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PubMed2003

Returning to work while breastfeeding.

Mothers who work outside the home initiate breastfeeding at the same rate as mothers who stay at home. However, the breastfeeding continuance rate declines sharply in mothers who return to work. While the work environment may be less than ideal for the breastfeeding mother, obstacles can be overcome. Available breast pump types include manual pumps, battery-powered pumps, electric diaphragm pumps, electric piston pumps, and hospital-grade electric piston pumps. Electric piston pumps may be the most suitable type for mothers who work outside the home for more than 20 hours per week; however, when a mother is highly motivated, any pump type can be successful in any situation. Conservative estimates suggest that breast milk can be stored at room temperature for eight hours, refrigerated for up to eight days, and frozen for many months. A breastfeeding plan can help the working mother anticipate logistic problems and devise a practical pumping schedule. A mother's milk production usually is well established by the time her infant is four weeks old; it is best to delay a return to work until at least that time, and longer if possible.

Breast Feeding↗
PubMed1990

Effects of cardiac rehabilitation after coronary artery bypass grafting on readmissions, return to work, and physical fitness. A case-control study.

In a case-control study 49 consecutive post-coronary artery bypass grafting (CABG) patients (10 f, 39 m) participating in a comprehensive rehabilitation programme were compared with 98 individually matched double control patients, receiving standard care. The rehabilitation programme, starting 6 weeks after surgery, consisted of follow-up at a coronary clinic, repeated health education, and physical training in out-patient groups. During the first year after CABG, fewer study group patients were readmitted to hospital (14% vs 32%, p less than 0.01) and on fewer occasions (1.1 vs 2.9, p less than 0.05). Fewer patients used anxiolytic drugs (0% vs 15%, p less than 0.01). At the one year post-CABG exercise test we found in the study group a tendency to a greater increase in work capacity, as compared with the values obtained at the preoperative exercise test (33 vs 25 W ns). There were no differences in the rates of returning to work (59% vs 64%). In a long-term follow-up study (av. 38 months post-CABG) the patients were asked to fill in a questionnaire evaluating perceived physical work capacity and training habits. The study group patients rated their physical work capacity higher, and more patients had continued with regular physical training (66% vs 46%, p = 0.05). There were fewer patients using anxiolytic drugs (9% vs 30%, p less than 0.01). Although the programme did not influence the return to work we conclude that it improved the quality of life of our patients as it entailed fewer readmissions and reduced the use of anxiolytic medication; in addition it promoted physical fitness and training habits.

Adult↗
PubMed1993

Return to work for persons following severe traumatic brain injury. Supported employment outcomes after five years.

Supported employment is a recently developed rehabilitation alternative that is being used to assist individuals with traumatic brain injury to return to work. The present study reports the results of a supported employment program that has placed 80 individuals into competitive employment during a 5-year time period. All individuals had sustained a severe traumatic brain injury; 72% of the injuries involved a motor vehicle. A mean of 6.1 years had passed since injury for all participants, who had been unconscious an average of 48 days. Neuropsychologic evaluation revealed defective cognitive functioning, which contributed to diminished employment potential. A key outcome indicator used to assess return to work capacity is the monthly employment ratio, which is computed by dividing the number of months employed during an employment phase (i.e., pre/post injury) by the total possible months an individual would have the opportunity to be employed. The monthly employment ratio increased from 13% after injury with no supported employment to 67% with supported employment services. The majority of individuals were employed in warehouse, clerical and service-related occupations. A mean of 250 staff intervention hours were required to train and provide follow-up services to program participants.

Adolescent↗
PubMed1999

The model of human occupation and prediction of return to work: a review of related empirical research.

The purpose of this paper is to investigate through a review of research literature whether empirical support exists to support the theoretical arguments of the Model of Human Occupation. A literature review of 44 predictive studies of factors influencing return-to-work published over the last 25 years was conducted. The factors most commonly found to be associated with return to work or with long-term disability were then organized according to the subsystems of the Model of Human Occupation.

Journal Article↗
PubMed2006

Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: prospective study with clinical implications.

