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At least 469 records · Page 26Linked to original sources
PubMed1989

Intensive care unit patient follow-up. Mortality, functional status, and return to work at six months.

Six months after hospital discharge, we followed up 1545 patients who had received care in the general medical-surgical intensive care unit (ICU) of a tertiary care hospital. Vital status could not be ascertained for 200 of these patients. Of the 1345 former ICU patients for whom a determination of vital status could be made, 1261 (94%) were alive and 84 (6%) had died. Of those known to be living, 887 (70%) responded to a questionnaire regarding employment, functional, and social status. A large proportion of survivors less than 40 years of age had returned to work. Younger patients admitted to the hospital for elective surgery reported as much compromise of physical and psychological activity as did older patients admitted for emergency reasons. Older survivors reported an increase of interaction with family members and a decrease of social interaction with those other than family.

Adult↗
PubMed2005

Depression and the perpetuation of an incapacitated identity as an inhibitor of return to work.

The aim of the current study was to conduct a qualitative investigation of attitudes to work among people diagnosed with clinical depression. It was of particular interest to understand the role played by illness in attitudes to recovery. The economic and social burden of adult depression on society is becoming increasingly apparent. It has been argued that recovery from mental illness of this kind is most appropriately understood in 'functional terms' (i.e. 'getting on with life beyond illness'). One important goal in this process is return to work. Accordingly, in-depth semi-structured interviews were conducted with 19 people formally diagnosed with clinical depression. These interviews were the analyzed using Interpretative Phenomenological Analysis: a method of investigation and analysis concerned with making sense of participant experiences and accounts of their ill-health. This process identified three master themes, only one of which is the focus of this paper. This theme pertains to the unwitting role that can be played by the health care system in reinforcing the 'sick role' and in so doing providing a continued justification for an 'off-work' identity. Consequently, this study provides an unusually penetrating insight into the way depression can, through institutional practices, become inextricably part of someone's identity, with important implications for functional recovery.

Depression↗
PubMed2001

Return to work: conducting a worksite assessment.

George is a 46 year old who, at work, develops back pain with right sided sciatica. Initial findings include an absent right ankle jerk with sensory loss in the distribution of the right S1 nerve root. MRI scan confirms the diagnosis of an L5-S1 disc herniation with pressure on the right S1 nerve root. Following referral to a neurosurgeon he undergoes microdiscectomy. He is now six weeks postoperative. The scar healed well. His sciatica and ankle jerk have improved. He is now considering returning to work.

Humans↗
PubMed1999

Evaluating patients for return to work.

The family physician is often instrumental in the process of returning a patient to the workplace after injury or illness. Initially, the physician must gain an understanding of the job's demands through detailed discussions with the patient, the patient's work supervisor or the occupational medicine staff at the patient's place of employment. Other helpful sources of information include job demand analysis evaluations and the Dictionary of Occupational Titles. With an adequate knowledge of job requirements and patient limitations, the physician should document specific workplace restrictions, ensuring a safe and progressive reentry to work. Occupational rehabilitation programs such as work hardening may be prescribed, if necessary. If the physician is unsure of the patient's status, a functional capacity evaluation should be considered. The family physician should also be familiar with the Americans with Disabilities Act as it applies to the patient's "fitness" to perform the "essential tasks" of the patient's job.

Algorithms↗
PubMedDate not supplied

[Two-year follow-up study of postoperative rehabilitation, return to work, and athletic activities of 111 Lebanese patients after coronary bypass].

The goal of this paper is to study the progress of the first phase of rehabilitation of a Lebanese population treated by coronary artery bypass surgery, as well as to follow long-term socioprofessional reinsertion and resumption of physical activity in these patients. 111 patients operated in our hospital of coronary artery bypass in 1997 have been studied retrospectively two years after the surgery. The analyzed parameters are socioprofessional demographic data, physical and sports activities before and after the bypass surgery as well as the applied rehabilitation program. Among the studied patients (mean age = 64 years, 77% of men), 30% only had a professional activity before the surgery. The majority of these patients returned to work in a mean delay of 45 days. 76% of the patients have regular physical activity two years after the surgery versus 50% before. On the 63 smoking patients before the bypass surgery, 41 continue to smoke 2 years later. The behavior of the Lebanese patients after a coronary artery bypass surgery is particular and different from what is reported in the literature: 1) The resumption of the initial work is more frequent and more precocious. 2) The patients start regular physical activity without surveillance or previous codification of the frequency and the intensity of the effort. 3) The majority of the smoking patients continue to smoke after surgery. 4) The functional rehabilitation is limited to the phase I.

Adult↗
PubMed2000

Long-term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation.

