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PubMed1998

Patient satisfaction and return to work after endoscopic carpal tunnel surgery.

One hundred twenty-eight patients with idiopathic carpal tunnel syndrome were evaluated before surgery and 3 and 6 months after unilateral endoscopic carpal tunnel release. The variables analyzed included patient demographics, symptoms and signs, activities of daily living (ADL), sensibility and strength measurements, preoperative distal motor latency of the median nerve, operating surgeon, postoperative palmar pain and tenderness, return to work, and patient satisfaction with the results of surgery. Multivariate statistical analyses were performed, with patient satisfaction at 6 months after surgery and the time until return to work after surgery as the dependent variables. On stepwise logistic regression analysis of all preoperative variables, significant predictors of patient dissatisfaction at 6 months after surgery were higher age, heavy vibration exposure, worse ADL score, and better distal motor latency. Analysis of all preoperative and 3-month postoperative variables showed heavy vibration exposure, better distal motor latency, and worse 3-month postoperative ADL score to have the strongest independent correlation with patient dissatisfaction at 6 months. No significant independent association was found between any of the preoperative variables studied and the length of time until return to work after surgery.

Activities of Daily Living↗

PubMed1984

Early discharge and return to work following myocardial infarction.

Individuals who have experienced a myocardial infarction (MI) account for the largest component of all hospitalization costs and foregone earnings due to cardiac disease. Early return to full employment and premorbid activity level should be the focus of cost-effective rehabilitative programs. Yet the economic benefits of vocational rehabilitation have not been directly researched. Therefore, issues of import regarding activity after MI include the timing of ambulation, discharge and return to work. Studies of early mobilization and discharge are contrasted in terms of methodology and outcome. These cite economic, social and psychological advantages, yet these factors are examined in isolation of other variables. A review of the literature reveals that there is a reluctance by many health professionals to institute such practices based in part on the dilemma surrounding selection of specific indicators and risk factors. Yet analysis reveals that the contention surrounding these exclusion criteria is perhaps unfounded, as the variance is less than is commonly assumed. Recurrent themes likewise emerge regarding the multiplicity of variables associated with the timing of resumption of employment, which is considered to be the most precise index of recovery following an MI. Of these, only early intense rehabilitation, directed at attitudinal and behavioural change, is amenable to modification by health professionals. Related research endeavours have examined employment following aortocoronary bypass surgery, risk factors in the work environment and work stressors which occur following MI. Controversy arises regarding the correlation of age and personality factors with return to work. Discrepancies in research findings are attributed to the diverse approaches to data collection, obstacles encountered in measuring psychological states, lack of operational definitions, differences in degree of rehabilitation and length of follow-up and the absence of controlled trials. Clearly, experimental research focusing on the job-related economic and human cost impact of specific rehabilitation programs must be conducted.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical Trials as Topic↗

PubMed1996

Cardiac rehabilitation: potential for ergonomic interventions with special reference to return to work and the Americans with Disabilities Act.

This paper briefly reviews the contemporary cardiac rehabilitation process and highlights its limitations. It argues that, in order to improve return-to-work chances, cardiac rehabilitation should focus on simulating actual work conditions. The role of ergonomics in the cardiac rehabilitation process is also outlined. Finally, the current impediments to early return to work are identified and corrective actions are suggested.

Deinstitutionalization↗

PubMed2006

Psychological and clinical predictors of return to work after acute coronary syndrome.

AIMS: Resumption of paid employment following acute coronary syndrome (ACS) is an important indicator of recovery, but has not been studied extensively in the modern era of acute patient care. METHODS AND RESULTS: A total of 126 patients who had worked before hospitalization for ACS were studied with measures of previous clinical history, ACS type and severity, clinical management, and sociodemographic characteristics. Depressed mood (Beck Depression Inventory) and type D personality were measured 7-10 days following admission. Among them, 101 (80.2%) had returned to work 12-13 months later. Failure to resume work was associated with cardiac factors on admission (heart failure, arrhythmia), cardiac complications during the intervening months, and depression scores during hospitalization. It was not related to age, gender, socioeconomic status, type of ACS, cardiac history, acute clinical management, or type D personality. In multivariate analysis, the likelihood of returning to work was negatively associated with depression, independently of clinical and demographic factors [adjusted odds ratio 0.90, CI 0.82-0.99, P=0.032]. CONCLUSION: Depressed mood measured soon after admission is a predictor of returning to work following ACS. The management of early depressed mood might promote the resumption of economic activity and enhance the quality of life of cardiac patients.