STUDY DESIGN: Prospective cohort study with 18-month follow-up. OBJECTIVE: To investigate if long-term sick listed persons' own predictions of their future return to work (RTW) have an impact on their RTW when controlling for other established factors. METHOD: Postal questionnaires at baseline were sent to persons who had been on sick leave for more than 90 days, and were employed in five municipalities and four county councils in Sweden. A follow-up regarding their RTW was performed 18 months later. RESULTS: After 18 months 135 out of 508 persons (27%) had returned to work, full or part-time. In a multivariate logistic regression, the sick listed persons' own prediction of their RTW proved to be highly significant (OR=8.28, 95% CI: 3.31-20.69). Only six out of 132 persons with a negative view of their RTW did return to wok. Other predictive factors that were found for RTW were: being on sick leave for a period of less than 1 year (OR=2.09, 95% CI: 1.19-3.67), having less pain than persons in the quartile with most pain (OR=2.65, 95% CI: 1.21-5.81), perceiving that one was welcome back to work (OR=1.98, 95% CI: 1.10-3.58), and being under 55 years of age (OR=2.37, 95% CI: 1.07-5.23 for age between 45 and 54 years and the same trend for age below 45 years OR=1.85, 95% CI: 0.82-4.20). CONCLUSION: Persons with a positive prediction should get help to realise their potential for RTW. Offering traditional rehabilitation measures to a person with a negative prediction of his/her RTW, could be a waste of resources if done ahead of improving self-confidence and view of what is possible. The problems in this group might decrease or be easier to handle if decisions about the future are taken within a year.

Adult↗
PubMed2003

Return to work and claim duration for workers with long-term mental disabilities: impacts of mental health coverage, fringe benefits, and disability management.

This paper examines the relationship of mental health benefits provided by 116 employers, to return to work and duration of disability claims for 407 of their employees who were on long-term disability (LTD) leave for mental disorders. Mental health benefits data were coded from summary plan description booklets provided by employers. Information on other fringe benefits and employers' disability management practices were obtained from a survey of the employers. Relationships between mental health benefit features, other fringe benefit and disability management factors, and our outcomes were estimated via logistic regression and survival analysis. Results indicated that three mental health benefit plan features were negatively related to the return-to-work probability:(1) a high deductible (> $600), (2) longer preexisting condition exclusion periods, and (3) having a carve-out. This suggests that cost saved by access restrictions may be partially offset by higher turnover costs for employees with disabilities due to mental disorders. Carve-outs were also predictive of shorter claims duration.

Female↗
PubMed2006

Return to work still possible after several years as a disability pensioner due to musculoskeletal disorders: a population-based study after new legislation in Sweden permitting "resting disability pension".

Different strategies have been used to stimulate a return to work (RTW) among individuals suffering from long-term ailments. In Sweden a new law on "resting disability pension" permits disability pensioners to go back to work without jeopardising their benefits. In this study different variables related to RTW during 2000 by means of this legislation were identified among disability pensioners with musculoskeletal disorders. Individuals in the study group, when compared to a control group, had more often been disability pensioners for several years, had additional education, estimated their previous job to have been physically strenuous to a lesser degree, were more satisfied with the treatment at the social insurance office and had a more positive self-image. This study shows that it may be meaningful to continue/resume rehabilitation efforts and to try to motivate an individual suffering from musculoskeletal disorders to return to work even after several years as a disability pensioner.

Adult↗
PubMedDate not supplied

Return to work after rehabilitation following traumatic brain injury.

The relationship of medical variables and discharge functional status to vocational and educational outcomes was examined in 79 closed head-injured patients who were consecutively admitted to an inpatient rehabilitation hospital during a two-year period. A follow-up study, conducted after hospital discharge (median, 16.5 months), found that 66% (n = 52) of the patients had returned to work or school, while 34% (n = 27) did not. Patients were divided into return and non-return to work groups. Traditional variables included age, severity of brain-damage as characterized by CT head scan, duration of post-traumatic amnesia, duration of coma, length of stay and acute inpatient rehabilitation program. Discharge functional scores were analysed by t-tests and chi-square analysis. Results suggest that traditional factors of younger age, shorter length of coma, minimal CT head scan findings and shorter length of stay were significant contributors to educational/vocational outcome. Their significance was enhanced by discharge functional profile measurement of medical, physical and psychological/neuropsychological integrity. Those functional measures not significant were in social, vocational, recreational and communication areas. These factors may continue to improve over a longer period of time and should be tracked in the post-acute rehabilitation phase for their significance in return to work/school.

