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PubMed1978

The clinical and economic effects of early return to work after elective inguinal hernia repair.

Since 1 January 1976 male patients of four consultant surgeons undergoing elective repair of a unilateral inguinal hernia have been included in a trial to see if 'early' return to work or normal activity is associated with an increased recurrence rate and also to investigate any economic consequences. To date 295 patients have been entered into the trial and the first 150 have been reviewed at 1 year. There was a complete follow-up at 1 year. There was 1 recurrence (0.7 per cent) at 1 year, and this had occurred by the time the patient came to the clinic to be included in the trial. Patients supervised by their general practitioner were off work for 78.5 days, while those advised to return to work early were off work for 52.1 days. This difference of 25.4 days is significant at the 0.1 per cent level. Loss of earnings while off work was reported by 36.7 per cent of patients, and the average sum lost was 19.86 per week. Thus, patients lost 72.06 on average. If patients went back to work at 52 days instead of at 78 days, the benefit to the economy would be of the order of 7 m., and this 'early' return to work is not associated with an increase in the recurrence rate at 1 year.

Convalescence↗
PubMed2005

Evaluation of effective return-to-work treatment programs for sick-listed patients with non-specific musculoskeletal complaints: a systematic review.

OBJECTIVE: This systematic review seeks to gain insight into the effectiveness of return-to-work treatment programs among sick-listed patients with non-specific musculoskeletal complaints. The focus here lies on the composition of effective treatment programs, itemized for regional non-specific musculoskeletal complaints. METHODS: A systematic literature search was performed and methodological quality criteria were applied. RESULTS: Eighteen high quality articles were selected, which reported on a combined total of 22 treatment programs, including a total of 3,579 participants. Of these 22 treatments programs, seven experimental treatments (32%) resulted in faster return to work compared to the control treatment. None of the studies reviewed reported negative findings. What appeared to be essential to effective treatment was knowledge conditioning, psychological, physical and work conditioning, possibly supplemented with relaxation exercises. Most of the high quality studies (64%) reported on a low back pain population. CONCLUSION: The findings were inconsistent regarding the effectiveness of treatment programs in enabling sick-listed patients with non-specific musculoskeletal disorders to return to work. Except for low back pain, none of the studies explicitly itemized the effects of treatment programs on return to work by regional musculoskeletal disorders, such as upper extremity musculoskeletal disorders.

Humans↗
PubMed2002

Return to work following vocational rehabilitation for neck, back and shoulder problems: risk factors reviewed.

PURPOSE: The present aim was an overview of factors associated with return to work following vocational rehabilitation for problems in the neck, back, and shoulders. METHOD: Studies were identified through a systematic keyword search in databases. For inclusion, return to work had to be in focus and studies to have been published between 1980 and 2000. RESULTS AND CONCLUSION: A great number of demographic, psychological, social, medical, rehabilitation-related, workplace-related and benefit-system-related factors are associated with return to work. The different types of risk factor are associated in many ways. People with greater chances of job return after vocational rehabilitation are younger, native, highly educated, have a steady job and high income, are married and have stable social networks, are self-confident, happy with life, not depressed, have low level of disease severity and no pain, high work seniority, long working history and an employer that cares and wishes them back to the work place. Unfortunately, people with the above profile are seldom found among the long-term sick.

Back Injuries↗
PubMed1980

[Return to work after reconstructive arterial surgery (author's transl)].

The authors studied the conditions of the return to work of 65 patients, with a maximum age of 55 years, after reconstructive arterial surgery. Of the 51 patients who were working at the time of the operation, 46 (90.2%) had started working after an average period of 97 days, but only one of the patients who were no longer working started work after the operation. If the nature and more especially the site of the operation is analyzed, the highest level of return to work was after aorto-iliac surgery (96,4%), with a lower level (81%) after femorotibial operations. In a small group of 6 patients operated upon for aneurysms (of which 5 were aneuryms of the abdominal aorta), 4 had started work again, but after a longer period of 4 months on average. These results are compared with those obtained by a British team in Newcastle (Waters, Proud, and Chamberlain) who conducted a similar study in 1977. These overall results prove that reconstructive arterial surgery is favourable from the social and occupational point of view, as very large proportion of the operated patients continue working, and some of them start work again after having stopped their occupation before the operation.

