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PubMedDate not supplied

[Return to work and cardiovascular status after myocardial infarction].

110 male subjects, under 60, admitted for myocardial infarction in 1980 and 1981, have been considered. 85 answers to the questionnaire, sent by post have been obtained, 6 pertaining to patients who died in the meanwhile. Among the 79 living patients who replied, 57 (72.1%) had resumed work within the average time of 4.8 months (min. 0.5-max. 12). Return to work has been significantly higher among self-employed people than employees; only 15 subjects had changed job or task. The subjective rating of the actual health status, two years after the infarction, has been satisfactory in 90.5% of cases, in spite of 56.5% complaining of heartburn, 38.1% of dyspnea and 35.7% of palpitation. The work-load has been rated as tiring only by 12.6% of them, while 65.6% have maintained unchanged their work capacity. Electrocardiographic monitoring (by the Holter method), during a normal workday, showed no significant differences between working and retired subjects and, also, in work and normal activity periods. 19 subjects (47.5%) presented ventricular arrhythmias, in 12 cases at high risk, most of them being unaware of it. These arrhythmias were more frequent during wake periods, but not strictly connected to the type and the quality of the work activity. The patients subjected to rehabilitation showed no differences in the cardiovascular patterns during the ergometric test and ECG monitoring when compared to those not subjected to rehabilitation.

Adult↗
PubMed2004

Disability management, return to work and treatment.

Individuals with severely disabling mental illness receive more benefit from supported employment initiatives than from other vocational services, but these initiatives show variable job tenure and low implementation by governments. For those with less severely disabling mental illnesses, such as depression, evidence-based treatment results in substantial restoration of job function, and restored work function occurs in synchrony with reduced symptomatology. However, there is a substantial degree of residual impairment despite receiving standard treatment. Major research trends include an increasing focus on occupational recovery in less severe forms of mental illness and potential application of integrated disability management models to occupational recovery from disabling mental disorders. Promising research directions include effectiveness of standard mental healthcare in restoring work function; effectiveness of actively managing co-morbid mental health problems for disabling physical disorders; population factors affecting return to work in those with disabling mental disorders; identification of policies fostering occupational recovery for disabling mental disorders; effectiveness of innovative mental healthcare focused on occupational recovery; and organizational interventions to foster occupational recovery in employees with disabling mental disorders.

Comorbidity↗
PubMed1998

Postpartum return to work: mothering stress, anxiety, and gratification.

Over half of mothers with infants less than 1 year old are employed, yet there is limited research examining the early parenting experiences of these women. The purpose of this study was to examine maternal gratification, stress, and separation anxiety, in relation to employment patterns and selected health-status indicators, of women returning to work during the first postpartum year. Data were gathered from 142 employed, well-educated, partnered, predominantly Caucasian women at 1, 4, and 8 months postpartum, using a mailed questionnaire. Their parenting experiences improved throughout the first postpartum year. While depression and fatigue were associated with greater parenting stress and anxiety, as well as a decreased sense of gratification from parenting, few women experienced these symptoms at clinically significant levels. Employment patterns were unrelated to parenting stress or gratification. These findings can be used by clinicians when counselling women regarding the decision to return to work after childbirth.

Adult↗
PubMed2001

Return to work after myocardial infarction/coronary artery bypass grafting: patients' and physicians' initial viewpoints and outcome 12 months later.

Nonmedical factors play an important role in determining whether patients resume their work after myocardial infarction or CABG. The main questions dealt with in this study are: What is the respective basis of physicians' and patients' judgements as far as vocational disabilities are concerned, and what are the decisive factors that facilitate a prediction as to who will return to work and who will not? 132 male patients participating in a cardiac rehabilitation program served as subjects. The age group was limited to patients between 40 and 59 yr of age. The work situation 12 months following rehabilitation is known for 119 subjects; 74 had resumed their occupations. Results of regression analyses show that patients' and physicians' views on disabilities and re-employment are based on different factors. The physicians derive their estimates mainly from medical variables (cardiac status and comorbidity), whereas the patients' views are based on the overall health status, their former job status, job satisfaction, and negative incentives for the return to work. Three variables were found that allow a prediction to be made as to re-employment in 85% of all cases: (1) age, (2) patients' feelings about the extent to which they are disabled by their cardiac problem, and (3) the physicians' views on the extent to which the patient is vocationally disabled by his overall medical situation. Medical variables (e.g. cardiac status) had little relevance to re-employment. The results are discussed with regard to the consequences for cardiac rehabilitation.