Activities of Daily Living↗
PubMed1971

Return to work after treatment of rheumatoid arthritis.

This study reports on the prognosis for return to competitive work of men disabled by rheumatoid arthritis following an intensive in-patient rehabilitation program. Ninety-four men were followed up at a mean time of 3.5 years after discharge from the unit. Sixty-five per cent of the city dwellers and 50% of those living in small communities or rural areas were working either full-time or half-time. Other factors such as education, work background and geographical location influenced the success of return to work.In the city, 12 families (22%) were receiving welfare assistance prior to admission to the comprehensive rehabilitation program. At follow-up six of these families were off welfare and paying taxes. This group alone represented a minimum saving of $35,000 yearly to public funds.

Adult↗
PubMedDate not supplied

Return to work and the person with heart failure.

Heart failure (HF) is an economic and social problem for millions of Americans. Medical bills and living costs can be an overwhelming stress on the person diagnosed with this life-threatening disorder. Once the acute condition has been stabilized, nurses are often called on to provide counseling and to act as an advocate for the person with HF who is attempting to return to work. The purpose of this article is to review the literature on return to work and to offer suggestions for the nurse who is treating persons with HF. It is recommended that nurses be prepared to assess patients with HF, to provide resources, and to act as an advocate as needed. Further research is needed on the safe and effective transition of persons with HF into the workforce.

Coronary Disease↗
PubMed1988

Predicting return to work after acute myocardial infarction. Significance of clinical data, exercise test variables and beta-blocker therapy.

Among 66 full-time employed men surviving an acute myocardial infarction (AMI) and participating in the Norwegian postinfarction study with timolol, 50 (75.7%) resumed their previous work within 12 months, and 16 (24.3%) retired. Stepwise logistic regression analysis of clinical data and of results from an exercise test 3 months post AMI revealed the following factors of independent predictive value for enhanced return to work: previous labor characterized as light or moderately heavy (p = 0.001), low age at the time of infarction (p = 0.001), timolol treatment (p = 0.009), ability to stop smoking post AMI (p = 0.006), and a high exercise capacity on the exercise test (p = 0.016). It is concluded that the clinical history and an exercise test 3 months after AMI can identify patients who are more likely to resume work, and that post-AMI beta-blocker treatment with timolol and ability to stop smoking are predictive of an enhanced return to work.

Adrenergic beta-Antagonists↗
PubMed2006

Return to work after ill-health retirement in Scottish NHS staff and teachers.

BACKGROUND: Most major public and private sector pension schemes have provision for ill-health retirement (IHR) for those who become too ill to continue to work before their normal retirement age. AIM: To compare the causes, process and outcomes of IHR in teachers and National Health Service (NHS) staff in Scotland. METHODS: A total of 537 teachers and 863 NHS staff who retired due to ill-health between April 1998 and March 2000 were mailed an IHR questionnaire by the Scottish Public Pensions Agency. RESULTS: The response rate for teachers was 53% and for NHS staff 49%. The most common cause of IHR was musculoskeletal disorders for NHS staff and mental disorders for teachers. Teachers retired at a younger average age than NHS staff. Ninety-two per cent of NHS staff but only 11% of teachers attended occupational health services (OHS) prior to IHR. Eighteen per cent of NHS staff and 9% of teachers were offered part-time work by their current employer in response to their ill-health. Fifteen per cent of NHS staff and 5% of teachers were offered alternative work prior to retirement. Seventeen per cent of NHS staff and 36% of teachers subsequently found employment. Multiple logistic regression analyses showed the following variables as independent predictors of subsequent employment: occupational group, age group, sex, managerial responsibility and cause of IHR. CONCLUSIONS: Return to work after IHR suggests that some IHR could be avoided. Teachers had a higher rate of return to work and much less access to OHS.

Age Distribution↗
PubMedDate not supplied

Exploratory analysis to identify factors impacting return-to-work outcomes in cases of cumulative trauma disorder.