Adolescent↗

PubMed2005

Case management interviews and the return to work of disabled employees.

This study measures the effect of case management interview (CMI) on 1,000 long-term sick-listed employees' probability of returning to work. In contrast to previous studies, we use instrumental variables to correct for selection effects in CMI. Using a competing hazard rate model, we find that CMI increases the probability of returning to work for the pre-sick leave employer, but has no effect on the probability of resuming work for a new employer. We argue that CMI either motivates the sick-listed employees to resume work or adjusts for asymmetric information between the employee and the pre-sick leave employer.

Adult↗

PubMed2006

Return to work for individuals with Human Immunodeficiency Virus (HIV) disease: dichotomous outcome variable or personally-constructed narrative challenge?

Advances in the management of HIV disease have increasingly focused attention on the possibilities of return to employment for individuals with HIV disease. However whilst mortality has decreased and life expectancies have lengthened, life for the individual with HIV remains both complex and unpredictable. This article explores the notion of return to work as narrative theme. A case study highlighting the narrative nature of how return to work might be conceptualised by the HIV positive individual is presented; ahead of a brief discussion as to how the lived reality of combination therapy may impact upon the individual's conceptualisation of employment in the broader context of their life story.

Adult↗

PubMedDate not supplied

[Early return to work after arterial surgery and strict control of disabled patients].

Coronary surgery represents an increasing economic burden to society. This is aggravated a great deal by the fact that these patients do not return to work and are often placed in permanent postoperative disability. Comparative analysis of return-to-work rates after coronary by-pass, according to the social benefits system, clearly demonstrates the magnitude of the possible savings. Attending physicians, specialists and experts must, therefore, motivate the patients with total disability.

Adult↗

PubMed1994

When to return to work following a routine inguinal hernia repair: are doctors giving the correct advice?

Recurrence of an inguinal hernia following routine repair is not influenced by the convalescent time off work. Advice on this interval off work should not be influenced by the type of hernia, or the physical content of the patient's occupation. To determine if this is the case a questionnaire was sent to the 32 consultant surgeons and 487 general practitioners in the Nottingham district. They were asked when they advised males between 18 and 65 years of age to return to work following a routine hernia repair and what factors influenced this time interval. The median advised time off work (4-6 weeks) was longer than that proposed by earlier studies (3-4 weeks). The advice of only 4% of doctors was not influenced by other factors. The physical content of the patient's job and whether he was self-employed had most influence on the advice doctors gave on when to return to work. In conclusion most doctors are wrongly advising patients on when to return to work following an inguinal hernia repair.

Absenteeism↗

PubMed1998

Predicting return to work. A long-term follow-up study of railroad workers after low back injuries.

STUDY DESIGN: Evaluation of the long-term outcomes of 178 railroad employees with low back injury who had completed a multidisciplinary rehabilitation program. OBJECTIVES: To study two major areas: 1) outcomes of the rehabilitation program in terms of the patient's improvement in function and rate of return to work and 2) factors that predict long-term retention at work, both at the railroad and elsewhere. SUMMARY OF BACKGROUND DATA: Several studies have been published examining rehabilitation outcomes of individuals covered under workers' compensation law, but few exist that have examined railroad workers covered by the Federal Employers Liability Act, and few studies exist with follow-up periods longer than 3 years. METHODS: Physical/medical, self-reported, and employment/financial data were collected on each patient from medical and employment records. Follow-up data regarding employment status were obtained either from the employer or from the patient by telephone interview. RESULTS: On average, the patients improved in all objective and subjective measures after rehabilitation. Improvements in these measures were not predictive of return to work. At follow-up examination, 89% of the contacted patients were employed--61% still at the rail-road. The employment factors of lost work days and length of employment and the financial factor of wage rate were the most predictive of long-term work status. CONCLUSIONS: The multidisciplinary program in the current study was found to improve patient physical functioning and reduce pain. However, success in these measures was not predictive of long-term work status, suggesting that other factors have an impact on work status. Clinicians must be aware that employment and financial factors may have a strong influence on return-to-work outcomes.

