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PubMed1988

Psychosomatic aspects of coronary artery bypass graft surgery. A prospective study of 101 male patients.

101 consecutive male patients were examined by means of clinical interviews and depression, anxiety, personality, psychometric and life stress tests. The examinations took place preoperatively, on the 9th postoperative day (average) and 7.5 months after surgery. The mean age of the patients was 52.2 years and the mean duration of CHD was 6.7 years. Prior to surgery 77% had experienced myocardial infarction and 85% belonged to NYHA class III or IV. 74% had a 3-vessel disease. When the NYHA classification was used as criterion for rehabilitation the result was excellent. Postoperatively 80% belonged to NYHA class I or II. Hospital mortality rate was 4% and one patient died from myocardial infarction prior to the final follow-up. Preoperatively 17% of the study group were working. 87% of the patients experienced negative effects on work life, caused by CHD. Postoperatively 33% worked regularly. The postoperative work situation correlated with the duration of preoperative unemployment (p less than 0.0001), the patient's own opinion about work return (willingness/unwillingness to return to work) (p less than 0.01), as well as with the amount of negative life stress experienced preoperatively (p less than 0.01). Only 13% of the series experienced positive effects on work life, caused by CABG surgery. The majority of the patients had experienced negative effects on social and economic life (51%), as well as on sexual life (70%), caused by CHD. After surgery improvements were noted by 36% on social life and by 27% on sexual life. 15% experienced impairment of sexual life postoperatively. According to the Beck Depression Inventory 29% showed depression preoperatively, and 10% postoperatively. The difference is significant (p less than 0.0001). Clinically the figures tended to be higher. The same tendency holds for anxiety scores as measured by the Hamilton anxiety scale. The incidence of postoperative psychoses was 35%. Higher age (p less than 0.01) and/or absence of psychosomatic diseases (p less than 0.05) correlated with higher frequency of psychoses. Even though cardiological rehabilitation according to the NYHA classification was excellent, 22% of the series did not think their expectations were fulfilled. Psychic and social rehabilitation was in several aspects unsatisfactory, and the patients did not seem prepared for this. The importance to consider rehabilitation from a psychosomatic standpoint is clearly shown. To predict the result of rehabilitation preoperatively is not possible.

Adaptation, Psychological↗
PubMed2004

Fractures of the calcaneum. A review of 70 patients.

We have assessed the long-term results after operative and non-operative treatment of undisplaced and displaced calcaneal fractures. At a mean of 6.5 years, we reviewed 70 patients with a calcaneal fracture who were divided into four groups: group 1, 18 patients with undisplaced fractures and a normal Böhler's angle (BA) who had been treated non-operatively; group 2, 23 with intra-articular fractures and a BA < 10 degrees who had been treated non-operatively; group 3, 13 with intra-articular fractures and a BA > 10 degrees who had been treated surgically; and group 4, 16 with intra-articular fractures and a BA < 10 degrees who had been treated surgically. The results were assessed by a clinical score considering pain, return to work, return to physical activity, change in shoe-wear and the requirement for subtalar arthrodesis. Patients with undisplaced calcaneal fractures had a good outcome. Those with displaced fractures treated surgically who presented at follow-up with a BA > 10 degrees had a satisfactory functional outcome and those with displaced fractures who had non-operative treatment had a poor outcome. The poorest outcome was consistently seen in patients who were treated operatively without restoration of BA. Open reduction and internal fixation of intra-articular calcaneal fractures can only be expected to benefit those patients in whom nearly anatomical reconstruction is obtained.

Adult↗
PubMed1992

Cardiac rehabilitation 1992.

The goal of cardiac rehabilitation is to optimize function through attention to the patient's medical needs, risk factors for recurrent events, physical reconditioning, and psycho-social needs. Medical needs include beta-adrenergic blocking agents and aspirin unless contraindicated, angiotensin converting inhibitors for left ventricular dysfunction, and relief of residual ischemia. Smoking, lipid abnormalities, physical inactivity, and hypertension remain important predictors of reinfarction and death and must be controlled. Obesity must be addressed because it exacerbates these problems. Therefore, the principles of behavior change should be applied to help patients control their risk factors and adopt healthy lifestyles. Smoking cessation and appropriate dietary behaviors can be adopted by the patient while in the hospital. Physical reconditioning can also begin with twice-daily exercises. After discharge from hospital and after an initial submaximal exercise evaluation, the patient will benefit from three sessions per week of outpatient cardiac rehabilitation for six to eight weeks. These sessions should last about an hour and raise the patient's heart rate as much as 30 beats per minute. Along with physical reconditioning, the cardiac rehabilitation program provides an opportunity to address risk factor modification, return to work, return to sexual activity, management of depression and anxiety, and the presence of risk factors in the patient's family. The patient should attend reinforcing sessions every three months for the first year and as necessary after that to control risk factors and reinforce the necessity for physical fitness.