Adult↗
PubMed2006

Determinants of "return to work in good health" among workers with back pain who consult in primary care settings: a 2-year prospective study.

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.

Adaptation, Psychological↗
PubMed2004

Return-to-work interval and surgery for carpal tunnel syndrome. Results of a prospective series of 233 patients.

AIM OF THE STUDY: To evaluate the connection between the type of patient insurance and the time taken to return to work after carpal tunnel surgery. PATIENTS AND METHODS: Two hundred and thirty-three patients in full-time work were operated on for carpal tunnel syndrome between 1 January and 30 June 1998. They were divided into three groups: independent workers (n=87), wage earners in the private sector (n=90) and civil servants (n=56). Four categories were defined: manual workers, non-manual workers, patients with social security insurance and patients with workers compensation. The average return-to-work interval after surgery for each of the groups was evaluated and compared group by group. RESULTS: For independent workers the average time off work is 17 days, for those in the private sector it is 35 days, and for civil servants it is 56 days. Patients with social security insurance were off work for 32 days and those with workers compensation for 49 days. DISCUSSION: The comparison shows significant differences with regard to social security insurance: the return-to-work interval in civil servants is larger than for private sector workers, and this is higher than in independent workers. The difference between patients with workers compensation and those with social security insurance is 17 days and significant. There is a significant difference between manual and non-manual workers in independent and private sector workers. There is no significant difference between the sub-groups in the civil servants. These cross references enable us to work out the influence that social security status has on the return-to-work time following surgery.

Adolescent↗
PubMed2001

Is participation in cardiac rehabilitation programs associated with better quality of life and return to work after coronary artery bypass operations? The Israeli CABG Study.

OBJECTIVE: To explore the putative effect of cardiac rehabilitation programs on the 'health-related quality of life' and 'return to work' in pre-retirement patients one year after coronary artery bypass grafting. METHODS: Of the 2,085 patients aged 45-64 who survived one year after CABG and were Israeli residents, 145 (6.9%) had participated in rehabilitation programs. Of these, 124 (83%) who answered QOL questionnaires were individually matched with 248 controls by gender, age within 5 years, and the time the questionnaire was answered. All patients had full clinical follow-up including a pre-operative interview. The Short Form-36 QOL questionnaire as well as a specific questionnaire were mailed to surviving patients one year after surgery. Study outcomes included the scores on eight scales and two summary components of the SF-36, as well as 'return to work' and 'satisfaction with medical services' from the specific questionnaire. Analysis was done for matched samples. RESULTS: Cardiac rehabilitation participants had significantly higher SF-36 scores in general health, physical functioning, and social functioning. They had borderline significant higher scores in the physical summary component of the SF-36. The specific questionnaire revealed significantly better overall functioning, higher satisfaction with medical care, and higher rate of return to work. While participants in cardiac rehabilitation and their controls were similar in their socio-demographic and clinical profiles, participating patients tended to be more physically active and more fully employed than their controls. CONCLUSIONS: Rehabilitation participants had a self-perception of better HRQOL, most significantly in social functioning. Our findings of more frequent return to work and higher satisfaction with medical care should induce a policy to encourage participation in cardiac rehabilitation programs after CABG.

Case-Control Studies↗
PubMed2004

The worker role interview--preliminary data on the predictive validity of return to work of clients after an insurance medicine investigation.

The aim was to investigate the predictive validity of the Worker Role Interview (WRI) for return to work at a 2-year follow-up of clients who attended an insurance medicine investigation center. The WRI identifies psychosocial and environmental factors that influence a person's abilities to return to work. Forty-eight of 202 consecutively selected clients constituted the study group. The Mann-Whitney U test was used to test the statistically significant differences in WRI ratings between those who were working (n = 6) and those who were not (n = 42) 2 years after their investigations. Five of the 17 items in WRI had a tentative predictive validity of return to work. The content area "personal causation" in WRI, had the best predictive validity. The results emphasize the importance of considering the unique individual's beliefs and expectations of his/her effectiveness at work when assessing clients' work ability and planning for further rehabilitation.