Accidents, Occupational↗

PubMed2006

Return to work and adjustment latitude among employees on long-term sickness absence.

INTRODUCTION: The aim was to study whether return to work (RTW) after long-term sickness absence is affected by adjustment latitude i.e. opportunities to adjust one's work to one's state of health by e.g. choosing among work tasks and deciding about work pace and working hours. We also studied whether the effect of adjustment latitude differed between those returning full-time and those returning part-time. METHODS: Differences between men and women were also studied. A questionnaire was sent to 5,590 salaried employees who had been on sick leave for at least 90 days in 2000. The year after, 2001, they received a questionnaire which included questions about work status, working conditions, adjustment latitude and health. RESULTS: The questionnaire was returned from 3056 persons. Among women 32% were fully back to work, 34% were partly back and 34% were still on sick leave. Comparable figures for men were 33%, 32% and 36%. CONCLUSION: For both men and women the likelihood to RTW increased with increasing number of opportunities to adjust. Adjustment latitude increased returning to part-time as well as full-time work. The study indicates that work organisation is important for RTW.

Adaptation, Physiological↗

PubMed2005

Return to work experiences for veterans with severe mental illness living in rural group home facilities.

OBJECTIVE: Independent living services were provided to fourteen veterans with severe mental illness who live together in a rural group home setting. The return to work efforts for three veterans who identified this as a personal goal are described. METHOD: Data were collected using The Satisfaction with Life Scale, The Independent Living Continuum, The Minnesota Follow-up Scale, The Recovery Assessment Scale, The Readiness to Change Scale, The Flinn Performance Screening Tool, observation, and informant interviews. Descriptive methods were used to compare and contrast residents who were working vs. those who were not. RESULTS: Two of the three individuals who were working remained employed after eighteen months. The three consumers who ultimately returned to work expressed an initial desire to be employed and were more likely to participate in performance-based activities than other residents of the group home. The skills and barriers to employment were different for each person due to different interests, skills, and motivations. Likewise, their experiences of finding and attempting to maintain employment differed, both because of their personal attributes and because of situational factors. This suggests the need for individualized vocational rehabilitation programs. CONCLUSION: In spite of the limitations of the study, including a small and homogenous sample, the findings can assist caregivers, mental health professionals, and consumers with severe mental illness in recognizing those individuals who are work-ready and who live in this type of supportive environment.

Adult↗

PubMed1976

Return to work after a myocardial infarction: evaluation of planned rehabilitation and of a predictive rating scale.

This paper reports the first recorded controlled trial of cardiac rehabilitation after myocardial infarction in men of working age, viewed as a team intervention effort to facilitate the patient's return to normal work. Our results show that this intervention is helpful in returning to jobs which they can handle successfully men who would otherwise be at risk of remaining unemployed. A previously developed rating scale for predicting return to work after myocardial infarction was used and reevaluated. Employment and occupational level at admission to hospital, work history, availability of the previous job, educational level, family and social stability, age at which regular cigarette smoking commenced, and level of anxiety and depression on a personality scale proved highly predictive.

Evaluation Studies as Topic↗

PubMedDate not supplied

Predicting surgical outcome for pain relief and return to work.

BACKGROUND: We evaluated a new psychological test (Paindex) for identifying and quantifying psychological factors associated with poor surgical outcome, and predicting the degree of pain relief and return to work. METHOD: This test was administered to 120 randomly selected patients before carpal tunnel and laminectomy surgeries. RESULTS: This test correctly predicted the probability of pain relief and return to work in 46 of the 50 laminectomy patients (92%), and 63 of the 70 carpal tunnel patients (90%). The overall test sensitivity was 86% and the specificity 94%. CONCLUSION: These findings indicate that this can be a useful adjunctive test for identifying psychological problems that could have a bearing on the decision to operate and then problems that could occur after surgery, particularly in cases where the extent and degree of pain and disability are judged to be considerably in excess of the objective medical findings.

Algorithms↗

PubMedDate not supplied

Predicting surgical outcome for pain relief and return to work.

Absenteeism↗

PubMed2001

[Predictors of return to work after inpatient cardiac rehabilitation under workers' compensation plan].