Coronary Disease↗
PubMed1996

Open vs endoscopic carpal tunnel release.

We examined a consecutive group of patients who had undergone either open (34 patients) or single portal endoscopic (12 patients) carpal tunnel release performed by one surgeon over a period of 3 years. Fifty-seven total procedures were performed. There were no operative complications. Retrospective evaluation was done by questionnaire. We were unable to demonstrate any statistically significant difference between the two groups in terms of return to work, return to activities of daily living, or on a symptom severity scale.

Activities of Daily Living↗
PubMed1996

Development of critical paths for post-acute brain injury rehabilitation: lessons learned.

One important tool for case management is critical path analysis. This article explains four critical pathways developed by an interdisciplinary team for a post-acute brain injury rehabilitation program. The heterogeneity of the brain injury population mandates the need for systematic coordination of direct care services. Yet, variations in the neurobehavioral consequences of brain injury necessitate differing goals and treatment tracks for individual clients. The critical pathways in this setting define and describe the procedures and services to be rendered from admission to discharge to achieve optimal goals for four treatment program tracks: Return to Work, Return to School, Functional Independence, and Neurorehabilitation. The tracks reflect a hierarchy of expectations for information processing and functional performance. Critical pathways provide a tool for enhancing communication among service providers and external case managers and for determining the extent to which a client's course of treatment compares with a clinical standard considered to be ideal. This article compares the four critical pathways, provides representative case samples, and discusses lessons learned in the development and implementation process.

Activities of Daily Living↗
PubMed2000

Outcome measures for adult critical care: a systematic review.

OBJECTIVES: 1. To identify generic and disease specific measures of impairment, functional status and health-related quality of life that have been used in adult critical care (intensive and high-dependency care) survivors. 2. To review the validity, reliability and responsiveness of the measures in adult critical care survivors. 3. To consider the implications for future policy and to make recommendations for further methodological research. 4. To review what is currently known of the outcome of adult critical care. METHODS DATA SOURCES: Searches of electronic databases (MEDLINE, EMBASE, CINAHL, PsycLIT, The Cochrane Library and SIGLE) from 1970 to August 1998. Manual searches of five journals (1985-98) not indexed in electronic databases and relevant conference proceedings (1993-98). Reference lists of six existing reviews, plus snowballing from reference lists of all relevant articles identified. STUDY SELECTION: Randomised trials, non-randomised trials (cohort studies) and case series that included data on outcomes after discharge from adult (16 years and over) critical care. DATA EXTRACTION AND SYNTHESIS: If reported, the following data were extracted from each paper: patient characteristics (age, gender, severity of illness, diagnostic category) number of patients eligible for study, follow-up period, number of deaths before follow-up, number and proportion of survivors included in follow-up method of presentation of outcome data - proportion normal as defined by reference values, or aggregate value (e.g. mean or median), or aggregate values plus an indication of variance (e.g. standard deviation or inter-quartile range). Evidence for three measurement properties was sought for each outcome measure that had been used in at least two studies - their validity, reliability and responsiveness in adult critical care. If the authors did not report these aspects explicitly, an attempt was made to use the data provided to provide these measurement properties. For measures that were used in at least ten studies, information on actual reported outcomes were also extracted. RESULTS: MEASURES USED IN CRITICAL CARE: Measures of impairment were largely confined to the respiratory system so are almost certainly not appropriate for many critical care survivors. They can be categorised as respiratory volumes (e.g. vital capacity), gas flow within the respiratory system (e.g. forced expiratory volume in 1 second (FEV1)), pulmonary diffusing capacity (e.g. carbon monoxide diffusing capacity) and visualisation of the upper airway (e.g. bronchoscopy). Multiple tests are often performed. Eight measures of physical functional status were used, five generic and three disease-specific. The most frequently used generic measures were multi-item scales. Two single-item global measures attempted to capture a person's overall activity level or functional status. Five multi-item measures of mental functional status were used, four generic and one specific to trauma patients. The generic measures were either confined to assessing depressive symptoms or also encompassed a measure of anxiety. Measures of neuropsychological functioning relate to a person's cognition, attention, ability to process information and memory. Apart from one single-item measure, which focused on communication level, six multi-item measures were used with critical care survivors. Such measures are particularly appropriate for use with survivors of head injury or other neurological insult and, in that sense, they are disease-specific rather than generic measures. Single item measures of recovery were frequently used but researchers often invented their own, so there was little consistency in the wording. These measures had five principal foci - return to work, return to own home, degree of recovery, productivity and chronic health status. One multi-item scale was also used. (ABSTRACT TRUNCATED)