Current findings suggest that cumulative trauma disorders are multifaceted and have less predictable outcomes than trauma cases. The purpose of this study was to attempt to identify emerging patterns and predictive relationships in this diagnostic group that might be worthy of eventual prospective research. The data source was a comprehensive electronic database containing clinical information collected at point of care over a four-year period. A retrospective analysis was performed on 459 workers' compensation cases with upper extremity cumulative trauma disorders and a subset of 312 with carpal tunnel syndrome. The outcome criterion was return to work as a dichotomous variable. Only two significant correlations with return to work were found: the therapist's estimate of rehabilitation potential and the patient's outcome expectation of the ability to work. Further investigation of the role of beliefs and expectations in the therapeutic process would be a productive area for prospective study.

Adult↗
PubMed2006

An audit of the laboratory service provided to the Health Service Executive Orthodontic Department, St James Hospital, Dublin.

PURPOSE OF THE STUDY: To evaluate the service purchased from contracted orthodontic laboratories used by HSE (SWA) regional orthodontic unit, St. James's Hospital, Dublin and identify deficiencies in the current service. MATERIALS AND METHODS: A data collection questionnaire was designed and distributed to the departmental orthodontists for a period of three months (October-December 2004). Gold standards, drawn up based on the authors' ideal requirements and published guidelines, were supplied to grade the work returned. RESULTS: During the study period 363 items of laboratory work were requested. 20% of the laboratory work arrived late and most of the delayed work was delayed for more than 24 hours. Most laboratory delays occurred with functional appliances, retainers and study models. Prior to fit, 20% of the appliances required adjustments for more than 30 seconds. 65% of laboratory work returned to the department met all of the gold standards. 10% of appliances were considered unsatisfactory. Functional appliances were most often ill fitting accounting for almost half of the unsatisfactory laboratory work. CONCLUSIONS: The majority of the laboratory work returned to the department met our gold standards and arrived on time. Forty six percent of the appliances required adjustments. Functional appliances required the most adjustments; one in five of all functional appliances ordered were considered unsatisfactory.

Dental Audit↗
PubMed2004

Functional outcomes after surgery for spinal fractures: return to work and activity.

OBJECT OF STUDY: The literature regarding surgical treatment's impact on patient function after spinal fracture is sparse. Some authors have speculated that operative injury--the dissection of paraspinous muscle tissue, damage to spinal motion segments, implantation of spinal devices--may impair functional recovery in spine trauma patients. Nonoperative care has produced satisfactory results in some hands, but results are difficult to reproduce, treatment is resource-intensive, and functional outcomes are poorly documented. This study reports return to work and functional recovery in a 5-year follow-up of severely injured patients treated with segmental spinal instrumentation. MATERIALS AND METHODS: Seventy consecutive patients treated with Cotrel Dubousset instrumentation for unstable thoracic, thoracolumbar, and lumbar spine fractures were followed-up. All had high-energy trauma and were admitted directly to a level 1 university trauma center; 38% were polytraumatized; and 56% had neurologic injuries. Indications for surgery included: (1) segmental instability; (2) incomplete or progressive neurologic injuries with residual spinal canal compromise; (3) concomitant injuries precluding cast treatment; and (4) polytrauma. Two patients died and six were lost to follow-up, leaving 62 (91%) for assessment at a mean 5-year follow-up (range 2-8 y). Clinical outcome has been reported. Functional recovery was assessed based on return to work, level of work, and level of daily activity. RESULTS: Despite the severity of spinal and concomitant injuries, 70% of patients returned to full-time work and another 8% were considered capable: 54% to their previous level of employment without restrictions and 16% to full-time, but lighter, jobs. Twenty-two percent were working part-time or not at all, and 8% were unemployed despite unrestricted functional status. Work status correlated directly with neurologic impairment (P < 0.00005) and was not related to level of injury, hardware failure, extent of surgical dissection, or construct pattern. Of patients with limitations, 18% were limited by pain and 27% by neurologic injury. CONCLUSION: Neurologic injury had a greater impact on functional outcome than any other variable. Patients limited by pain were more often impaired by residual radicular and neuropathic symptoms than by back pain. Impairment was not related to the extent of either the surgical incision or the instrumentation. Patients with persistent back pain generally had an identifiable and correctable mechanical problem-sagittal imbalance, pseudarthrosis, or persistent instability--as the underlying cause. Our series of trauma patients was predominantly young and male. Among this cohort, individual characteristics of occupation (often physical laborers and craftsmen) and judgment (criminal convictions and incarceration) may have restricted opportunities for re-employment in 40% of the entire study group.

