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PubMed2001

Tracheotomy in severe TBI patients: sequelae and relation to vocational outcome.

The aim of the present study was to find the influence of performing tracheotomy on outcome of severe TBI patients. TBI patients, many of them intubated during the very acute phase post-injury, who remain unconscious for more than a few days, undergo tracheotomy to provide a reliable long term artificial airway. Tracheotomy, although being a simple elective surgical procedure, may have a negative influence on the rehabilitation process. Tracheotomy was performed in 25% (n=69) of 277 consecutive severe TBI patients admitted to the rehabilitation department during 3 years. In seven patients (10%), tracheotomy was performed immediately after injury due to cranio-facial trauma, in 18 patients (29%) due to respiratory disturbances, in 42 patients (55%) after prolonged intubation, and in two patients (6%) due to combined problems. Forty-five per cent of patients with tracheotomy suffered from respiratory disturbances and 8.6% from complications of tracheotomy. Longer periods of unconsciousness and mechanical ventilation were significantly associated with respiratory complications (p<0.0001 and p<0.001, respectively). However, presence of tracheotomies per se, did not affect vocational rehabilitation.

Adolescent↗
PubMed1996

Utility of a verbal reasoning test in indicating vocational readiness following traumatic brain injury.

Present tests are often inadequate to assess subtle aspects of cognitive-communicative functioning following traumatic brain injury (TBI), making it difficult to predict vocational readiness, particularly for those in professional occupations. This study examined the viability of the Ross Test of Higher Cognitive Processes (RTHCP) as a measure of verbal reasoning deficits following TBI. The verbal reasoning performance of a 43-year-old lawyer with TBI was compared, at two stages in his rehabilitation, to that of a peer group of lawyers (n = 43). The RTHCP detected noticeable differences in speed and accuracy of performance at different stages of recovery. The RTHCP also revealed individual differences among the peer group, who presumably were competent in verbal reasoning. Thus, the RTHCP may be an effective tool to measure subtle deficits in verbal reasoning post-TBI. Some cautions in using this test for the TBI population are presented, as well as suggestions for further test development and validation.

Adult↗
PubMed1996

Vocational outcome of aphasic patients following severe traumatic brain injury.

The incidence and course of aphasia, and its impact on vocational outcome, were determined in a group of 351 patients with severe traumatic brain injury (TBI). Aphasia was found in 11.1%, the common forms being amnestic (56%, 22/39), expressive (10.3%, 4/39) and receptive (10.5%, 8/39), as found on the first language assessment. No age difference was found between the aphasic and non-aphasic patients. Coma was more common in the aphasics than the non-aphasics (95% and 82%, respectively), although its mean duration was shorter. Aphasics had more severe locomotor deficits (p < 0.01, Fisher test) and tended towards more severe cognitive disorders (p = 0.07, Fisher test). There was no difference between the groups in incidence of behavioural disturbances or occupational outcome. Most of the aphasic patients improved after therapy, and two recovered completely. The presence of aphasia did not have negative prognostic implications for occupational outcome.

Activities of Daily Living↗
PubMed1999

Cognitive indicators of vocational outcome after severe traumatic brain injury (TBI) in childhood.

Recent studies suggest that plasticity does not benefit outcome when diffuse cerebral pathology of the young child's brain is concerned. Thirty-three patients with severe traumatic brain injury (TBI) at preschool age were followed-up until adulthood. After the age of 18 years, a thorough neurological, neuropsychological and social evaluation, including detailed patient history and assessment of identity, was made by the team. When the youngest patients were 21 years old, the study was completed, with a questionnaire assessing employment status and ability to live independently. Twenty-seven per cent of the patients worked full time, 21% had subsidised work, 37% lived independently at home and 15% needed help with every-day functions. Tests measuring speed, executive and memory functions were significantly associated with vocational outcome, as was the sense identity, which was independent of the test scores. The results support the recent reports on the vulnerability of a young child's brain to early trauma. The study also strongly suggests that the final assessment of outcome after childhood TBI should be done in adulthood.

Adolescent↗
PubMed2002

The physician's role in the vocational rehabilitation process.

PURPOSE: To describe and analyse physicians' experiences of working with sick-listing and vocational rehabilitation, their perceptions of their co-actors and the interaction they participate in. METHOD: Thematic interviews with 14 physicians in Västerbotten County, northern Sweden. The physicians were active in primary or occupational health care, or as hospital doctors. The interviews were conducted during the autumn of 1996. The interviews were tape recorded and analysed according to Grounded theory. RESULTS: Feelings of isolation and diminished control, lack of time and increased demands are all seen as obstacles for doing an optimal job with sick-listing and rehabilitation. Other obstacles are insufficient knowledge regarding the labour market and the social insurance legislation. Interaction between primary and in-patient care does not function satisfactorily. The doctors believe in their patients and a majority of the doctors feel that the patients' own understanding of/need for sick-listing guides the doctor in his or her position regarding sick-listing. To facilitate return to work, the doctors encourage part-time sick-listing. CONCLUSIONS: The interviews show that the physicians experience a growing discrepancy between ideal and reality. They want to be able to act as "team players", but experience increasing demands due to the increased number of patients who are sicker than before. The doctors experience that decision latitude has diminished and this has been followed by less time for patients.

Attitude of Health Personnel↗
PubMed1995

Rehabilitation technology assessment practices in vocational rehabilitation agencies.

A rehabilitation technology assessment is an essential element in the array of rehabilitation technology services provided for vocational rehabilitation (VR) clients. As a part of a comprehensive survey of rehabilitation technology services in VR agencies, information was collected on current practices in rehabilitation technology assessment. Some variation in length, components included, and professionals involved were found among agencies. A complete description of these assessments as reported by VR agencies is discussed and commonalities in current practice are described.

Consultants↗
PubMed2005

Assessing cost-effectiveness in mental health: vocational rehabilitation for schizophrenia and related conditions.

OBJECTIVE: Existing evidence suggests that vocational rehabilitation services, in particular individual placement and support (IPS), are effective in assisting people with schizophrenia and related conditions gain open employment. Despite this, such services are not available to all unemployed people with schizophrenia who wish to work. Existing evidence suggests that while IPS confers no clinical advantages over routine care, it does improve the proportion of people returning to employment. The objective of the current study is to investigate the net benefit of introducing IPS services into current mental health services in Australia. METHOD: The net benefit of IPS is assessed from a health sector perspective using cost-benefit analysis. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis of the net benefit, defined as the benefits of IPS (comprising transfer payments averted, income tax accrued and individual income earned) minus the costs. The second stage involves application of 'second-filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using the multivariate probabilistic sensitivity analysis. RESULTS: The costs of IPS are 10.3M Australian dollars (95% uncertainty interval 7.4M-13.6M Australian dollars), the benefits are 4.7M (3.1M-6.5M Australian dollars), resulting in a negative net benefit of 5.6M Australian dollars (8.4M-3.4M Australian dollars). CONCLUSIONS: The current analysis suggests that IPS costs are greater than the monetary benefits. However, the evidence-base of the current analysis is weak. Structural conditions surrounding welfare payments in Australia create disincentives to full-time employment for people with disabilities.

Adult↗
PubMed2004

The effectiveness of vocational services for substance users in treatment.

Employment appears frequently in the literature as an outcome criterion for substance users in treatment, and most clinicians subscribe to the belief that work plays an important role in recovery from addiction. Despite the importance attached to employment, the major standard treatment modalities have not been shown as effective in increasing client employment after treatment. The article presents a critical review and synthesis of three decades of research on the effectiveness of specialized vocational intervention for addiction treatment clients.

Employment↗
PubMed2004

Special section: the most critical unresolved issues associated with contemporary vocational rehabilitation for substance users. The critical relationship between employment services and patient motivation.

Several interventions and service delivery models now exist to help unemployed people in treatment for substance use disorder seek gainful employment (Platt, 1995). Some of these interventions can be conveniently offered within substance user treatment settings. One of the best known examples of these interventions is job seeking skills training and support services that help patients develop resumes, complete employment applications, learn effective networking strategies, and develop and practice effective responses to common issues and questions raised during employment interviews. A wide range of more comprehensive off-site employment programs that provide intensive vocational training and rehabilitation also exist in many communities. The growing availability of on-site services in substance user treatment programs also creates the

Employment↗
PubMed2004

Working it out: development and testing of a multimedia, vocational education program.