Adult↗
PubMed1987

Psychological predictors for return to work after a myocardial infarction.

The relationships between a return to work (RTW) 6 months after a myocardial infarction and selected personality traits, emotional reactions, health knowledge and beliefs, expectations and global health perceptions have been examined in a prospective study of 249 patients below 67 yr of age. Patients' in-hospital expectations of their future work capacity proved to be a strong predictor for RTW. In addition, level of anxiety and depression during hospitalization and level of cardiac lifestyle knowledge were independently associated with RTW. These effects could not be explained by demographic, work-related, or medical factors. It is concluded that patients' early illness perceptions and affective reactions influence later work resumption. Outcome-specific expectancy measures may be the most effective methods for early identification of patients needing rehabilitation efforts after an acute somatic disease.

Adaptation, Psychological↗
PubMed1984

Return to work after coronary angioplasty: a report from the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.

Employment status was analyzed in 2,250 patients enrolled at 65 clinical centers in the NHLBI PTCA Registry. Patients were classified into 3 groups depending on the outcome of PTCA. In 63.6%, PTCA was successful without MI or CABG (Group A); in 25.3%, PTCA was unsuccessful and was followed by CABG (Group B); and in 11.1%, PTCA was unsuccessful and was followed by medical therapy alone (Group C). At entry, 68.3% of all patients were employed full- or part-time. The clinical characteristics of the 3 groups were different. Patients in Group C had a higher incidence of previous MI and previous CABG. In addition, patients in Group C had a significantly decreased baseline employment rate compared with those in Group A. At a mean follow-up of 1.5 years, there was a small but similar decrease in the percentage employed full- or part-time in all groups. Employment status also was analyzed in a subset of 1,150 patients working full- or part-time at baseline and aged 60 years or younger, who would be expected to have the highest return to work rates. At a mean follow-up of 1.4 years, 81 to 86% of patients remained working irrespective of the outcome of PTCA. However, patients with successful PTCA returned to work significantly sooner. The occurrence of chest pain during follow-up in these patients was an important predictor of return to work, irrespective of the outcome of dilatation. In patients with chest pain during follow-up, only 77% were working, compared with 90% of patients who had not had chest pain.

Angioplasty, Balloon↗
PubMed1993

Intramedullary nailing of femoral shaft fractures: reoperation and return to work.

OBJECTIVE: To define the functional outcome and residual disability in adults treated for isolated femoral shaft fractures. DESIGN: A retrospective case study of HMRI records. The mean follow-up was 34.5 months from the time of injury. SETTING: A tertiary-care teaching hospital. PATIENTS: One hundred and thirty adults with femoral shaft fractures. Of these, 47 were isolated and qualified for study. INTERVENTIONS: Primary reamed intramedullary nailing performed between April 1987 and September 1990. MAIN OUTCOME MEASURES: Reoperation and return to work. RESULTS: Of the 47 patients, primary healing occurred in 41 (87%) patients; 6 (13%) patients had delayed union or nonunion. Twenty (43%) patients had delayed implant-related pain after fracture healing; 85% of these had relief of pain after implant removal. Of 41 patients available for analysis of function based on return to work, 33 (80%) had returned to work full time in their original occupation at the time of follow-up, and 4 (10%) were working in other full-time employment; 3 (7%) were working part time. Only one (2%) patient was disabled and unable to work. CONCLUSIONS: Primary reamed intramedullary nailing is an effective method of achieving consistent primary union in adults with femoral shaft fractures. However, the majority of patients will require secondary surgery. Most patients will be able to return to work after these injuries.

Adult↗
PubMed1997

Acute predictors of successful return to work 1 year after traumatic brain injury: a multicenter analysis.

