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PubMed1991

Employee experiences with early return to work programs.

Those who administer early return to work programs should be aware of the differing needs of workers who have suffered on the job injuries. Many employees are able to move through a program without problems; others are at risk for poor outcomes. Those workers most in need of assistance should an on the job injury occur are those who have relatively poor satisfaction in the job in which injury occurred, a longer period of disability due to injury, aggravation of injury while on the early return to work program, or perceptions of little support from within the company. Particular attention to certain aspects of programs (identification of workers at risk for poor outcome, design of modified jobs, and communication of concern for workers) may enhance favorable response to early return to work programs.

Accidents, Occupational↗
PubMed1998

Motivating factors for return to work.

BACKGROUND AND PURPOSE: A new concept to increase return to work for patients listed as sick with chronic musculoskeletal pain has been used at a rehabilitation centre in Luleå, Sweden. The programme includes work for three days a week and intensive rehabilitation for two days a week, for 12 weeks, as a combination of 'on the job' training and rehabilitation after a period off work sick. The rehabilitation programme focused on pain reduction, identifying and finding solutions to pain problems in actual work and life situations and training of the functional capacities needed in the work and life situation. The aim of the study was to describe patients' perceptions of motivating factors for return to work. METHODS: A phenomenological method was used. A naïve reading of interview notes was followed by structural analyses and reflections on the interpreted whole. Inclusion criteria for the study were musculoskeletal pain for at least one year and a period of at least four weeks' sick leave during that time. Ten patients, aged 30-54 years, participated in the study. An initial conceptual framework was developed to inform the scope of the study and to guide data collection and analysis. RESULTS: Different factors in the study framework influenced motivation to return to work. Among structural factors the division of labour at work was the most important motivator, particularly the ability to do as much as work colleagues, quantitatively and qualitatively. All the patients had jobs in the healthcare or service sectors, jobs with many social contacts. They perceived their work task content as being of minor importance compared to whether the tasks were perceived as meaningful or highly needed by others. All wanted a meaningful job content and a job which they could do in a satisfactory way according to their own norms and compared to colleagues. This highly increased motivation for return to work. Relationships (in terms of co-operation with colleagues and service to patients or clients) were important motivating factors for return to work. Self-confidence was a new factor of importance for return to work; work tasks had to be meaningful and needed by others, work must be done in a way satisfactory for the individual and in a way that was acceptable to others in the group. Everyday responsibility, feedback and support in daily work tasks were important. These aspects increased self-confidence. The results supported the development of a new conceptual framework for possible motivating factors for return to work. CONCLUSIONS: Structure, content, relationships, health and self-confidence were all important motivating factors for return to work.

Adult↗
PubMed2006

Systematic review of the qualitative literature on return to work after injury.

OBJECTIVES: This paper reports on a systematic review of the international qualitative research literature on return to work. This review was undertaken in order to better understand the dimensions, processes, and practices of return to work. Because return to work often includes early return before full recovery while a person is undergoing rehabilitation treatment, physical recovery is embedded in complicated ways with workplace processes and practices and social organization. These process-oriented dimensions of return to work are well described in the qualitative literature. METHODS: This systematic review of the literature covered peer-reviewed papers that focused on musculoskeletal and pain-related injuries and were published in English or French between 1990 and 2003. Findings from papers meeting relevance and quality criteria were synthesized using the meta-ethnographic approach. RESULTS: This review found that return to work extends beyond concerns about managing physical function to the complexities related to beliefs, roles, and perceptions of many players. Good will and trust are overarching conditions that are central to successful return-to-work arrangements. In addition, there are often social and communication barriers to return to work, and intermediary players have the potential to play a key role in facilitating this process. CONCLUSIONS: This paper identifies key mechanisms of workplace practice, process, and environment that can affect the success of return to work. The findings illustrate the contribution that qualitative literature can make to important aspects of implementation in relation to return to work.

Accidents, Occupational↗
PubMed1995

Randomized controlled trials in industrial low back pain relating to return to work. Part 1. Acute interventions.