Vocational reintegration is one of the major goals of cardiac rehabilitation. 70 % of blue-collar workers under 50 years of age resume their job after in-patient cardiac rehabilitation. 10 % are hindered to do so by cardiac problems. Specific measures exist that may facilitate work resumption. As these measures should be started as soon as possible there is a need for predictors of return to work which can be obtained easily and at an early stage. Subjects of this prospective study were 650 patients (10 % female) under 50 years of age who participated in an in-patient cardiac rehabilitation programme under the workers' pension insurance scheme. At the beginning of programme participation, problems in work resumption as expected by the patient and by his physician were obtained, as well as depression and anxiety scores (HADS-D). Physicians' and patients' expectations concerning problems in resuming work turn out to be significant predictors of the vocational situation of the male patients six months following medical rehabilitation. The depression score obtained at the outset of the programme is the only predictor of return to work in female patients.

Adult↗

PubMed2006

Return to work and quality of life in severely injured patients.

BACKGROUND: Little is known about the long-term consequences of severe injuries in terms of return to productivity and quality of life. METHODS: In this study we focused on the return to work status and quality of life in 53 severely injured patients (AIS/ISS > or = 16, mean ISS 24, range 16 - 54), mean age 37 years, one to two years after the injury. Questions were asked concerning employment in the past and at present. Quality of life was measured by means of the Sickness Impact Profile (SIP) questionnaire. Injury-related parameters were analysed in order to study their relation with disablement. RESULTS: Of those patients who survived their injuries, 87% had resumed their former work. Only 10% of the patients received disability benefits. A mean SIP-total score of 6.7 was found, the mean SIP-physical score was 5.9 and the mean SIP-psychosocial score was 6.9. "No disability" (SIP score < or = 3) was found in 55% of the patients, whereas 11% of the patients reported "severe disability" (SIP score > or = 20). Age was a significant predictor of disablement (odds ratio 1.07). The Injury Severity Score (ISS), the length of hospital stay and the number of diagnoses did not predict disablement. CONCLUSIONS: Although the results were obtained in a relatively small sample size, the return to work rate in the surviving severely injured patients appears to be excellent. The quality of life is good; the majority of patients are not disabled. Age (and not the ISS) seems to be a significant predictor of disablement.

Adolescent↗

PubMed2003

Depression as a predictor of return to work in patients with coronary artery disease.

The importance of depression in coronary artery disease (CAD) outcomes is being increasingly recognized. The aim of this study was to investigate the power of depression as a predictor of return to work, both at full time and at reduced working hours, within 12 months of participation in a behaviorally oriented rehabilitation program in Sweden. The sample comprised 198 employed patients who had recently experienced an acute myocardial infarction (AMI, n=85), or had been treated with coronary by-pass surgery (CABG, n=73) or coronary angioplasty (PTCA, n=40). The results showed that clinical depression before intervention (>or=16 as measured by the Beck Depression Inventory) exerted a great influence on work resumption both at full-time (odds ratio 9.43, CI=3.15-28.21) and at reduced working-hours (odds ratio 5.44, CI=1.60-18.53), while mild depression (BDI 10-15) influenced only work resumption at full-time (odds ratio 2.89, CI=1.08-7.70). Education and, at full-time hours, age also predicted work resumption. This highlights the importance of depressive symptoms in relation to return to work after a CAD event. More research is needed in order to elaborate the degree to which treatment of depression enhances work resumption rates.

Adult↗

PubMed2001

Low job satisfaction predicts delayed return to work after laparoscopic cholecystectomy.

We studied 102 consecutive employed patients treated by elective laparoscopic cholecystectomy to determine job characteristics and psychological factors that predict delay in return to work after their procedure. Median sick leave was 13 days, and five variables significantly added to a model predicting sick leave of at least 20 days (31.4% of the workers): low job satisfaction (odds ratio [OR], 12.56; 95% confidence interval [CI], 3.34 to 47.2); physical effort at work (OR, 4.99; 95% CI, 1.46 to 17.04); pain at 7 days (OR, 5.55; 95% CI, 1.56 to 19.76); patient's expectation of slow recovery (> 7 days) (OR, 6.12; 95% CI, 1.82 to 20.55); and patient's expectation of no financial loss (OR, 3.85; 95% CI, 1.14 to 12.50). The model was excellent (area under the receiver operating characteristic curve, 89.6%). We conclude that low job satisfaction is a major predictor of delayed return to work.

Adult↗