Attitude of Health Personnel↗
PubMed2001

Employer attitudes, training, and return-to-work outcomes: a pilot study.

This work was concerned with investigating and changing employer attitudes and practices that impede return to work and rehabilitation for injured workers. Prior studies have shown that employer responses to workers reporting work-related musculoskeletal discomfort have significant and independent effects on disability outcomes. Based on these findings, a pilot training program was developed by occupational rehabilitation specialists to improve the response of supervisors to employees reporting work-related injuries. The training was delivered to 108 supervisors at seven southeastern New Hampshire companies that volunteered to participate. A survey was developed and pilot-tested, then administered before the training. Survey participants were employees who had work-related injuries in the past year. The survey asked about types and onset of injury, specific supervisor responses, and overall impression of supervisor interaction at the time of injury. Employee responses before the intervention were compared with those collected from workers who reported injuries after the training. The postintervention results demonstrated significant decreases in supervisors (1) blaming employees for the injury, (2) not taking the condition seriously, and (3) discouraging the worker from filing a claim. Positive trends in confidentiality of discussions, access to medical care, and accommodation and work modifications were also noted. Although anecdotal reports from the companies indicated a consistent decrease in work-related lost time after the intervention, actual verification was not possible, and other components of the intervention may have accounted for this outcome. Small numbers of cases and possible lack of comparability of cases before and after the intervention are significant limitations. However, rehabilitation professionals may be able to improve disability management practices and accommodations through employer education, especially when training is directed toward front-line supervisors.

Attitude↗
PubMed2004

[Return-to-work strategies in Statoil Forpleining].

BACKGROUND: Since 1997, the catering department at Statoil, a Norwegian oil company, has worked systematically in order to facilitate employees' ability to avoid sick leaves and return to work after illness, and to improve their ability to cope with the challenges entailed in their work. MATERIAL AND METHODS: All employees in the catering department were sent a questionnaire about how they felt about their working environment. Sick leave data from Statoil and from Statistic Norway were collected. RESULTS: From 1997, sick leaves in catering have declined by 8%. 60% of employees and 90% of managers say that the physical as well as the psychosocial working environments have improved because of the programme described in this article. INTERPRETATION: Better support from co-workers and supervisors has created a more positive culture in the workplace.

Adult↗
PubMed2001

Lisfranc injury--surgical fixation facilities an early return to work.

BACKGROUND: Lisfranc injury is rare and the diagnosis maybe easily missed. This study reviews the experience of a single centre. METHODS: A prospective review of patients with Lisfranc injuries presenting to a single surgeon with a specialist interest in foot and ankle surgery over a one year period. RESULTS: Five patients were identified--four men and one woman with a median age of 31 years (range 22-50 years). Presentation was a mean of 25 days after injury (range 3-56 days). The left foot was affected in three cases and the right in two. There was joint diastasis in four patients and fracture-dislocation in one. Three patients presented early and were treated by internal fixation and two presented late and were managed conservatively. Mean follow-up was eight months (range 4.5-12 months). Surgery resulted in a return to work by 6 months with no symptoms. The two patients managed conservatively continued to experience pain at 12 months and were unable to return to their original occupations. CONCLUSION: Injury to the Lisfranc joint should be excluded in any foot injury. Early diagnosis and internal fixation appears to result in an earlier return to work when compared to non-operative management.

Adult↗
PubMed2006

Initial patient and clinician expectations of return to work after acute onset of work-related low back pain.

OBJECTIVE: The objective of this study was to compare patient and provider expectations of return to work (RTW) after acute onset of low back pain (LBP). METHODS: Workers sick-listed after onset of LBP (N = 300) completed a questionnaire about work, injury, and psychosocial disability risk factors and rated their likelihood of full RTW within 4 weeks. Clinicians provided an independent estimate of work absence, and patients were followed for 3 months. RESULTS: Clinician and patient expectations were weakly correlated, and both were predictive of actual RTW outcomes. Patient expectations were associated with differences in pain, mood, prior back pain, job demands, functional limitation, and marital status. Factors associated with clinician prognosis were similar but with more emphasis on physical examination findings. CONCLUSIONS: Even before treatment, patients may form a negative expectation for RTW that is associated with a longer duration of work absence.

Accidents, Occupational↗
PubMed1983

Hospital costs and return to work after coronary bypass surgery.