Adult↗
PubMed1999

A teaching model for work practice in occupational therapy.

Given the global changes in how work is conceptualized, organized and performed [8], it is critical that graduating occupational therapists have an up-to-date knowledge of work and work practice. This article briefly explores the relative dearth of work practice courses in current occupational therapy curricula and presents the rationale for developing a model for teaching and learning about occupational therapy work practice. It introduces a client-centered and occupation-focused model developed for an undergraduate work practice course and describes the use of the model in a specific course. The model identifies eight common work-related areas of concern - values clarification, vocational exploration, vocational choice, job search, starting work, maintaining work, returning to work and leaving work. Occupational Therapy tools, techniques and programs which may be useful in addressing these concerns; and the environmental factors that influence therapist and client in addressing work issues are also part of the model. The article concludes with examples of topics and issues which could be explored using this teaching and learning model.

Journal Article↗
PubMed1983

Rehabilitation after myocardial infarction. A controlled study.

The effects of a rehabilitation programme one year after myocardial infarction (MI) were investigated in 171 patients under 65 years of age. These patients were allocated at random to rehabilitation and control groups before discharge from hospital. The groups were comparable with regard to age, sex and clinical data. The programme included physical exercise, counselling of patients and relatives, and social measures over a 3-month period during the convalescent stage. One year after MI patients in the rehabilitation group showed lower systolic blood pressure at rest and lower diastolic pressure on submaximal exercise than controls. No differences were found with regard to mean work capacity, days off work, return to work, psychological status, and understanding of the illness. At 12 months all patients were less physically and socially active than before MI, they were more dependent on their relatives than before, and they had poor understanding of their illness.

Adult↗
PubMed1997

A randomized prospective study of vocational outcome in rehabilitation of patients with non-specific musculoskeletal pain: a multidisciplinary approach to patients identified after 90 days of sick-leave.

This study was designed to evaluate the effectiveness of a multidisciplinary rehabilitation programme offered to a general population with 90 days of sick-leave due to non-specific musculoskeletal pain. The results concerning return to work and re-sick-listing during a follow-up period of five years were evaluated for Swedes and immigrants separately. Compared to a control group, the rehabilitation offer resulted in improved work stability after work return among the Swedes. The immigrants, as a group, did not benefit from the programme compared to the controls in primary care.

Adolescent↗
PubMed1999

Relationship of hardiness and sense of coherence to post-liver transplant return to work.

The article reports a retrospective survey designed to determine the relationship of hardiness and sense of coherence to post-liver transplant return to work (RTW). Instruments used included Pollock's Health-Related Hardiness Scale and Antonovsky's Sense of Coherence Questionnaire. Study results were based on 230 adult liver transplant recipients responding to a mailed questionnaire. After transplantation, 63% of the participants were working. Participants with higher levels of hardiness and higher sense of coherence scores demonstrated higher RTW rates. Using logistic regression, a model comprising hardiness and sense of coherence correctly classified 90% of the participants who returned to work.

Adaptation, Psychological↗
PubMed2002

Motivation and return to work among the long-term sicklisted: an action theory perspective.

