Addressing work disability through vocational rehabilitation services.
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Arthritis↗
Biomedical subjects
P R Fine
Publications and source records attributed to P R Fine.
Barriers to return to work among persons unemployed due to arthritis and musculoskeletal disorders.
OBJECTIVE: To identify barriers to return to work (RTW) among persons likely to be seen in a clinician's practice who are unemployed due to arthritis and musculoskeletal disorders. METHODS: Two hundred eighteen persons unemployed due to arthritis and musculoskeletal disorders were interviewed at baseline and followed up for 1 year, at which time their work status was ascertained. Backward stepwise logistic regression was used to determine the association of baseline clinical, sociodemographic, and work-related factors to their work status at 1 year of followup. RESULTS: Fifty-one (24%) of 216 initially unemployed subjects had returned to permanent paid employment of > or = 20 hours/week after 1 year. Having rheumatoid arthritis, Social Security Disability Insurance (SSDI) status, a high pain level, older age, and lower education were barriers to reemployment. CONCLUSION: This study establishes the importance of chronic pain and having rheumatoid arthritis as factors independently associated with failure to RTW among persons unemployed due to arthritis and musculoskeletal disorders. The importance of SSDI beneficiary status, age, and education level in RTW is further confirmed. Duration of unemployment or previous work factors were not predictors of RTW in this group.
Adult↗
Factors influencing failure to return to work due to traumatic brain injury.
About 63% of all traumatic brain injuries (TBI) occur in teenagers and adults aged 15-64 years, the primary working population. Since reports of failure to return to work (FTRTW) vary, understanding the factors that influence FTRTW is key to improving work outcomes for this primarily working-age population. Our study sample consists of 343 previously employed persons who were hospitalized following TBI and had either returned to work at 1 year or had failed to return to work because of their injury (injury-related FTRTW). Medical records were reviewed and participants were interviewed by telephone at 1 year post-discharge. Individuals with injury-related FTRTW were far more likely to report dependence or modified independence on the Functional Independence Measure (FIM) than those who were employed at 1 year. The joint distribution of motor and cognitive items suggests that, for a given level of cognitive function, the addition of a motor limitation will result in greater injury-related FTRTW. In addition as motor function declines, FTRTW is further increased. Injury-related FTRTW is also associated with being unmarried and not completing high school. While the importance of behavioural, economic, and psychosocial factors should not be minimized, services aimed at improving function can be expected to have an impact on RTW after TBI.
Absenteeism↗
Factors associated with life satisfaction among a sample of persons with neurotrauma.
Factors were examined that are associated with life satisfaction one year post-discharge for persons with a spinal cord (SCI) or traumatic brain injury (TBI). Findings show persons with SCI or TBI should be considered as two distinct groups with regard to factors affecting life satisfaction. Different strategies might be considered to affect either group. Three psychosocial variables significantly increased life satisfaction for persons with SCI: closeness to family, the level of family activities, and blaming oneself for the injury. For persons with TBI, total family satisfaction, blaming oneself for the injury, being employed, being married, and having memory and bowel independence significantly increased life satisfaction. For persons with TBI, there was a difference in the number of factors affecting life satisfaction dependent on whether the persons blamed themselves or not. Those who do not blame themselves show a greater number of functional activities as indicators for their self-satisfaction.
Activities of Daily Living↗
Explaining quality of life for persons with traumatic brain injuries 2 years after injury.
OBJECTIVE: To model the complex effects of demographic, psychosocial, physical, and rehabilitation variables on quality of life 2 years after hospital discharge. DESIGN: Medical record and longitudinal survey data on traumatic brain injury (TBI) survivors who did or did not receive formal rehabilitation services after being injured were analyzed. SETTING: The study sample was selected from a representative sample of hospitals in north-central Alabama. PARTICIPANTS: Criteria for inclusion were: (1) 18 years and older with TBI; (2) discharged after hospital stay of 3 or more days; and (3) resided and injured in Alabama. There were 293 persons eligible for the 24-month follow-up survey, 186 (63%) of whom participated; the focus was on the 116 persons (of 186) who responded to the surveys themselves. MAIN OUTCOME MEASURE: A causal model of hypothesized direct and indirect effects of several variables on quality of life outcomes. RESULTS: Employment was the strongest contributor of improved quality of life. Persons unable to pay for health care showed less improvement in functional independence 12 to 24 months postinjury and reported a poorer quality of life. The psychosocial variables of self-blame and family support improved quality of life by reducing impairments and increasing the likelihood of employment. Family support also improved quality of life by increasing functional independence. Fewer physical impairments and gains in functional independence directly improved quality of life. CONCLUSION: The interrelationships between psychosocial and physical variables are important when examining quality of life. Interventions are recommended targeting psychosocial variables and functional independence in efforts to improve quality of life.
