title: What are the social consequences of stroke for working-aged adults? A systematic review.
abstract: OBJECTIVE
  Approximately one fourth of strokes occur in people aged <65 years. UK current policy calls for services that meet the specific needs of working-aged adults with stroke. We aimed to identify the social consequences of stroke in working-aged adults, which might subsequently inform the development and evaluation of services for this group.
  
  
  METHODS
  We reviewed quantitative and qualitative studies identifying social consequences for working-aged adults with stroke using multiple search strategies (electronic databases, bibliographic references, hand searches). Social consequences were defined as those pertaining to the World Health Organization International Classification of Functioning, Disability and Health domain "participation." Two authors reviewed articles using a standardized matrix for data extraction.
  
  
  RESULTS
  Seventy-eight studies were included: 66 were quantitative observational studies, 2 were quantitative interventional studies, 9 were qualitative studies, and one used mixed methods. Seventy studies reported data on return to work after stroke with proportions ranging from 0% to 100%. Other categories of social consequences included negative impact on family relationships (5% to 54%), deterioration in sexual life (5% to 76%), economic difficulties (24% to 33%), and deterioration in leisure activities (15% to 79%).
  
  
  CONCLUSIONS
  Methodological variations account for the wide range of rates of return to work after stroke. There is limited evidence of the negative impact of stroke on other aspects of social participation. Robust estimates of the prevalence of such outcomes are required to inform the development of appropriate interventions. We propose strategies by which methodology and reporting in this field might be improved.
authors.affiliation: King's College London, Division of Health and Social Care Research, 42 Weston Street, London SE1 3QD, UK. katie.daniel@kcl.ac.uk
authors.forename: Katie
authors.initials: K
authors.lastname: Daniel
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
authors.forename: Markus A
authors.initials: MA
authors.lastname: Busch
authors.forename: Christopher
authors.initials: C
authors.lastname: McKevitt
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003627:Data Interpretation, Statistical; D004185:Disability Evaluation; D004651:Employment; D005195:Family Relations; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D019529:Sexuality; D012919:Social Behavior; D020521:Stroke / Q000191:economics* / Q000453:epidemiology* / Q000523:psychology; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult