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PubMed2000

[Methicillin-resistant Staphylococcus aureus in medical and paramedical personnel returned from work in a foreign hospital].

The cultures of two patients of the Surgical Intensive Care Unit (IC) of the Medical Centre of Utrecht University were found positive for methicillin-resistant Staphylococcus aureus (MRSA). A male nurse turned out to be the source, 4 months after his return from working in an English hospital. Cultures were, by mistake, not taken directly on arrival from abroad. Pulsed-field gel electrophoresis proved MRSA strains from both source and the 2 patients to be identical to a strain which was epidemic in Great Britain but had never occurred in the Netherlands. The IC has meanwhile been closed; at source investigation, 14 other patients and six staff members were found MRSA-positive. The policy in the hospital is to screen health care workers for MRSA carriership on return from an hospital abroad. The success of the policy depends strongly on the cooperation of health care workers in this matter.

Adult↗
PubMed2003

The narratives of 12 men with AIDS: exploring return to work.

Analyses of life stories has increasingly been used to understand how different individuals interpret and respond to an experience such as the onset of disability. This paper presents findings of a prospective qualitative study of 12 men living with AIDS who attempted to return to paid employment. Narrative analysis of four interviews over 12 months was used to explore the relationship between return-to-work efforts and whether participants' narratives progressed, remained stable, or regressed. Findings suggest that the men who demonstrated progressive narratives recreated an identity including a view of themselves as workers and recaptured a sense of competence. Men with regressive narratives demonstrated decreased identity and competence while men with stable narratives showed little change in either identity or competence. This paper contributes to our understanding of how the framing of an illness or disability by an individual may influence the progression of his life history narrative.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Health status, its perceptions, and effect on return to work and recurrent sick leave.

STUDY DESIGN: Prospective cohort study with 1-year follow-up. OBJECTIVES: The purpose of this study is to describe the improvement in several health outcomes during sick leave resulting from musculoskeletal disorders and in the first months after return to work (RTW), and to evaluate the personal and work-related factors associated with these health outcomes, in order to provide some insight in the timing of RTW. SUMMARY OF BACKGROUND DATA: Although improvements in pain perception and functional disability appear to be associated with time of RTW, little is known about the required improvement enabling RTW, the additional health improvement after RTW, and whether the health status at the time of RTW is associated with the probability of a recurrence of sick leave. METHODS: Workers were included when on sickness absence between 2 to 6 weeks due to musculoskeletal disorders. Self-administered questionnaires at baseline, after RTW, and at 12-month follow-up were used to collect information on changes in symptom status, functional status, and general health. RESULTS: All health outcomes were improved significantly at the time of RTW, whereas perceived pain, functional disability, and physical health also improved significantly in the first months after RTW. Previous sick leave 12 months before study entry was significantly associated with the level of functional disability and general health at time of RTW and also predictive for recurrence of sickness absence. Personal and work-related factors showed little, if any, association with health status at RTW and improvement thereafter. CONCLUSIONS: Being fully recovered is not a stipulation for regaining work activities. We hypothesize that workers with musculoskeletal disorders may need additional medical guidance shortly after RTW, especially those with a history of sick leave.

Adult↗
PubMedDate not supplied

Impact of functional restoration after anterior cervical fusion on chronic disability in work-related neck pain.

BACKGROUND CONTEXT: Spinal surgery in the workers compensation population shows evidence of less favorable outcomes than in general health cases. Although spine surgery has been alleged to be a cause of poor outcomes, such outcomes may be improved by appropriate postsurgical rehabilitation. PURPOSE: To compare objective demographic, physical and psychological measurements and socioeconomic outcomes of treatment in work-related disabling cervical pain for the combination of anterior cervical fusion (ACF) plus functional restoration, compared with rehabilitation alone. STUDY DESIGN/SETTING: A prospective study of patients undergoing ACF for degenerative disc disease before rehabilitation for work-related musculoskeletal disorders versus neck pain unoperated controls, with data collected in an outpatient tertiary interdisciplinary rehabilitation setting. PATIENT SAMPLE: A group of 52 patients completed a functional restoration treatment program after undergoing ACF (Group S) at one or two levels for degenerative cervical disc disease. During the study period, 625 patients with work-related neck pain were identified from the same study population, from which a rehabilitation (Group R) comparison group (n=150) was identified who were stratified according to the number and location of other compensable body parts. OUTCOME MEASURES: Socioeconomic outcomes relevant to chronic disabling work-related cervical spinal disorders are reported based on 1-year posttreatment interviews. Pre- to posttreatment assessment of pain intensity, disability, depression and cumulative physical capability were assessed prospectively. METHODS: All patients were totally or partially disabled before completing an intensive, medically supervised, functional restoration program combining quantitatively directed exercise progression with a multimodal disability management approach. Preprogram preparation included drug detoxification, psychotropic medication management and preparatory aerobic and mobility training. The intensive treatment phase involved strength and endurance training, with counseling geared to goals of work return and fitness maintenance. The 1-year structured clinical interview had a contact rate of 93% to 95%, and partial information acquisition on all patients. RESULTS: Although Group S had lower work return and work retention outcomes, the differences were not significant. Group S patients had significantly more health utilization from a new provider in the year after completion of functional restoration (46% vs 24%; OR=2.7 [1.3, 5.3], p<.004). Group S patients were also more likely to be depressed, both at pre- and postrehabilitation. There were no significant differences in recurrent injury, additional surgery, physical measures or pain/disability self-report between the groups. CONCLUSIONS: Workers compensation patients with chronic disabling work-related cervical spinal disorders who undergo a cervical fusion, combined with functional restoration, have socioeconomic outcomes after their surgery statistically similar to those for unoperated controls. Surgery patients had a higher rate of additional health-care-seeking behaviors from new providers and a greater likelihood of being clinically depressed before and after rehabilitation. This study suggests that cervical fusion for degenerative disc disease in workers compensation patients is not contraindicated, as long as interdisciplinary rehabilitation is available for complex cases after the surgical procedure.