Adult↗
Musculoskeletal disability, employment, and rehabilitation.
OBJECTIVE: To determine which, if any, baseline social and disease characteristics can be used to identify persons with musculoskeletal disabilities accepted for state-federal vocational rehabilitation services who are most likely to return to work. METHODS: A database of case closures from the Alabama Vocational Rehabilitation Service was analyzed using segmentation modelling. This included all persons (n = 4093) with musculoskeletal disability who were accepted by the Alabama Vocational Rehabilitation Agency in 1987-91. Demographics, income, type of disability, severity of disability, medical insurance, similar benefits, benefit status, and referral source were independent variables. Outcome (dependent) variable was work status at end of agency services. RESULTS: Overall, 71% of persons with arthritis and musculoskeletal disorders who were accepted for vocational rehabilitation services in 1987-91 returned to work at the end of agency services. Segmentation modelling created a tree in which certain baseline characteristics formed subgroups with differing rates of successful rehabilitation. Social Security Disability Insurance (SSDI) status was the single best predictor of rehabilitation. Seventy-three percent of nonbeneficiaries were rehabilitated compared to 55% of beneficiaries (p < 0.00001). For non-SSDI beneficiaries, education level > or = grade 12 was associated with better rehabilitation outcome (p < 0.00001). SSDI beneficiaries with nonback disorders fared better than those with back disorders (p < 0.05). Disease severity, assessed by Federal Special Programs criteria, was not associated with rehabilitation outcome at any level of the tree. CONCLUSION: Simple baseline social and disease characteristics can be used to identify groups of persons accepted for vocational rehabilitation services with musculoskeletal disability with differing rates of vocational rehabilitation. Disability benefit status and education level are important predictors of return to work after agency services. These findings can lead to the development of strategies to improve the efficacy of vocational rehabilitation services.
Adult↗
Homicide among black males in Jefferson County, Alabama 1978-1989.
This study examined 1505 of 1573 (96%) homicides occurring in Jefferson County, Alabama, between 1978 and 1989, that were investigated by the Coroner/Medical Examiners' Office. During this 12 year period, Jefferson County's average annual homicide rate was 18.9 per 100,000 compared to an 11.3 per 100,000 State of Alabama's rate and a 9.3 per 100,000 US rate. In Jefferson County, the average annual homicide rate among blacks (41.4) was almost six times the rate among whites (7.1). The highest average annual race-specific homicide rate was in black males (75.9), followed by black females (12.4), white males (10.4) and white females (4.1). Black males in the 25-34 year age group had the highest rate (159.7), followed by black males in the 35-44 year age group (151.7) and then by black males in the 15-24 year age group (96.2). These rates ranged from almost eight to over eleven times the rates of similarly aged, black females or white males and were over 33 times higher than the rates for white females of the same age. Our results emphasize the high rates of black male on black male violence, the acquaintance of the black male victim and perpetrator, and the importance of arguments as an inciting event. Moreover, we determined that while the raw numbers and rates for black homicides were and are staggering, the average annual homicide rate for black males was actually declining at a greater rate than for all other race-sex groups. Further, our results suggest that a number of hypothesized determinants commonly believed to be associated with the increase in the homicide rate among black males between 15 and 24 years of age, such as drug use, increased availability of firearms and increased child abuse were not, in fact, major determinants of the change in homicide rates.
Adolescent↗
Social and physical factors in the referral of people with traumatic brain injuries to rehabilitation.