BACKGROUND: Low-back problems are one of the most frequent reasons for disability compensation claims by workers. However, the effect of Workers' Compensation status on the long-term outcome for workers with sciatica has not been studied in detail, to our knowledge. Therefore, we believe that it is important to describe the long-term outcomes for patients who have herniation of a lumbar disc and sciatica according to the Workers' Compensation status at the time of the preoperative consultation. METHODS: We conducted a prospective, observational study of patients who had sciatica and were seeking care from specialist physicians in community-based practices throughout Maine. Among 440 eligible patients, 199 were receiving Workers' Compensation at the time of entry into the study (baseline) and 241 were not. Three hundred and twenty-six patients (74 percent) completed questionnaires at the time of a four-year follow-up. The outcomes that we assessed included disability compensation and work status as well as relief from symptoms, functional status, and quality of life. RESULTS: Patients who were receiving Workers' Compensation at baseline were more likely to be young, male, and employed as laborers. They reported worse functional status; however, the clinical findings for these patients were similar to those for patients who were not receiving Workers' Compensation. Patients who had been receiving Workers' Compensation at baseline were more likely to be receiving disability benefits at the time of the four-year follow-up compared with those who had not (27 percent of 133 compared with 7 percent of 189; p<0.001); however, they were only slightly less likely to be working at the time of the four-year follow-up (80 percent of 133 compared with 87 percent of 190; p = 0.09). Operative management did not influence these comparisons, but it decreased symptoms and improved functional status. Patients who had been receiving Workers' Compensation at baseline also had significantly less relief from symptoms and improvement in quality of life than patients who had not been receiving Workers' Compensation (all p<0.001). In multivariate models, Workers' Compensation status at baseline was an independent predictor of whether the patient would be receiving disability benefits after four years (odds ratio, 3.5; 95 percent confidence interval, 1.7 to 7.6) but was not an independent predictor of whether the patient would be working on a job for pay at the time of the four-year follow-up (odds ratio, 0.6; 95 percent confidence interval, 0.3 to 1.2). CONCLUSIONS: Even after adjustment for the initial treatment of the sciatica and for other clinical factors, patients who had been receiving Workers' Compensation at baseline were more likely to be receiving disability benefits and were less likely to report relief from symptoms and improvement in quality of life at the time of the four-year follow-up than patients who had not been receiving Workers' Compensation at baseline. Nonetheless, most patients returned to work regardless of their initial disability status, and those who had been receiving Workers' Compensation at baseline were only slightly less likely to be working after four years. Whether or not they had been receiving Workers' Compensation at baseline, patients who had been managed with an operation reported greater relief from symptoms and improvement in functional status at the time of the four-year follow-up compared with patients who had been managed nonoperatively, even though the outcomes with regard to disability and work status in these two groups were comparable.

Adult↗
PubMed2003

Cost effectiveness of a multi-stage return to work program for workers on sick leave due to low back pain, design of a population based controlled trial [ISRCTN60233560].

BACKGROUND: To describe the design of a population based randomized controlled trial (RCT), including a cost-effectiveness analysis, comparing participative ergonomics interventions between 2-8 weeks of sick leave and Graded Activity after 8 weeks of sick leave with usual care, in occupational back pain management. METHODS DESIGN: An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain. Interventions used are 1. Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist. 2. Graded Activity based on cognitive behavioural principles by a physiotherapist. 3. Usual care, provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain. The primary outcome measure is return to work. Secondary outcome measures are pain intensity, functional status and general improvement. Intermediate variables are kinesiophobia and pain coping. The cost-effectiveness analysis includes the direct and indirect costs due to low back pain. The outcome measures are assessed before randomization (after 2-6 weeks on sick leave) and 12 weeks, 26 weeks and 52 weeks after first day of sick leave. DISCUSSION: The combination of these interventions has been subject of earlier research in Canada. The results of the current RCT will: 1. crossvalidate the Canadian findings in an different sociocultural environment; 2. add to the cost-effectiveness on treatment options for workers in the sub acute phase of low back pain. Results might lead to alterations of existing (inter)national guidelines.

Cost-Benefit Analysis↗
PubMed1983

Clinical problems in the management of patients with acute myocardial infarction from its onset to the patients' return to work.

Out of 330 patients with acute myocardial infarction (AMI) admitted to our institution, 256 patients entered our 3-week rehabilitation program and discharged from the hospital. Through the execution of the program, its feasibility and safety were examined, and guidelines for the progress of the program were re-evaluated. The state of outpatient community life and its determining factors were also investigated by a questionnaire. The following results were obtained: 1) Over 90% of patients with uncomplicated MI could complete the rehabilitation nearly on schedule, indicating the feasibility of the program. 2) Mortality after ambulation and serious complications related to rehabilitative activities were very few, indicating the safety of our rehabilitation program. 3) Among guidelines for the progression of the program generally accepted, the case for an elevation of blood pressure as well as an ST depression was found to be especially important in order to prevent serious complications. 4) Age, discharge exercise capacity, left ventricular function and the severity of coronary disease were important factors influencing the patients' returning to work.

Activities of Daily Living↗
PubMed1995

Workers' Compensation and return-to-work in low back pain.

The relationship of Workers' Compensation and litigation to low back pain (LBP) outcome is not established in the literature. Our study investigated the characteristics of disabled persons applying for Worker's Compensation or employing a lawyer, the factors predicting receipt of compensation, and the effects of compensation and litigation on employment outcome. One hundred sixty-nine unemployed persons with LBP were assessed by medical history, physical exam, biomechanical testing, psychiatric interview, and MMPI. Subjects were asked whether they had applied for compensation, received it, or had employed a lawyer. Six months later, subjects were asked about their employment and compensation status. Neither compensation status nor involvement of a lawyer significantly improved prediction of employment status 6 months later. Receipt of compensation predicted better outcome in those at risk for poor outcome due to external locus of control. Factors predicting failure to obtain compensation over 6 months, having applied, include education, spinal flexion, ability to do daily activities and affective inhibition. Neurological dysfunction did not predict receipt of compensation in univariate or multivariate analyses; emotional distress reduced the probability of receiving compensation, after controlling for severity of spinal dysfunction. Receipt of compensation and use of a lawyer did not reduce the probability of RTW in disabled persons in the present sample, but increased the likelihood of return to work for groups of individuals at higher risk such as those with external locus of control. Although compensation is awarded on the basis of physical evaluation under the present system, the present findings suggest that the likelihood of receiving compensation is also significantly determined by level of emotional distress.

Absenteeism↗