Adult↗
PubMedDate not supplied

Returning to work after heart transplantation.

This study was designed to identify the determinants of postoperative work status among 47 heart transplantation patients at the University of Arizona Medical Center and to focus attention on those actions or policies that increase the probability that a patient will return to work within 6 months after transplantation. Issues regarding work status, disability, and early retirement have become increasingly salient. Case study methods were employed to assign each of the patients to one of four categories, which together form a typology of postoperative work status. Analysis of the patients identified four major variables of work status: age, length of disability before transplantation, control over working conditions including job redefinition/discrimination, and type of health insurance including cost of medication. Although these variables are interdependent, each also has an independent effect on postoperative outcome. The study concludes that although age and length of disability before transplantation cannot be directly affected, both control over working conditions and types of insurance are amenable to intervention.

Adolescent↗
PubMed1996

Randomized controlled trials in industrial low back pain relating to return to work. Part 2. Discogenic low back pain.

The purpose of this review was to determine the efficacy of treatments for discogenic low back pain (LBP) by examining all randomized controlled trials (RCTs) of discogenic LBP published in the English language literature between 1975 and 1993 with "return to work" (RTW) as the end point. From more than 4,000 LBP citations, nearly 600 articles were initially reviewed; 35 studies met our selection criteria. Twenty-two studies were discussed in Part 1 (Acute Interventions) or will be discussed in Part 3 (Chronic Interventions). In this review, of 13 RCTs assessing interventions for LBP with sciatica, 9 were appropriate for their focus on, and radiologic confirmation of, discogenic LBP. The treatments assessed included chemonucleolysis, surgical discectomy, and epidural steroid injection. A 26-point system to assess the quality of methodologic rigor was used for each article. Our literature survey found a need for additional studies comparing surgery, conservative care, epidural steroids, traction, and other approaches to determine their individual effects for RTW after discogenic disease.

Adrenal Cortex Hormones↗
PubMed2005

Significant resources needed for return to work after sick leave.

There are increasing numbers of people on long-term sick leave, especially with stress-related ill health and musculoskeletal disorders. The main purpose of this study is to, early on in the sick leave, find predictors of individual resources for a return to work. The study group consists of women and men on sick leave compared with reference groups of healthy persons. A questionnaire was used regarding diagnosis given on the doctor's certificate, self-reported symptoms, residential area, education, and kind of work. It also contained open questions about consequences in daily life and beliefs about future. Checklists concerning life satisfaction, sense of coherence, locus of control, coping resources and sick leave information over a four-year period have been used. Significant differences between the study group and the reference groups were found, relating to sense of coherence, locus of control, life satisfaction and coping resources. More than half of the study group were still on sick leave at a two-year follow-up. Important predictive factors turned out to be: previous sick leave, own belief about future and self-reported symptoms.

Adaptation, Psychological↗
PubMed1980

[Return to work and pensioning of state insured myocardial infarction patients (author's transl)].

With reference to an enquiry among a total of 961 patients of a longitudinal myocardial infarction study (replies from 97%) participants in the study and drop-outs were compared with regard to questions on returning to work and pensioning. The results point to the effectiveness of follow-up care within the scope of this longitudinal study which consists essentially of the combination of inpatient curative treatment and regular follow-up outpatient examinations with a six-monthly rhythm. 85% of the participants in the longitudinal study have taken up work again after the infarction compared with only 66% of the drop-outs. At the time of the enquiry in 1976, after an average of 45 months care in the study, 68% of the participants were working, on the other hand only 48% of the drop-outs with an average care of only 4 months were working.