Adolescent↗
PubMed1998

Patients with low back pain not returning to work. A 12-month follow-up study.

STUDY DESIGN: A prospective study of patients treated with a light mobilization program for long-term low back pain. OBJECTIVES: To examine whether medical, psychological, or social factors predict failure to return to work within 12 months in the Scandinavian system of compulsory workers' compensation and social insurance, after a light mobilization program administered 8-12 weeks after initial sick leave. SUMMARY OF BACKGROUND DATA: The relative power of predicting factors varies in previous work, and there are no previous data on prognostic factors for light mobilization programs. METHOD: Patients (n = 260) on sick leave for 8-12 weeks for low back pain were examined with a battery of psychological and medical tests, before entering a light mobilization program. The treatment was given regardless of radiographic or clinical findings. The patients were encouraged to be active participants in the management and prevention of their back pain. Their sick leave status then was checked through registers 12 months after they had entered the treatment program. RESULTS: For those not returning to work within 12 months (23%), only combined models had acceptable predictive power (77%; discriminant analyses). Dominant variables were low Internal Health Locus of Control Score, restricted lateral mobility, and reduced work ability. The predictive value of each set of variables, taken alone, was significant only for medical variables (67% correct prediction). CONCLUSIONS: The final discriminant function may have potential as a brief screening instrument for the number of patients with low back pain who do not benefit from the light mobilization program.

Adolescent↗
PubMed1988

The influence of the type of occupation on return to work after myocardial infarction, coronary angioplasty and coronary bypass surgery.

Between January 1980 and December 1983 the medical and social status of 423 patients who were considered candidates for aortocoronary bypass surgery (ACBS) was assessed by a questionnaire, at a mean of 16 months after coronary angiography. Of these patients 54 had refused surgery, 15 were re-operated, 23 had angioplasty and seven had died on the waiting list. After exclusion of these 117 patients, 306 remained, who form the basis of this report. Fifty three patients (17%) had retired before surgery, four (1.3%) had died perioperatively and 19 were on sick-leave for less than three months. Of those who were still employed pre-operatively, 102 (44.3%) went back to work, 85 (37%) had retired and 42 (18%) were on sick-leave for longer than three months. Significant differences were noted between the 102 working and the 85 retired patients as far as medical and social factors are concerned. Of the medical factors, post-operative freedom of symptoms (P less than 0.0001), postoperative exercise tolerance (P less than 0.0001) and completeness of revascularization (P less than 0.05) seemed to have influence on return to work. Of the social factors, age (P less than 0.0001), type of occupation (P less than 0.0002), duration of preoperative absence from work (P less than 0.001) and heavy manual work (P less than 0.05) showed significant differences between the groups. Since duration of preoperative absence from work is the only preoperative factor that can be modified, strategies for improving the return-to-work rate should aim at the shortening of waiting times for coronary angiography and ACBS.

Angioplasty, Balloon↗
PubMed2001

[Common lumbago and returning to work: various thoughts about a complex problem].

Non specific low back pain (NSLBP) is commonly a persistent or recurrent problem. In general the longer a worker is off work with NSLBP, the more disabling the condition becomes, the less successful any form of treatment, and the greater the probability of long term sickness absence. The obstacles to return to work are diverse. Scientific evidence shows that the development of chronic low back pain and disability depends more on individual and work-related psychosocial issues than on physical or clinical features. There is strong empirical evidence that treatment at the subacute stage (NSLBP lasting for approximately 5-12 weeks) is more effective at preventing chronic pain and disability than attempts to treat chronic intractable pain and disability once it is established. Active rehabilitation programmes should be interdisciplinary, adapted to the local socioeconomic context and include education toward overcoming fear avoidance beliefs and promoting self-care, some kind of active exercises, some behavioural principles of pain management, and some intervention at the workplace to help and assist the worker in early return to work. Some of these programs have produced desirable occupational outcomes when all the stakeholders in the disability problem (worker, employer, insurer, attending physician) worked together.

Chronic Disease↗