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PubMed2001

Occupational-psychosocial perceptions influencing return to work and functional performance of injured workers.

Much has been done to identify psychosocial factors influencing risk of vocational injury and prolonged disability. The purpose of this paper is to enhance the ability of injured workers to return to their prior worker role through the identification of the influencing psychosocial perceptions. Psychosocial perceptions may assist in the identification of negative or counterproductive factors that hinder the rehabilitative process. Identifying perceptions are individual centered and focused on the views of injured workers as they proceed through the transition in life following injury. Occupational therapists play a key role in the rehabilitative process of injured workers through enhancing the person-job-environment fit [4].

Journal Article↗
PubMed1996

The causality field (extrinsic and intrinsic factors) in industrial subacute low back pain patients.

In a prospective, randomized study, primarily designed to test the efficacy of activation on consecutive blue-collar workers sick-listed for 6 weeks due to subacute low back pain, 25% of the workers were excluded for medical reasons. In the intervention study (n = 103), only a minority of cases (6%) had 'true' subacute complaints, i.e. no prior history of low back pain. Subjective reports on general well-being, health status and work-related ergonomic factors were significantly lower or worse in patients than in reference samples. The randomized intervention study could establish a significant effect of graded activation on work return, but the effect seemed to be restricted to patients moderately disabled, i.e. one-third of the subacute low back pain patients included. A predictive four-factor model on work return increased the possibility of identifing nonresponders (chronic low back pain) more than threefold with a specificity (91%) and sensitivity (74%) comparable to that of clinical disc herniation. The history of a prolonged disablement process, cognitive factors, pain behavior and mentally straining ergonomic factors seemed to be of importance. Psychological reactions, or 'barriers to recovery', were slightly different in treatment and control groups but the type of intervention did not significantly alter the predictive model, suggesting that subsets of the study sample may benefit from other optional functional approaches. Descriptive characteristics of the study sample emphasized that subacute low back pain patients cannot be conceptualized as a homogeneous group. Four sub-groups could be identified: (a) specific medical disorders; (b) spontaneous recovery group; (c) moderately disabled back pain patients; and (d) nonresponders. The results support proposals that treatment should be tailored according to individual needs and that better case management should have priority for those belonging to the nonresponder group.

Adult↗
PubMed1995

Traumatic brain injury: factors predicting return to work or school.

Prediction of outcome for brain-injured individuals will facilitate effective rehabilitation programme planning which will ultimately improve the patient's quality of life. A sample of traumatic brain-injured subjects who had completed their rehabilitation were contacted post-discharge to identify predictive factors for return to work/school. Subjects were given a telephone interview and their charts were examined retrospectively along five subsets of variables in the predictive matrix: sociodemographics, chronicity, indices of severity, physical impairment, and cognitive functioning. Forty-five subjects were used as the study sample to investigate their vocational and educational outcome, and to generate the best predictive model for return to work/school. Twenty subjects made up the test sample used to evaluate the generalizability of the predictive model. Performance IQ score of the Wechsler Adult Intelligence Scale-Revised emerged as the most significant predictor of return to work/school. Implications of these findings for treatment and rehabilitation are discussed.

Activities of Daily Living↗
PubMed2002

Occupational contact dermatitis I: incidence and return to work pressures.

Since the passage of the United States Occupational Safety and Health Act (OSHA) in 1970, there have been extensive changes in United States workplaces that should have served to enhance the prevention of occupational skin disease (OSD). Analysis of skin diseases reported to OSHA (OSHA recordables) shows that the number of OSDs declined steadily from 1974 to 1983 to about half the previous annual incidence. After 1984, there was a modest resurgence peaking in 1994, with a subsequent decline. A similar but somewhat greater decline in the late 1990s has been observed for occupational respiratory diseases, diseases caused by toxic agents and for poisonings. Likely explanations for the trends in OSD are discussed; the initial decline probably reflected an improvement in workplace conditions, the later resurgence and decline may have been attributable to changes in recording behaviors and in worker's compensation. The decline in recorded OSD since 1996 has been fairly uniform in most major industrial sectors but has been less marked in agriculture, forestry, and fishing so that this sector has replaced manufacturing in recording the highest incidence rate. In 1999, the incidence rate of recorded OSD was 0.49 per 1,000 workers, which appears to grossly under report the true incidence. OSD now constitutes about 10% of all occupational disease cases. Currently, there is increasing emphasis in corporate and occupational medicine on reducing costs and maintaining productivity as well as in preventing occupational injuries and diseases. This is shown by the trend for a greater proportion of workers with occupational conditions to return to modified duty positions rather than to be completely off work. Implications of this phenomena for management of OSD are discussed.