Germany, West↗
PubMed2001

Clinical factors influencing return to work after ambulatory inguinal herniorrhaphy in Hong Kong.

Ambulatory inguinal hernia repair is the commonest day case general surgery operation. The present study was conducted to evaluate factors influencing the contemporary pattern of convalescence following ambulatory inguinal hernia repair in Hong Kong. A total of 271 consecutive ambulatory inguinal hernia repairs were performed at a day surgery centre from December 1995 to December 1998. The convalescent period prior to resuming work was analysed by multi-variate analysis with respect to significant clinical variables. A sick leave of 3 weeks was adequate for most patients following uncomplicated ambulatory inguinal hernia repairs. Factors associated with early return to work included age </=50 years, indirect inguinal hernia and sedentary occupation. Occupation was the only independent factor affecting the duration of time off work on multi-variate analysis.

Journal Article↗
PubMed1996

Disease evaluated on return-to-work examinations: aviation ground personnel compared to other workers.

Aviation ground personnel are subjected to a wide range of chemical and physical exposures that may lead the occupational physician to see a different spectrum of morbidity in the airport compared to other settings. It is essential to determine the most common medical problems in airport ground personnel in order to identify possible work-related conditions and in order to set the priorities for establishing health promotion programs and training occupational physicians. We compiled the diagnoses in 1000 consecutive visits of ground workers to the airport clinic for return-to-work examinations, and compared them to 7000 workers seen in general occupational clinics. The frequencies of the various categories of disease were similar in both type of clinics, except that low back pain was significantly more common in the ground personnel [251 (20.6%) vs. 1176 (15.2%), p < 0.003]. Over 80% of the diseases occurred in 10 diagnostic categories: cancer, fractures, hypertension, ischemic heart disease, knee pain, low back pain, neck pain, operations for various medical conditions, phonal trauma, and pregnancy. We conclude that, except for low back pain, the spectrum of disease seen in the airport clinic is not significantly different from that seen in general occupational medicine clinics. Focusing on the interaction of a limited number of diseases with the work environment will provide the occupational physician with a comprehensive training program, and the emphasis needed for establishing health promotion programs.

Aviation↗
PubMed2000

Return to work for individuals with TBI and a history of substance abuse.

The highest incidence of TBI is among young adult males who also have the highest incidence of substance abuse [1]. Since these individuals have long life expectancies, it is important that they are productive post injury; however, the employment rate is extremely low. This is understandable, given the fact that a person with either a TBI or substance abuse disorder would have difficulties with work. Naturally, the combination of the two compounds the problem and further complicates matters. This article provides an overview of how a Supported Employment approach can be used to assist persons with a TBI and substance abuse problems with returning to work.

Journal Article↗
PubMed2003

Participatory ergonomics as a return-to-work intervention: a future challenge?

BACKGROUND: Participatory ergonomics (PE) are often applied for prevention of low back pain (LBP). In this pilot-study, a PE-program is applied to the disability management of workers sick listed due to LBP. METHODS: The process, implementation, satisfaction, and barriers for implementation concerning the PE-program were analyzed quantitatively and qualitatively for 35 workers sick listed 2-6 weeks due to LBP and their ergonomists. RESULTS: Two-hundred-and-seventy ergonomic solutions were proposed to the employer. They were targeted more at work design and organization of work (58.9%) than at workplace and equipment design (38.9%). They were planned mostly on a short-term basis (74.8%). Almost half (48.9%) of the solutions for work adjustment were completely or partially implemented within 3 months after the first day of absenteeism. Most workers were satisfied about the PE-program (median score 7.8 on a 10-point scale) and reported a stimulating effect on return-to-work (66.7%). Main obstacles to implementation were technical or organizational difficulties (50.0%) and physical disabilities of the worker (44.8%). CONCLUSIONS: This study suggests that compliance, acceptance, and satisfaction related to the PE-program were good for all participants. Almost half of the proposed solutions were implemented.

Adult↗
PubMed1999

Return to work after surgery for lumbar disc herniation. A rehabilitation-oriented approach in insurance medicine.