PURPOSE: The purpose of this study is to enlighten motivation and return to work among the long-term sicklisted. METHOD: Data are from a mail questionnaire answered by 185 people living in the Stockholm metropolitan area in Sweden. All subjects were on long-term sick leave owing to back or neck symptoms, they were 18-55 years of age and had an employer. A part of the questionnaire was based on an action theory perspective emphasising the respondent's own view of his or her present and future situation. People answered structured questions about what kind of work they wanted, if they thought they could get such work and if they thought they could manage this type of work. All three aspects are of importance in the study of motivation. A follow-up of the employment status of the respondents was made about two years after the questionnaire had been answered. The relationships between their plans and employment status were studied. RESULTS: The results show that our questions had good predictive validity, i.e. there were clear correlations between the answers and employment status two years later. It was shown that wanting to return to work is connected to one's view of own possibilities. What a person wants is not an isolated opinion, but clearly connected with the other aspects, particularly own competence ("can manage"). CONCLUSION: It is concluded that the action theory approach could be developed into an instrument for "action analysis" that could be used in work with vocational rehabilitation. Such a development is now under way.

Adolescent↗
PubMed2003

Views of laypersons on the role employers play in return to work when sick-listed.

Sickness absenteeism is an increasing public health problem, but few studies have examined the views of laypersons regarding factors that promote return to work. The present investigation concerns the opinions of such individuals on the role employers play in this context. Data from five focus-group interviews of laypersons with experience of long-term sickness absence were subjected to grounded theory analysis. When asked about factors that hinder or promote return to work, the laypersons spontaneously emphasized the importance of the employer. Specifically, they stressed the need for a structured back-to-work program at each workplace, which should include contacting absent employees and informing fellow workers of possible changes in task assignments upon return of the absent person. Reported hindering factors included lack of such information, leading to envy and harassment. Respondents also asserted the importance of work supervisors in creating a positive emotional atmosphere.

Absenteeism↗
PubMed1986

Rehabilitation and return to work of employers' liability claimants.

Examination of employers' liability (workers' compensation) claims files confirms that accidents at work, resulting in major injury, continue to present a significant challenge to rehabilitation. This review of 209 patients who have pursued such claims describes them from relevant socio-economic, clinical and occupational perspectives; records their return to work; examines medical opinion on their residual disabilities and potential occupational handicap and traces their involvement with rehabilitation and resettlement services. A major finding is an interval of almost two years, on average, between patients' discharge from medical treatment and settlement of their claims. Given the severity of injuries, length of absences from work and the relatively high proportions who either lost their jobs or who were advised to seek less physically demanding alternative occupations, the rate of referral to specialist vocational rehabilitation services during this period was very low. Timely and effective delivery of relevant rehabilitation and resettlement services to such patients should be made a priority for future policy and practice. One half of the sample returned to work before settlement, with more who were unsuccessful in their attempts to do so. The adversarial climate of personal injury claims negotiation in Great Britain therefore may be a less formidable barrier to return to work than is sometimes supposed. Nevertheless, conventional practices and procedures in medicine, law and insurance may still delay or prevent resettlement in some cases. Any attempt to enhance the effectiveness of the present medicolegal system should pay at least as much attention to these iatrogenic factors as to the psychological explanations that have dominated previous thinking on this subject.

Accidents, Occupational↗
PubMed1999

Myocardial revascularization in patients < or = 45 years old: evaluation of cardial and functional capacity, and return to work.

OBJECTIVE: To investigate whether patients < or = 45 years old benefit from myocardial revascularization, measured by New York Heart classification, functional status and return to work. METHODS: The data of 188 consecutive patients 45 years old and younger, and who were undergoing primary isolated aortocoronary bypass operation, were studied. Follow-up information was obtained from our follow-up databank. A cross-sectional follow-up was conducted and an additional functional evaluation by the Duke Activity Status Index and the work situation. RESULTS: The follow-up, was complete for 98.2% of patients and showed a survival rate of 99% at 12 and 86.1% at 120 months. Eight patients died during follow-up. There was a significant improvement of NYHA classification. The Dukes Activity Status Index showed a good correlation with the NYHA class; however, only 47% of the patients returned to work.

Adolescent↗
PubMed2004

Agricultural workers' return to work following spinal cord injury: a comparison with other industry workers.