Dermatitis, Occupational↗
PubMed1979

Return to work and quality of life after surgery for coronary artery disease.

Changes in work capability and quality of life were assessed retrospectively in 130 patients with ischaemic heart disease who had undergone aortocoronary bypass operations during 1976-7 because of medically uncontrollable angina. A total of 85 patients (65.4%) reported complete relief from angina six months after operation, though 12 later suffered a recurrence. Substantially fewer patients needed drugs after the operation. Before operation 9 out of 117 men fully employed at the onset of angina were working without restriction or doing lighter, fulltime work, 38 were at work but seriously incapacitated by angina, and 70 were forced to stop work. After operation 70 were working without restriction or engaged in lighter work, 15 were at work but still restricted by angina, and only 32 were forced to stop work. This result was highly significant (P less than 0.001). These differences were even more pronounced in heavy manual workers, of whom none cobld work normally before operation, whereas 16 were working without restriction afterwards. Of patients wishing to engage in hobbies or sports, social activity, and sexual intercourse but were restricted before operation, about two-thirds could resume these activities afterwards. Coronary artery surgery provided dramatic symptomatic relief in up to 90% of patients and permitted rehabilitation and return to gainful employment irrespective of type of labour. The degree of symptomatic improvement and increase in exercise tolerance after successful surgery is usually far greater than occurs with any other form of treatment and directly improves quality of life and work capability.

Activities of Daily Living↗
PubMed1996

Relationship between health status and postoperative return to work.

BACKGROUND: Time back to work or normal activity is often regarded as an outcome measure of interest after surgery. It has recently been used as a way of quantifying the benefits of minimal access surgery. However, the extent to which variation in time back to normal reflects differences in health status is unclear. METHODS: The relationship was examined in 140 patients recovering from inguinal hernia repair. A multi-dimensional measure of health status, the Short Form 36 (SF-36), was administered preoperatively, and at ten days and six weeks postoperatively. The relationship between scores on the SF-36 dimensions and return to normal activity was examined using correlation statistics and stepwise regression. RESULTS: Health status dimensions measuring role limitation owing to physical restriction at 10 days and 6 weeks, and role limitation owing to mental problems at ten days were associated with time to return to normal on univariate analysis. Social class was also strongly associated. Using stepwise regression these two dimensions of health status together explained 33 per cent of the variance in time to normal. Other factors unrelated to health status clearly contributed to this outcome. CONCLUSION: Time back to normal activity postoperatively is influenced by a number of factors unrelated to health status and is an unreliable proxy for it. Time to normal is therefore, not a good outcome measure for quantifying the benefits of surgical interventions. Claims currently being made to justify investment in some minimal access interventions should be interpreted in the light of this.

Activities of Daily Living↗
PubMed1987

Return to work and social adjustment after traumatic head injury.

During follow-up of 485 adult patients with mainly mild head injury 27% of the patients were unemployed after an observation period of 3-5 years (mean 4.0 years). The length of sick leave during the last 3 years was longer than for a control group. Reduced physical capacity and time of sick leave during the last 3 years were the variables which were most closely associated with unemployment at follow-up. The long term family life, contact with friends and income were less favourable in the head injured patients than in the control group.

Absenteeism↗
PubMed2002

Long-term survivors with adult acute leukemia in complete remission: complications and return to work.