A study to assess the cost and some of the benefits of coronary bypass surgery was carried out at the Alfred Hospital, Melbourne. The minimum cost to the hospital of a typical coronary bypass graft procedure in 1980 was estimated to be $4700. The benefit of the procedure in terms of symptomatic relief and return to work was assessed by means of questionnaires. In the working-age group (55 years and under) of 591 patients, assessed from two to nine years after surgery, 68% of patients were working. In a group of 100 patients, aged 55 years and under, and interviewed from one to two years after surgery, 56 patients were working before surgery, but only 16 of these at full capacity. After surgery, 78 patients were working; 64 of these at full capacity. The cost of a coronary bypass graft operation is considerable, but this is offset in the majority of patients in the working-age group by a return to gainful employment.

Adult↗
PubMed1995

[Does recanalisation of chronic right coronary occlusion improve long-term quality of life and the return to work?].

Between 1985 and 1990, right coronary artery recanalisation was attempted in 60 consecutive patients. In order to evaluate the long-term benefits, 2 groups were compared: group A (27 patients: 26 men, 1 woman) with an initial success; 1 patient was lost to follow-up (3.7%); group B (33 patients, 31 men, 2 women) with an initial failure; no patients were lost to follow-up and 1 patient died after secondary coronary artery surgery. After a follow-up of at least 1 year, the patients assessed their health and compared it with their pre-angioplasty state with the aid of a questionnaire. Age, initial left ventricular ejection fraction, the percentage of multiple vessel disease and the number of patients at work before angioplasty were the same in the two groups. After a mean follow-up period of two and a half years, 7.6% of patients had undergone coronary bypass surgery in group A compared with 18.2% in group B (NS); 69% of patients in group A claimed to be improved compared with only 24% in group B (p = 0.07); a bi or triple anti-anginal therapy was used in 58% of patients in group B and 42% of patients in group A (NS); however, 59% of patients returned to work in group B compared with 44% in group A (NS). Initial successful recanalisation of chronic right coronary occlusion improves the quality of life at long-term but does not increase the chances of returning to work.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1998

Return to work after lung transplantation.

The social rehabilitation of lung transplant recipients becomes increasingly important as the results of lung transplantation improve. Although return-to-work (RTW) rates have been published for recipients of other organ transplants, no such data are available after lung transplantation. The purpose of this study was to determine what factors influence RTW after lung transplantation. Of 99 lung transplant recipients (43 single, 56 bilateral) surveyed from Denver, Colorado, (n = 49) and Toronto, Ontario, Canada (n = 50), 22% (n = 22) were employed, 38% (n = 38) were unemployed but medically able to work, 29% (n = 29) were medically disabled, and 10% (n = 10) had retired. The RTW rate for those medically able to work was 37% (22/60), and it was identical at each center (n = 11). Only Canadian lung transplant recipients (36%, 4/11) secured new jobs, whereas all Colorado lung transplant recipients returned to their previous employment (100%, 11/11). A stepwise discriminant analysis revealed that (1) pretransplantation employment, (2) a diagnosis of emphysema, cystic fibrosis, or primary pulmonary hypertension, (3) a self-report of being physically able to work, (4) greater functional improvement as measured by post-lung transplantation percent predicted forced vital capacity, and (5) post-lung transplantation 6-minute walk > 550 m positively influenced RTW. This analysis accurately profiled 82% of the employed and 76% of the unemployed recipients for an overall effectiveness of 79%. The findings of this study are that (1) a 37% employment rate for those physically able was comparable to other types of organ transplant recipients, (2) employment was not determined by the type of lung transplantation procedure (single or bilateral), and (3) social factors remain employment barriers for some recipients, but their absence did not guarantee a better employment rate.

Adult↗
PubMedDate not supplied

Symptomatic cervical disc herniation following a motor vehicle collision: return to work comparative study of workers' compensation versus personal injury insurance status.