Using standardized data abstracted from a representative sample of hospitals in north-central Alabama, we analyze significant social and physical factors in acute care discharge referral patterns for 756 people with traumatic brain injury (TBI). When a Physical Medicine and Rehabilitation specialist is involved in the referral, patients receive more formal rehabilitation care following discharge, even after controlling for the relevant social and physical characteristics of the patient. Other significant variables predicting the level of rehabilitation care include presence of injury-related complications, abnormal computed tomography scan, longer length of acute care stay, being unmarried, older, and having an unintentional injury. Patients not seen by rehabilitation medicine specialists and/or those whose injuries provide less clinical evidence (implying greater uncertainty of diagnosis) are less likely to be referred to more formal rehabilitation. Thus, social and demographic factors may be significant in referral patterns when diagnostic uncertainty is present. Results suggest the importance of increasing availability of rehabilitation medicine consultation for TBI patients, while informing acute care providers about formal rehabilitation as a management option.
Adult↗
Vocational rehabilitation for persons with arthritis and musculoskeletal disorders: fact or fantasy?
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Arthritis↗
Fatal incidents involving pickup trucks in Alabama.
Death or injury resulting from crashes involving light trucks (ie, pickup trucks) is a significant problem. Data show that fatal crashes and occupant fatalities involving light trucks have steadily increased since 1983. This project describes vehicle crashes involving passengers riding in the beds of pickup trucks. Actual crashes were identified through the Fatal Accident Reporting System (FARS) of the National Highway Traffic Safety Administration. The 40 incidents studied involved 204 pickup truck passengers. Of these, 45 were killed, 107 sustained visible injuries or were carried from the scene, 6 had bruises and abrasions, and 2 had no visible injury but were briefly unconscious or had a documented complaint of pain. The risk of death among pickup truck passengers who were fully ejected from the vehicle was nearly six times that of passengers not fully ejected. Correspondingly, the risk of ejection from the truck was 26.7 times greater among occupants riding in the bed than occupants riding in the cab.
Accidents, Traffic↗
The influence of age at time of spinal cord injury on rehabilitation outcome.
The purpose of this study was to compare the experiences of older and younger patients with spinal cord injury. Data from 866 patients hospitalized between 1973 and 1985 were analyzed by age at injury. Outcomes were measured at discharge and 2 years after injury. Patients who were at least 61 years of age were 2.1 times more likely to have developed pneumonia, 2.7 times more likely to have experienced a gastrointestinal hemorrhage, 5.6 times more likely to have developed pulmonary emboli, and 16.8 times more likely to have had renal stones prior to first definitive discharge than their 16- to 30-year-old counterparts. Patients who were at least 61 years of age were 3.9 times more likely to have been rehospitalized during the second postinjury year than patients in the 16- to 30-year-old age group; 2.1 times more likely to have required artificial ventilatory support prior to discharge; 22.7 times more likely to have been discharged to a nursing home; 71.8 times more likely to be in a nursing home 2 years after injury; and 7.3 times more likely to have used hired attendants during the second postinjury year. Two-year survival rates were 59% for patients aged 61 to 86 years and 95% for patients aged 16 to 30 years. Although the prognosis for most patients with spinal cord injury has improved in recent years, older patients still have a comparatively poor prognosis.
Adolescent↗
Benefits of early admission to an organised spinal cord injury care system.
Patients admitted to the University of Alabama Hospital between 1973 and 1985 were studied to determine the benefits, if any, of early admission to an organised, multidisciplinary spinal cord injury (SCI) care system. Patients admitted within 1 day of injury who received all subsequent care within the system were compared with patients who received their acute care services elsewhere and who were admitted to the system solely for rehabilitation. Both patient groups were comparable with respect to age, neurologic level and extent of spinal cord lesion, pre-existing major medical conditions, associated injuries, ventilator dependency and acute surgical procedure experience. Findings included statistically significant reductions in acute care and total lengths of stay coupled with a highly significant reduction in the incidence of pressure ulcers for patients admitted within 1 day of injury. Moreover, for patients admitted within 1 day of injury, mortality rates were lower than reported previously for patients not admitted to an organised SCI care system.
Adult↗
The relationship between sponsorship and rehabilitation outcome following spinal cord injury.
The effect of sources of support on rehabilitation outcomes of 866 patients treated at the University of Alabama at Birmingham Spinal Cord Injury Care System since 1973 was assessed using multiple linear and logistic regression. System admission was delayed for Medicaid beneficiaries, while patients who were responsible for at least a portion of their incurred charges were admitted sooner than other patients. Increased lengths of stay were noted among vocational rehabilitation clients and patients with either Workers' Compensation or private insurance coverage. Patients with Workers' Compensation also had significantly higher average hospital charges. Medicaid patients were more likely to be rehospitalised after discharge from rehabilitation. Vocational rehabilitation clients averaged fewer days in nursing homes after injury while Medicaid and Medicare patients experienced longer stays in nursing homes. We conclude that source of support has a significant impact on numerous measures of outcome.