A self-administered, CD-ROM-based, interactive multimedia psychoeducational intervention, called Working It Out, was developed to improve employment functioning for clients in substance dependency treatment. The computer-based, program's effectiveness was tested in comparison with printed material. During 2000--2001 194 clients with employment concerns in six treatment programs were randomly assigned to a CD-ROM or print material condition and evaluated at baseline and 6 months later. A main effect for improvement was observed on employment indices, but there was no condition-by-time interaction. Results suggest that clients are willing and able to use vocational rehabilitation information presented in any format, although the CD-ROM-based program received significantly better satisfaction ratings than did the print material.

Adult↗
PubMed2004

The value of vocational rehabilitation in substance user treatment: a cost-effectiveness framework.

Vocational rehabilitation (VR) programs within addiction treatment traditionally consider employment as the desired outcome. This singular focus ignores other benefits, such as.reduced substance use. A framework for evaluating the cost-effectiveness of VR within addiction treatment is presented and illustrated with data from the Alcohol and Drug Services Study (ADSS, 1996--1999). VR was associated with a 2.5% increase in probability of abstinence at an $883 increase in cost per admission. Thus, the estimated cost-effectiveness of VR in promoting abstinence is $35,000 per additional abstinent client ($883/0.025), indicating that VR is a cost-effective contributor to other goals of addiction treatment.

Adult↗
PubMed2007

Vocational rehabilitation of locomotive engineers with ischaemic heart disease.

BACKGROUND: There is resistance among railway companies and their occupational health services to rehabilitating locomotive engineers with ischaemic heart disease to their former driving work. AIM: To study the outcome of vocational rehabilitation for locomotive engineers with ischaemic heart disease. METHODS: In seven European countries, selected locomotive engineers with ischaemic heart disease were compared to a matched group of healthy engineers. At the end of each calendar year between 1990 and 1999, questionnaires were completed by local occupational health physicians to provide information on accidents, incidents (professional mistakes), sick leave, (recurrent) cardiac events, death and early retirement. We used the life table method with five follow-up years to calculate the risk of accidents, incidents and recurrent cardiac events. RESULTS: The accident rate for the cardiac group was 3.8 accidents per 100 person-years, as compared to a rate of 6.0 in the reference group. The rates for incidents were 0.9 and 2.0, respectively. Neither of these differences were statistically significant. The duration of sick leave was significantly longer among the cardiac group than it was among the reference group, but only in the first follow-up year. Thirteen recurrent cardiac events occurred in the cardiac group, as compared to a single cardiac event in the reference group. There was no difference in the proportion of retirement cases. One engineer in each of the two groups died of cardiac disease. CONCLUSIONS: Locomotive engineers can safely resume driving duties following onset of cardiac disease.

Accidents↗
PubMed1983

Coronary artery surgery as a measure of vocational rehabilitation: an analysis of the working status of patients with mild angina randomly assigned to medical or surgical treatment.

Work status was studied in 76 male patients under the age of 60, who had been randomly assigned to surgical or medical treatment for coronary artery disease with relatively stable angina (Class I or II NYHA) One year after catheterization or surgery, there were as many patients employed in the medical (84%) as in the surgical (81%) groups, despite a marked improvement of functional symptoms in the latter group; 8% in surgical patients and 11% in medical patients were on social welfare. Surgery did not improve work resumption in patients who had been unemployed for seven months or more before inclusion into the study (71%, versus 67% in medical patients). It is concluded that aorto-coronary bypass surgery cannot be considered as a measure of vocational rehabilitation sufficient to improve employment in patients with mild stable angina, when compared to medical treatment.

Adult↗
PubMed1990

Vocational and social learning of people with severe disabilities in sheltered employment.

In addition to prevocational centres for young people with disabilities about to enter the labour market and vocational training centres for older persons, the Federal Republic of Germany provides a network of sheltered workshops for those who are unable or unlikely to work under competitive conditions. This paper describes the programme for persons in the latter category, based on applications of learning theory, provided at the sheltered workshop in Detmold, Westphalia. It also reports various steps which have been taken to evaluate and refine the two-fold approach to training developed at this centre, based on job analysis and detailed appraisal of workers' social and psychological characteristics, and to apply that approach to persons with a wider range of disabilities.

Persons with Disabilities↗
PubMed1994

Coping with illness and coping with handicap during the vocational rehabilitation of physically handicapped adolescents and young adults.