BACKGROUND CONTEXT: Patients with approved workers' compensation injuries receive guaranteed compensation for the duration of their injury, whereas patients with personal injury claims are only compensated, if at all, at the time of a successful settlement or trial verdict at a time point distant from their injury. PURPOSE: This study compares the financial impact and loss of work patterns due to a workers' compensation (WC) claim or personal injury in patients with a symptomatic cervical disc herniation resulting from a motor vehicle collision. STUDY DESIGN: A prospective study of patients who were seen by a single spine specialist between 1/2/96 and 9/1/01. PATIENT SAMPLE: A consecutive evaluation of 531 patients who were treated for a cervical pain syndrome caused by a motor vehicle collision. OUTCOME MEASURES: Mechanism of injury and insurance type, ie, workers' compensation or personal injury, was recorded for each patient as well as treatment response and return to work patterns. The data were analyzed using the two-way Z test. METHODS: All patients were managed in a similar manner with noninvasive treatment initially, followed by injections, and finally surgical intervention in those who failed conservative measures. Return to work rates and work disability were determined at either final follow-up or at the last doctor's visit before loss to follow-up. RESULTS: 270 of 531 patients were diagnosed with a symptomatic one or two level disc herniation by a cervical magnetic resonance imaging scan. Fifty-four patients were insured through the workers' compensation board, and 216 reported their crash as a personal injury claim. In the WC group the work disability at 3 months follow-up revealed a cumulative 2,262 total lost days of work (average 37.1 days per person). At the point of maximal medical improvement (MMI) or 2-year follow-up, total days lost from work were 7,107 (average 131.6 days per person.) In the personal injury non-WC group, the 3-month follow-up of lost days of work was 1,093 days (average 5.1 days per person.) At 2 years follow-up, the total lost days of work were 6,206 (average 28.7 days per person.) CONCLUSIONS: Participants compensated through the workers' compensation system demonstrated a significant loss of days of work as compared with injured patients who received compensation by other means. This may be a reflection of the guaranteed method of compensation afforded to WC patients as opposed to patients who receive no form of financial support (i.e., personal injury) during the recuperative process. Further analysis as to injury severity and a stratification of non-workers' compensation reimbursement methods are needed to further improve the validity of this study.

Accidents, Traffic↗
PubMed1988

Exercise training, cardiac rehabilitation and return to work in patients with coronary artery disease.

Few studies have analysed the influence of exercise training or cardiac rehabilitation on return to work in patients with coronary artery disease. In a consecutive series of 41 men less than 60 years of age admitted for acute myocardial infarction, 19 participated in a comprehensive rehabilitation programme focused on physical training, and 22 received standard care. The baseline clinical and social variables of the two groups were comparable except for left ventricular ejection fraction which was significantly lower in the intervention group. Work resumption was not significantly different between the two groups (9/19, 47% in the intervention group vs 17/22, 77% in the control group); after three years, 42% and 73%, respectively, were still employed. These results are in keeping with that of most controlled studies of cardiac rehabilitation after myocardial infarction or coronary artery surgery, which fail to demonstrate a significant improvement in work resumption. Psychosocial factors are probably more important determinants of work resumption than is exercise training.

Coronary Artery Bypass↗
PubMed1987

Return to work after severe head injury.

This paper reports attempts of a series of head-injured people to regain employment. Return to work after a severe head injury is generally considered to be a function of age, severity of injury, and nature of disability. The results showed that it was the opportunity to go back to the previous job, the provision of a work trial or easier work, and a lengthy period of support that were the more important factors. This demonstrates the importance of working to provide an environment that will help the individual learn to make adaptations and accommodate his or her disabilities.

Adult↗
PubMed1996

Recurrent or new injury outcomes after return to work in chronic disabling spinal disorders. Tertiary prevention efficacy of functional restoration treatment.

STUDY DESIGN: A large prospective longitudinal cohort study (n = 1204) to identify prevalence of new or recurrent injury and risk factors in a rehabilitated chronic disabling spinal disorder patient group with matched control subjects. OBJECTIVES: To evaluate prevalence and risk factors for new or recurrent injury on a chronic disabling spinal disorder population. SUMMARY OF BACKGROUND DATA: The rate of symptom recurrence after acute low back pain, like the rate of initial back pain episodes, is extremely high (40-70%). However, although the incidence of recurrent back pain after chronic disabling spinal disorder represents a small subcomponent of these cases, there is a large socioeconomic impact. An individual attempting to return to work after a chronic disabling spinal disorder episode usually bears a stigma of "high risk" for recurrent injury and related work disability that may result in barriers to reemployment or work retention. Before the present research, no large scale studies had been conducted to evaluate whether recurrent spine injuries or new injuries to other musculoskeletal areas could be prevented by medical treatment. In addition, no studies had emerged to evaluate physical and psychologic risk factors of injury recurrence in this context to facilitate design of prevention programs. METHODS: The present study assessed the incidence of claimed recurrent spinal and new musculoskeletal injuries in a population of 1204 workers. A subgroup of 5.3% (n = 64) of treated patients with a new injury claim in the ensuing 12 months was matched for gender, age, race, length of disability, workers' compensation venue, previous surgery, and litigation status to an identically sized control group who did not report new or recurrent injuries. Demographic, physical, and psychologic measures were obtained prospectively on all patients, before and after treatment, to be analyzed as risk factors. RESULTS: During the year after treatment, 1.3% (n = 16) of patients reported another injury to the same spinal area, with only a 0.9% (n = 11) recurrent disability rate. A new injury to a different musculoskeletal area was reported by 4.0% (n = 48) of patients. Only 3.4% of the whole cohort, or 64.1% (n = 41) of the sample reporting reinjuries after returning to work, experienced lost work time (i.e., disability) after the reinjury. Only a modest predictive association was found between risk for new or recurrent injury and two self-report indices. CONCLUSIONS: The present study suggests that even a sample of the most severe chronic disabling spinal disorder workers' compensation patients who complete a tertiary functional restoration program are at relatively low risk for either a recurrent spinal disorder or new musculoskeletal injury claim (with or without disability). No major physical or psychologic risk factors for recurrent injury could be identified in this large cohort. These findings argue powerfully against employer bias in not rehiring employees with previous chronic disabling spinal disorder or discriminating in pre- or reemployment on the basis of putative reinjury risk factors after an appropriate rehabilitation program. Literature review documents a surprising paucity of quality studies examining variables predictive of this important socioeconomic outcome variable.