For addressing, and eventually being able to predict and prevent, both disease-related complications and changes in social status in long-term acute leukemia survivors, the follow-up is the most important factor after treatment. To this end, we assessed the complications following the attainment of complete remission in adult acute leukemia patients and the changes in social status of patients surviving more than 5 years after disease onset. In our study population of 42 survivors, 24 (57.1%) suffered from various combinations of 18 types of identified complications including posttransfusion hepatitis, diabetes mellitus, and idiopathic osteonecrosis. Regarding fertility, 9 live births were recorded in this cohort, from 2 female patients and the partner of a male patient. Of these 42 long-term survivors, at the time of this report 48.5% were working full- or part-time, 9.0% were unemployed, 30.3% were homemakers, and 12.2% were retired.

Acute Disease↗
PubMed2006

A comparative study of living conditions in cancer patients who have returned to work after curative treatment.

GOALS OF WORK: The goal of this study was to explore living conditions among disease-free cancer survivors participating in the labour force after successful primary treatment. Their living conditions were compared with the conditions of matched controls from the general Norwegian population. PATIENTS AND METHODS: Living conditions are social indicators that stimulate social inclusion and reduce exclusion such as economy, employment, health, housing and social participation. A questionnaire covering living conditions with established questions from population surveys was mailed to 852 cancer survivors and 1,548 controls. Valid responses were obtained from 51% cancer survivors (216 women with breast cancer, 49 men with prostate cancer, and 165 with testicular cancer) and 39% controls (317 women and 279 men). MAIN RESULTS: Compared to their controls cancer survivors showed no difference in work hours or full-time jobs, but reported significantly poorer physical and mental work capacity. This was associated with significantly more somatic diseases among survivors and poorer general health status in male survivors. The survivors had significantly smaller households and more living space than controls. No significant differences were observed concerning economy or social participation, except that significantly more female survivors than controls stated that they had enough friends. CONCLUSIONS: In spite of poorer health, tumour-free survivors after breast, testicular, and prostate cancer report mostly equal living conditions compared to matched controls. The protection hypothesis of holding jobs as a precondition for normal living condition was confirmed in our study of a sample of cancer survivors with good outcome.

Activities of Daily Living↗
PubMed2006

Treatment of impingement syndrome: a systematic review of the effects on functional limitations and return to work.

The goal of this systematic review is to evaluate the effectiveness of different treatments for impingement syndrome and rotator cuff tear on the improvement in functional limitations and concomitant duration of sick leave. A systematic search for clinical trials or controlled studies was conducted with the following text words: should*, rotator cuff, impingement, work, sick leave, disabilit*, function*. Nineteen articles were included in this review. For functional limitations, there is strong evidence that extracorporeal shock-wave therapy is not effective, moderate evidence that exercise combined with manual therapy is more effective than exercise alone, that ultrasound is not effective, and that open and arthroscopic acromioplasty are equally effective on the long term. For all other interventions there is only limited evidence. We found many studies using range of motion and pain as outcome measures but functional limitations were less often used as an outcome measure in this type of research. Duration of sick leave was seldom included as an outcome measure.

Adrenal Cortex Hormones↗
PubMed2005

Beyond return to work: testing a measure of at-work disability in workers with musculoskeletal pain.

BACKGROUND: There are a limited number of validated measures of a patient's perception of the level of difficulty that they are having at their job. The purpose of this study was to evaluate the psychometric properties of the 16-item Work Limitations Questionnaire (WLQ-16). METHODS: A sample of 42 workers reporting to a workplace occupational health unit with upper limb or low back pain were enrolled in an observational study. Participants were assessed at baseline, 4 and 12 weeks post reporting. Psychometric testing (distributions, Cronbach's alpha, construct validity and responsiveness to change in problem and pain) was done using the baseline and 12-week data. RESULTS: The WLQ-16 had evidence of internal consistency, construct validity and responsiveness. Some ceiling effect was found in the domains of mental-interpersonal and output demands. Physical demands suffered from missing values in 18/42 due to not-applicable content. Construct validity revealed that there was less discrimination at the higher (less limited) end of the scale. Responsiveness was present, though less than found with other measures of function and pain. CONCLUSIONS: The WLQ-16 shows promise as a measure of at-work disability. Further testing to evaluate the ceiling effect and responsiveness to constructs of change more closely related to work disability is recommended.

Adult↗