OBJECTIVE: To investigate the influence of acute injury characteristics on subsequent return to work in traumatic brain injury (TBI) patients. DESIGN: Descriptive statistics were performed in a comparative study of 49 TBI patients who were competitively employed at 1-year follow-up and 83 unemployed patients. Independent t tests were then performed to examine the differences between the two groups on specific measures including the Disability Rating Scale (DRS), Functional Assessment Measure (FIM), Rancho Los Amigos Scale (RLAS), Glasgow Coma Scale (GCS), Neurobehavioral Rating Scale (NRS), and neuropsychological test results. SETTING: Four medical centers in the federally sponsored Traumatic Brain Injury Model Systems Project that provide emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services. PARTICIPANTS: Patients were selected from a national database of 245 rehabilitation inpatients admitted to acute care within 8 hours of TBI and seen at 1-year follow-up. MAIN OUTCOME MEASURE: Return to work at 1-year follow-up. RESULTS: Persons employed at 1-year follow-up obtained significantly better scores on specific acute measures of physical functioning (Admission FIM, Admission DRS, Discharge DRS), cognitive functioning (Logical Memory Delay), behavioral functioning (Admission RLAS, Discharge RLAS, NRS Excitement factor), and injury severity (Admission GCS, Highest GCS, Length of Coma, Length of PTA) than their unemployed counterparts. CONCLUSIONS: Persons obtaining better scores on certain acute measures (e.g., Admission GCS) are more likely to return to the workforce. Future research should focus on developing a standardized tool to assess a patient's ability to return to work, as well as an operational definition for successful employment.

Adult↗
PubMed1993

Return-to-work experiences of people with cancer.

Maintaining employment after a cancer diagnosis and even during therapy is becoming a major challenge for an increasing number of individuals. The purpose of this study was to further understanding of the experience of returning to work after a cancer diagnosis by discovering the nature and processes of the experience's dimensions. This exploratory, longitudinal study systematically analyzed the dimensions of the return-to-work experience that were evident in data from 19 unstructured interviews. Grounded theory methods of study design and constant comparative analysis guided the interviews and data analysis. The core social process suggested by the data is one of mobilizing social support in the work environment. The inceptive theory explains and delineates steps in a process that ultimately facilitates a person's reintegration of normal activities after a cancer diagnosis. The added understanding available in these results can guide nurses to focus not only on related dimensions of the return-to-work experience, such as time off for treatment, but on central concerns, such as the social benefits of returning to work.

Activities of Daily Living↗
PubMed2006

[Return to work after acute myocardial infarction].

OBJECTIVES: The aim of this work was to study the professional repercussions of acute myocardial infarction and to analysis medical, social and occupational factors which could influence return to work. MATERIAL AND METHODS: Our study concerns 70 patients less than 66 years old, working before their hospitalization and having been admitted for acute myocardial infarction between January 1-st, 1999 and December 31, 2000 in the Department of Cardiac Resuscitation of hospital La Rabta of Tunis. Data were collected from retrospective review of folders and answers to a questionnaire for which the patients have been summoned in 2002. RESULTS: There were 70 patients almost exclusively men (n=69). The mean age was 49.0 +/- 6.8 years. The mean follow-up was 27.2 +/- 7.7 months. Sixty one patients (87.1%) have initially been back to work and eight of them lost it secondarily. The average delay of return to work has been 91+/- 111 days. The direct repercussions of myocardial infarction on the professional capacities was observed at the majority of patients. CONCLUSION: Despite an important professional repercussions of acute myocardial infarction, our study showed a high rate of return to work with relatively short delays.

Adult↗
PubMed2006

Pride, empowerment, and return to work: on the significance of promoting positive social emotions among sickness absentees.

Sickness absence is a great public health problem and there is a lack of knowledge concerning the hows and whys of success or failure in promoting return to work of sick-listed persons. Discussions of and research into social and psychological aspects of this problem area are in need of theoretical contextualisation. In this paper it is suggested that theories of social emotions may be useful, and that the concept of empowerment can be applied provided that it is reasonably well defined. The notions of pride/shame and empowerment are elucidated and discussed, and it is shown that they can be related in the context of research into emotional dimensions of sickness absentees' experiences of the rehabilitation process in a way that may help to guide empirical studies. A simple model of hypothetical relations between pride/shame, empowerment/disempowerment, work ability, health, and return to work is sketched.