Adult↗
PubMed2001

Psychosocial job factors and return-to-work after compensated low back injury: a disability phase-specific analysis.

BACKGROUND: Job characteristics may constitute a barrier to return-to-work (RTW) after compensated disabling low back pain (LBP). This study examines the impact of psychosocial job factors on time to RTW separately during the acute and subacute/chronic disability phases. METHODS: This is a retrospective cohort study of 433 LBP workers' compensation claimants with 1-4 years of follow-up. The association of psychosocial job factors with duration of work disability was estimated with Cox regression models, adjusting for injury history and severity, physical workload, and demographic and employment factors. RESULTS: High physical and psychological job demands and low supervisory support are each associated with about 20% lower RTW rates during all disability phases. High job control, especially control over work and rest periods, is associated with over 30% higher RTW rates, but only during the subacute/chronic disability phase starting 30 days after injury. Job satisfaction and coworker support are unrelated to time to RTW. CONCLUSIONS: Duration of work disability is associated with psychosocial job factors independent of injury severity and physical workload. The impact of these risk factors changes significantly over the course of disability.

Adult↗
PubMed2006

The utility of functional capacity evaluation: the opinion of physicians and other experts in the field of return to work and disability claims.

OBJECTIVES: This qualitative study explored how Dutch experts perceive the utility of functional capacity evaluation (FCE) for return to work (RTW) and disability claim (DC) assessment purposes. METHODS: Twenty-one RTW case managers and 29 DC experts were interviewed by telephone using a semi-structured interview schedule. RESULTS: The RTW case managers valued the utility of FCE on a scale of 0-10. Their mean valuation was 6.5 (SD 1.5). The average valuation for DC experts was 4.8 (SD 2.2). Arguments in favor of FCE were (1) its ability to confirm own opinions and (2) the objectivity of its measurement method. Arguments against FCE were (1) the redundancy of the information it provides and (2) the lack of objectivity. Indications for FCE were musculoskeletal disorders, a positive patient self-perception of ability to work, and the presence of an actual job. Contraindications for FCE were medically unexplained disorders, a negative patient self-perception of ability to work, and the existence of disputes and legal procedures. CONCLUSIONS: The responding RTW case managers perceived FCE to be more useful than the responding DC experts. The question of whether the arguments presented for and against the utility of FCE are valid is one that should be addressed in a future study.

Attitude of Health Personnel↗
PubMed2005

Workplace-based return-to-work interventions: optimizing the role of stakeholders in implementation and research.

INTRODUCTION: The challenges of engaging and involving stakeholders in return-to-work (RTW) intervention and research have not been well documented. METHODS: This article contrasts the diverse paradigms of workers, employers, insurers, labor representatives, and healthcare providers when implementing and studying workplace-based RTW interventions. RESULTS: Analysis of RTW stakeholder interests suggests that friction is inevitable; however, it is possible to encourage stakeholders to tolerate paradigm dissonance while engaging in collaborative problem solving to meet common goals. We review how specific aspects of RTW interventions can be instrumental in resolving conflicts arising from differing paradigms: calibration of stakeholders' involvement, the role of supervisors and of insurance case managers, and procedural aspects of RTW interventions. The role of the researcher in engaging stakeholders, and ethical aspects associated with that process are discussed. CONCLUSIONS: Recommendations for future research include developing methods for engaging stakeholders, determining the optimal level and timing of stakeholder involvement, expanding RTW research to more diverse work settings, and developing RTW interventions reflecting all stakeholders' interests.

Community Participation↗