Abstract
Purpose: To examine whether the effects of psychosocial and vocational interventions delivered in the first 3 mo post-acute myocardial infarction (AMI) are effective for improving work outcomes compared with other interventions.
Methods: A search was completed for English language publications up to March 2016 across 4 electronic databases and gray literature. Inclusion criteria were (1) psychosocial and/or vocational interventions; (2) adults 18 years or older with an AMI who were within the first 3 mo post-AMI; (3) randomized or clinically controlled trials; and (4) reporting of at least 1 return-to-work (RTW) outcome: including return to paid/unpaid employment, either full-time or part-time, to the previous job role or on modified duties. Studies were independently screened by 2 reviewers and graded using the Cochrane Collaboration tool for assessing risk of bias. A narrative synthesis and meta-analysis of the included studies was undertaken.
Results: Eighteen studies of varying quality were analyzed. Individually delivered psychosocial and vocational interventions may improve work rates at 3 mo (relative risk = 1.17; P = .05) when compared with usual care but there was no difference at 6 or 12 mo. People receiving group or individual psychological/vocational counselling returned to work 6.11 d sooner than those who received usual care (95% CI, -6.95 to -5.26; P < .001).
Conclusions: Although psychosocial and vocational interventions show promise in people within 3 mo of AMI, compelling evidence is still limited. There is a need for more detailed, high-quality studies with valid comparison groups and adequate follow-up.