STUDY DESIGN: An intervention study by the medical advisers of a social security sickness fund on a mandatorily insured patient population after open discectomy for herniated lumbar intervertebral disc. The medical advisers were randomized into two groups: a control group (n = 30) and an intervention group (n = 30). OBJECTIVES: To compare a rehabilitation-oriented approach in insurance medicine focused primarily on early mobilization and early resumption of professional activities with the usual claim-based practice. SUMMARY OF BACKGROUND DATA: This study included 710 patients, with a mean age of 39.2 years, who underwent surgery for herniated lumbar disc. METHODS: Medical advisers in the rehabilitation-oriented group examined the patients monthly, starting at 6 weeks after the surgical intervention. They used a newly developed protocol to motivate the patients and treating physicians toward social and professional reintegration. RESULTS: At 52 weeks, 10.1% of the patients guided by medical advisers from the rehabilitation-oriented group had not resumed work in contrast to 18.1% of the patients in the control group. It was statistically proven that this effect also holds during the follow-up period. CONCLUSIONS: A rehabilitation-oriented approach by the medical advisers of social security can increase the probability of a return to work for patients after lumbar disc herniation surgery.

Adult↗
PubMedDate not supplied

Quality of life and return to work 5 years after coronary artery bypass surgery. Long-term results of cardiac rehabilitation.

BACKGROUND: Rehabilitation is an important part of the treatment of patients with ischemic heart disease. Therefore, many patients undergoing coronary artery bypass surgery (CABS) also participate in cardiac rehabilitation programs. This study was conducted to investigate whether rehabilitation influences quality of life and work status after CABS. METHODS: Consecutive patients undergoing elective CABS were randomly assigned to a rehabilitation group (R, N = 119) and a hospital-treatment group (H N = 109). All patients received usual medical care. Group R participated in a rehabilitation program based on exercise and counseling. The follow-up time was 5 years. The measured domains of health-related quality of life were heart symptoms, functional class, exercise capacity, use of medication, depression, the patients' perception of health, and overall life situation. The Nottingham Health Profile as a measure of perceived distress was used. RESULTS: Symptoms, use of medication, exercise capacity, and depression scores did not differ between groups R and H. Five years after the CABS, the patients in group R reported less restriction in physical mobility on the Nottingham Health Profile than patients in group H (P = 0.005), and more patients in group R than in group H perceived their health (P = 0.03) and overall life situation (P = 0.02) as good. The increase in the proportion of subjects working was higher in group R than group H at 3 years after the CABS (P = 0.02), but not at other follow-up times. CONCLUSION: A cardiac rehabilitation program in conjunction with usual medical care after CABS may induce a perception of improved health. The influence on return to work is limited.

Absenteeism↗
PubMed1982

[Studies on the step-wise return to work following prolonged illness (author's transl)].

This study permits analytical statements on the possibility of taking up work by progressive steps (increasing working hours 4-6-8 hrs), which had been initiated in 1971. Previous (publications had confined to purely descriptive statements (2,3,4). Summarising, the following findings are essential: Premature retirement is less frequent. Resettlement in employment is achieved more smoothly, if not in all instances earlier (in relation to the point of time when full-day working is resumed). The improved psycho-emotional situation created by this mode of resettlement is rather clearly felt by the clients, and is stated to have been an aid of decisive value. It was found that there is too little awareness of this possibility of step-wise return to work after prolonged incapacity for work. More factual information needs above all be disseminated to institutions at enterprise level (company doctors, personnel departments, members of the personnel and works councils).

Adaptation, Psychological↗
PubMed1989

Probability of a return to work after either coronary balloon dilatation or coronary bypass surgery.

To examine whether coronary angioplasty has a different effect on work resumption than has coronary artery bypass surgery, we studied the work status of patients before and at least 1 year after either intervention. The population consisted of men aged less than 60 years, submitted to these procedures from September 1983 to July 1984. Of the 261 eligible patients, 219 (84%) participated, 94 after an angioplasty and 125 after a bypass procedure. 6 months preceding the intervention, 52% of the men were working. This had decreased to 47% at follow-up. Multiple logistic regression analysis showed that failure to resume work was correlated with bypass surgery vs balloon dilatation (rate ratio 1.8; 95% CI, 1.0-3.4), not working beforehand (rate ratio 6.5; 1.2-4.3), age greater than 55 years vs less than or equal to 50 years (rate ratio 2.6; 1.3-5.4) and with angina at follow-up (rate ratio 1.8; 1.0-3.3). Taking these additional risk factors into account permits a prediction of the probability of a return to work.

Angina Pectoris↗
PubMed1975

[Medico-social aspects of the post-infarct state. Clinical, functional, psychological and return-to-work studies of 100 patients with myocardial infarct treated in the coronary unit].

To determine whether intensive care unit are able to improve long term as well as immediate prognosis of acute myocardial infarction, one hundred patients, aged 40 to 60 years, six months to three years after discharge have been studied. All patients were examined with ergometric test, psychological assessment and medico-social survey. Comparison was made with patients treated in general medical wards. Correlations between clinical picture, psychological pattern, functional capacity and return to work prove that treatment in a coronary care unit positively affects the future of these patients. The importance of a rehabilitation program and its principles are also discussed.

Adult↗