Humans↗
Cause of death for patients with spinal cord injuries.
An epidemiologic study of 5131 patients sustaining spinal cord injuries between 1973 and 1980 was conducted to determine and characterize the leading causes of death in this population. Patients who were studied had been admitted to one of seven federally designated regional spinal cord injury care systems and they survived for at least 24 hours after injury. When follow-up was terminated, 459 patients (9%) had died. Overall, the leading cause of death was pneumonia, followed by other subsequent unintentional injuries and suicides. The highest ratios of actual to expected deaths were for septicemia, pulmonary emboli, and pneumonia. Pneumonia was the leading cause of death among quadriplegics and persons at least 55 years of age, while among paraplegics and persons who were less than 55 years of age, subsequent unintentional injuries and suicides were the leading causes of death. While there is conclusive evidence that mortality rates for spinal-cord injured persons have declined dramatically since the end of World War II, many cause-specific mortality rates remain substantially above normal.
Adult↗
Nutritional status during the acute stage of spinal cord injury.
This study was designed to help clinicians establish objective guidelines for meeting the nutritional requirements of spinal cord injury (SCI) patients during their initial hospitalizations. The nutritional status of 51 SCI patients treated between 1983 and 1986 was assessed at two, four, and eight weeks after injury. Nutrient deficiencies such as albumin (100% of patients), carotene (62%), transferrin (37%), ascorbate (25%), thiamine (24%), folate (20%), and copper (11%) were documented most frequently at two weeks postinjury. There was an average of 2.0, 1.6, and 1.2 nutrient abnormalities per patient at two, four, and eight weeks postinjury, respectively. Although most depressed nutrient parameters improved with time, diet-dependent plasma proteins such as albumin and transferrin remained low throughout the entire eight-week period. Mean body weight declined 1.3 +/- 3.9 kg during the first two weeks, 2.0 +/- 4.4 kg between two and four weeks, and 0.4 +/- 2.0 kg between four and eight weeks after injury. Significant findings also included a strong correlation between plasma albumin, ascorbate, and carotene levels and maximal inspiratory and expiratory pressure (p less than .05). Although nutrient status usually improved with time and was not definitely associated with an increased risk of secondary medical complications, prudence dictates that these deficiencies should be prevented by appropriate intervention.
Adolescent↗
Seven-year survival following spinal cord injury.
This retrospective study of 5131 persons who sustained a spinal cord injury between 1973 and 1980 sought to determine the overall seven-year survival rate and the effect of several prognostic factors on survival. All study subjects had been treated at one of seven federally designated Model Regional Spinal Cord Injury Care Systems and each had survived at least 24 hours after injury. The cumulative seven-year survival was 86.7%. Advancing age at time of injury and being rendered a neurologically complete quadriplegic were significant prognostic factors. The cumulative seven-year survival among neurologically complete quadriplegics who were at least 50 years of age when injured, was only 22.7%. Spinal cord injury mortality rates ranged from 3.26 to 20.78 times higher than corresponding rates for nonspinal injured persons. Although mortality rates for spinal cord injury patients have declined dramatically since World War II, life expectancies for these patients are still substantially below normal.
Adolescent↗
The epidemiology and economics of spinal cord injury.
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Adolescent↗
Prediction of pyelocaliectasis in follow-up of patients with spinal cord injury.
Two hundred and fifty spinal cord injury patients were studied on each of two occasions, 12 to 24 months apart, to determine which urological findings could be used to predict the subsequent development of clinically significant pyelocaliectasis. An equation was developed which correctly classified 90% of the patients who remained free of clinically significant pyelocaliectasis and 82% of the patients who subsequently developed clinically significant pyelocaliectasis. The statistically significant risk factors were renal calculi, bladder diverticula and a decrease in effective renal plasma flow. This study suggests that the presence of these risk factors warrants careful monitoring of renal function in these patients and appropriate management of bladder dysfunction.
Dilatation, Pathologic↗