological, and cognitive restrictions which can influence the (health-related) quality of life and the ability to work. Even though, return to work is not necessarily related to the health status of the individual, but it is viewed as a sign of successful reintegration and is a vital parameter of recovery.

Objective: The aim was to systematically review factors influencing return to work (RTW) after suffering from major trauma.

Material and methods: A search on seven databases was performed. The identified publications were selected according to the inclusion criteria: adults (≥ 16 years) who suffered a major trauma (Injury Severity Score ≥ 16) in studies that explored factors associated with RTW. Risk of bias was assessed with the 'Quality in Prognostic studies' tool. Due to reporting quality of the included studies no meta-analysis was performed. Data were clustered, qualitatively analyzed and factors are assessed based on the strength of evidence. (PROSPERO registration: CRD42022357649).

Results: 12 studies with 6907 participants (mean age 45 years, 75% males, mean ISS 28) were included. The included studies had low to moderate risk of bias for most domains, the domain 'study confounding' had most often a high risk of bias. Many factors were identified including physical (e.g., injury locations), personal (e.g., age) but also environmental factors (e.g., preinjury income). Only four factors (age, educational level, intensive care unit (ICU) stay and Length of stay (LOS) hospital) are based on moderate or strong evidence. The identified factors reflect the complex interactions within the process of regaining the ability to work after major trauma.

Discussion: This systematic review was able to map the evidence surrounding factors affecting RTW after major trauma. Most of the identified factors are currently only based on limited evidence. According to these factors, younger patients with a higher educational level who have a shorter LOS in hospital and a shorter ICU stay might have better chances of RTW.