PURPOSE: To investigate the impact of spinal cord injury on employment outcomes as experienced by agricultural workers in comparison with persons employed in other industries. Because of the challenges associated with working in many of the agricultural industries, it was anticipated that agricultural workers would achieve inferior return-to-work outcomes. METHOD: Survey of all employed persons who experienced a traumatic spinal cord injury in southeastern Australia between 1990 and 1996 (inclusive). RESULTS: Contrary to expectation, agricultural workers had a significantly higher rate of return to work (61.7% vs. 41.1%). However, an investigation into the hours spent working and agricultural workers' satisfaction with their employment activities, indicated that most were underemployed and had the potential to achieve even better outcomes. CONCLUSION: Results indicate that more can be done to help injured agricultural workers achieve their employment potential.

Adult↗
PubMedDate not supplied

Reduce the nursing shortage: help inactive nurses return to work.

One solution to alleviate the nursing shortage is to help inactive nurses return to work. A self-directed refresher course at Tennessee State University School of Nursing is meeting the challenge to help inactive registered nurses return to practice. The course allows inactive nurses autonomy in scheduling their individual study and their clinical experiences. A survey, sent to nurses who completed the course, revealed that the flexible schedule was the key factor in their ability to return to practice. Refresher courses are one option to increase the number of registered nurses.

Attitude of Health Personnel↗
PubMed2006

Investigating risk factors for chronicity: the importance of distinguishing between return-to-work status and self-report measures of disability.

OBJECTIVE: The objective of this study was to examine whether the outcome of psychosocial risk factor analyses varied as a function of whether the outcome variable was return-to-work status or self-reported functional disability. METHODS: Participants were 255 workers who sustained a soft tissue injury to the back and participated in a community-based secondary prevention program. Assessment of psychologic risk factors (pain severity, pain catastrophizing, fear of movement/reinjury, depression) was conducted at pretreatment. RESULTS: Logistic regression revealed that pain catastrophizing (odds ratio [OR], 0.53; 95% confidence interval [CI] = 0.32-0.88) and pain severity (OR, 0.65; 95% CI = 0.45-0.94) were significant predictors of return to work. However, when change in self-reported disability was used as the outcome variable, none of the psychosocial risk factors emerged as significant predictors. CONCLUSIONS: Given the important theoretical, clinical, and policy implications of the outcome of risk factor research, more research is needed to further clarify the respective advantages and limitations to using self-reported versus return to work-based measures of disability.

Adult↗
PubMed2005

Spaghetti wrist trauma: functional recovery, return to work, and psychological effects.

BACKGROUND: Few studies on spaghetti wrist trauma have been published. The study populations have all consisted of small numbers of patients, and most studies have focused on functional recovery. In addition, different definitions of this injury have been used. The objective of this study was to assess outcome for a larger group of patients in terms of functional recovery, return to work potential, and psychological distress, and to compare outcomes between the two most commonly used definitions for spaghetti wrist injury. METHODS: The initial study-population consisted of 67 patients. Fifty patients completed a questionnaire package consisting of the Disabilities of Arm, Shoulder, and Hand questionnaire, including the Functional Symptom Score (range, 0 to 100), a questionnaire to evaluate return to work and time off work (range, 0 to 52), and the Impact of Event Scale (range, 0 to 75). Motor recovery and sensory recovery were assessed in an outpatient setting, on average, 10 years (range, 2 to 18) after the operation (n = 43). RESULTS: The mean Functional Symptom Score was 15.1 (SD, 16.1; range, 0 to 74) after a mean follow-up of 10.0 years (SD, 4.4; range, 2 to 18). Mean time off work was 34.7 weeks (SD, 17.9; range, 4 to 52), and 45.2 percent of the patients could not return to work within 1 year after the injury. Mean score on the Impact of Event Scale was 26.2 (SD, 19.7; range, 2 to 69). Compared with the unaffected hand, grip and tip pinch strength were decreased with means of 23.5 percent (SD, 22.4; range, 0 to 93) and 33.9 percent (SD, 23.7; range 0 to 83), respectively. Regarding sensory recovery, 12 patients (27.9 percent) had no protective sensation. No statistical differences were found between the two different definitions. CONCLUSIONS: This study demonstrated that spaghetti wrist injury can be placed among the severe disabling injuries. Comparison of the two definitions did not reveal any differences in outcome. To complete the evaluation of long-term outcome, a patient-derived assessment of function can be added to the clinical examination, and attention should be paid to psychological distress following the injury.

Adolescent↗