Coping with illness and coping with handicap during the vocational rehabilitation of physically handicapped adolescents and young adults are given great consideration in rehabilitation centres. The mutual dependence of defence styles and ways of coping with serious illnesses are demonstrated in case vignettes 1 and 2. Defence processes can block coping with illness. In adolescents who are physically handicapped since birth, other body and self-representations are developed according to the form of handicap. After an accident or illness in later childhood or adolescence, new body and self-representations have to be built up in a way that corresponds to the changed physical circumstances (case vignette 3). This is often a lengthy and painful process of mourning. The extent to which the adolescent patient will be granted independence and autonomy from the family will influence the course of the illness itself. The dangers and prospects of lengthy rehabilitation processes are discussed. The necessary adjustments that physically handicapped adolescents have to make when they are admitted into a residential facility for the physically handicapped are described.

Adaptation, Psychological↗
PubMed2002

Use of health-care services, work absenteeism, leisure-time physical activity, musculoskeletal symptoms and physical performance after vocationally oriented medical rehabilitation-description of the courses and a one-and-a-half-year follow-up study with farmers, loggers, police officers and hairdressers.

The aim of this study was to evaluate the effectiveness of vocationally oriented medical rehabilitation (VOMR) carried out in institutions with regard to the use of health-care services, work absenteeism, leisure-time physical activity, musculoskeletal symptoms and physical performance during 112 years of follow-up. The prospective cohort study consisted of 265 patients from four different occupational groups (loggers, hairdressers, police officers and female farmers) who took part in VOMR courses in three inhouse phases, financed by the Finnish Social Insurance Institution, and who had chronic musculoskeletal symptoms in their back and neck. The subjective physical and mental strain of work, subjective neck-shoulder and low-back pain, use of health-care services and leisure-time physical activity were assessed with a questionnaires. The muscle strength of the upper and lower extremities and trunk was determined and maximal VO2 was measured using the direct maximal bicycle ergometer test. The subjective physical and mental strain of work, subjective neck-shoulder and low-back pain and physical performance showed positive significant development and improvement. The changes in the use of health-care services and work absenteeism were minor or insignificant. The general finding was that the results from the second phase of the VOMR courses did not differ from those of the third phase. VOMR courses had a beneficial effect on physical performance and subjective pain caused by neck and back musculoskeletal diseases of farmers, loggers, police officers and hairdressers within 112 years of follow-up, but VOMR courses did not decreased the use of health-care services.

Adult↗
PubMed1995

Scoring the Farnsworth-Munsell 100-hue for vocational guidance.

BACKGROUND: We considered whether the color discrimination of mild color defectives scoring < or = 100 is the same as that of normals. METHODS: We analyzed the FM 100-hue results of 126 normals and 94 congenital color defectives retrospectively by considering the Total Error Score (TES) and individual cap errors (error profiles). RESULTS: A TES of 100 passes 95% of normals and 24% of congenital color defectives. The error profiles of some of the mild defectives who pass show abnormal peaks along a red-green axis. An error > or = 5 in these regions is a good indicator of abnormal color discrimination. CONCLUSIONS: Some 30% of mild defectives (TES < or = 100) have limited hue discrimination in the red-green domain, so both the TES and error profiles need to be considered when providing vocational guidance.

Adult↗
PubMed2003

Vocational rehabilitation in schizophrenia and other psychotic disorders: a literature review and meta-analysis of randomized controlled trials.

Although most individuals with schizophrenia are unemployed, plentiful evidence suggests that work rehabilitation is effective for this population. Yet, there have been only 11 published randomized controlled trials of work rehabilitation interventions for people with severe mental illness. We review these 11 studies, 9 of which were trials examining Individual Placement and Support (IPS) or supported employment (SE) interventions. Outcomes strongly favored the experimental groups in terms of the percentage of participants who worked at any point during the studies (weighted mean effect size = 0.66). In the 5 investigations comparing IPS/SE to conventional vocational rehabilitation services, 51% of the participants receiving IPS/SE worked competitively, versus 18% of those in the comparison groups (weighted mean effect size = 0.79). This effect size may be a useful benchmark for future trials. Further investigations should examine individual differences as predictors of response, to identify modifiable versus nonmodifiable factors that yield better outcomes.

Adult↗