Emotions↗
PubMed1996

Barefoot and in a German kitchen: federal parental leave and benefit policy and the return to work after childbirth in Germany.

"Since 1979 German federal maternity leave and benefit policy has given women incentives to stay at home and take care of their newborn and youngest children. In 1986 this leave and benefit policy was changed in several ways, turning it into a powerful instrument for delaying mothers' return to work after childbirth.... We estimate post childbirth return to work hazards for women during the federally protected leave protection period and immediately upon completion of this leave period. During the leave mothers are less likely to return to work the longer is the time left in the leave protection period; however, this result cannot be attributed generally to high levels of maternity benefits. When the leave protection period ends, mothers with strong labor force attachment who are still on leave return to their jobs."

Behavior↗
PubMed2006

Hemorrhoidopexy staple line height predicts return to work.

PURPOSE: Previous studies identified reduction in pain and complications with stapled hemorrhoidopexy relative to conventional hemorrhoidectomy. Previously, the presence of resected squamous epithelium and a staple line height <20 mm above the dentate line were predictive of postoperative pain. The purpose of this study was to further investigate and refine the role of staple height in the prediction of postoperative outcomes. METHODS: From July 2002 to October 2004, 75 patients with symptomatic Grade 3 and 4 mixed hemorrhoids underwent stapled hemorrhoidopexy in two teaching institutions with prospective data collection. All procedures were performed under the direct supervision of two colorectal teaching staff. The majority were performed under monitored anesthesia care as outpatient procedures. Preoperative, intraoperative, and postoperative patient characteristics were evaluated. This included demographics, staple line height, specimen histology, complications, days to return to work, duration of narcotic pain medicine, and preoperative/postoperative tone and seepage. The results were subjected to statistical analysis using t-test and ANOVA. RESULTS: Seventy-five patients with a median age of 49 (range, 25-87) years were identified. Histology identified 62 specimens with columnar and/or transitional cells, 10 with squamous epithelium, and 3 with muscle present. Overall complication rate was 14 percent. Complications included three readmissions for pain control, three acute postoperative anal fissures, two postoperative bleeds (with one requiring examination under anesthesia without intervention), one patient with subcutaneous emphysema, and one admission for fecal impaction. Staple line height was not a statistically significant predictor of postoperative complication. Median return to work was 14 (range, 1-31) days. Median duration of narcotic use was six (range, 0-40) days. Patients with a staple line height>22 mm required a significantly shorter duration of narcotic pain management (P=0.024). Median follow-up was 24 (range, 9-253) days. Staple line heights below 20 mm had a mean return to work of 15 days. A staple line height>20 mm had a mean return to work of nine days. Staple line height was inversely related to return to work (P=0.01). CONCLUSIONS: A hemorrhoidopexy staple line>or=22 mm above the dentate line correlates with a significantly shorter need for postoperative narcotics (P=0.024) and an earlier return to work (P=0.017). Staple line distance above the dentate line meaningfully impacts comfort-based outcomes.

Adult↗
PubMed1992

Return to work of road accident victims claiming compensation for personal injury.

Road accidents resulting in personal injury are an increasing cost to society. This study is based on 609 accident victims (of whom 521 survived injury) who were in employment when injured and whose claims for personal injury were settled for 5000 pounds or more by one insurance company over 2 years. It examines survivors' residual disablement, return to work and involvement with rehabilitation services. Data on a representative sample of 101 cases are analysed in more detail to identify possible 'predictors' of return to work. Both univariate and stepwise logistic regression analysis suggest that return to work is less associated with clinical variables, on which much medical advice on return to work is based, than with such other variables as time off work, absence of psychological problems and younger age. Very low rates of referral to rehabilitation may indicate that a rehabilitative approach to cost containment is underutilized in comparison with the traditional emphasis on preventive measures and enhanced medical treatment. More effective rehabilitation, however, may require new approaches to clinical case management, especially in orthopaedic departments where most personal injury claimants are treated.

Accidents, Traffic↗