Employers and insurers are interested in being able to use cost-effective interventions for returning injured workers to the workplace. Unfortunately, truly objective information is lacking. The purpose of this and two subsequent review articles was to perform thorough scrutiny and methodologic comparison among all obtainable, published randomized and controlled studies on low back pain (LBP) interventions leading to return to work. The study was confined to English language articles published from 1975 through 1993. Of more than 4,000 LBP citations, more than 500 were chosen for review. Of that number, 35 articles met the selection criteria of randomization, reasonable controls, and work return comparisons. This paper focuses on the 10 articles relating to interventions for acute (less than 4 weeks) LBP, and considers bed rest, exercise, spinal manipulation, back school, and case management. A 26-point quality system was used to compare the methodologic rigor of each article. This literature survey demonstrated the meager scientific foundations on which our industrial rehabilitation programs are based.

Bed Rest↗
PubMed2005

Failure to complete a functional restoration program for chronic musculoskeletal disorders: a prospective 1-year outcome study.

OBJECTIVE: To compare comprehensively the likelihood of various socioeconomically relevant outcomes between functional restoration completers and noncompleters, while simultaneously identifying risk factors for noncompletion. DESIGN: A prospective cohort study of patients with chronic disabling occupational musculoskeletal disorders (CDOMD). SETTING: Chronic pain management facility. PARTICIPANTS: A total of 1440 patients with CDOMD were consecutively divided into 2 groups-one with 303 patients who did not complete the prescribed treatment program (noncompleters [NC]) and a second with 1137 patients who did (completers). INTERVENTION: The Interdisciplinary Functional Restoration: Rehabilitation program. MAIN OUTCOME MEASURES: Validated questionnaires about pain, disability, and depression were added to results of a structured 1-year posttreatment telephone interview on socioeconomic outcomes covering work status, health utilization, recurrent injury claims, and resolution of financial disputes. RESULTS: The 1-year posttreatment socioeconomic outcomes were most striking. The NC group was 7 times more likely to have postrehabilitation surgery in the same area, and nearly 7 times more likely to have more than 30 visits to a new health provider in persistent health care-seeking efforts. The NC group also had only half the rates of work return and work retention, being 9.7 times less likely to have returned to any type of work, and 7 times less likely to have retained work at the end of the year. Regression analysis also revealed that work return, surgery in a compensable injured area, more health care utilization from a new provider, and more overall health care utilization (>30 visits) were most reliably predicted by whether the rehabilitation program was completed. CONCLUSIONS: This large prospective study determined that noncompleters of interdisciplinary tertiary rehabilitation for CDOMDs had comparatively poor socioeconomic outcomes in the year after discharge from treatment, especially on work status and health utilization outcomes. These outcomes are of great relevance to societal, medical, and indemnity costs and future worker productivity. Several risk factors of possible importance in identifying potential noncompleters early in the treatment program were identified that may yield more effective interventions tailored to maintain compliance and decrease the percentage of drop-outs.

Adult↗
PubMedDate not supplied

Factors reported to influence the return to work of cancer survivors: a literature review.

An overview is provided of research into the return to work of cancer survivors, examining both the rate of return to work and factors impacting this return. A series of literature searches was conducted on MEDLINE and PSYCLIT databases for the years 1985-1999. Studies had to focus on the patient's perspective and had to include either the percentage of return to work or factors associated with return to work. Case studies and studies of cancer as an occupational disease were excluded. The search identified 14 studies. The mean rate of return to work was 62% (range 30-93%). The following factors were negatively associated with return to work: a non-supportive work environment, manual labour, and having head and neck cancer. Sociodemographic characteristics were not associated with return to work. For increasing age, associations were mixed. The increased survival rate of cancer patients warrants attention to the problems survivors may encounter upon their return to work. More systematic research is needed to establish more clearly the relative importance of factors associated with return to work of cancer survivors, which, in turn, would contribute to an increase in the labour-participation of cancer survivors.

Adolescent↗
PubMed1994

[The rate and factors of return-to-work in head-injured patients following hospitalization].

Return-to-work is often used as a measure of overall recovery from injury or illness. This study focuses on the labor force population who inhabit in Kaohsiung City, and were hospitalized into Chung Ho Memorial Hospital Kaohsiung Medical College in 1992. The patients were contacted for an interview at least six months post-discharge. In addition to the rate of return-to-work by severity, factors were examined for their influence on return-to-work. Of those 85 eligible individuals, the rate of return-to-work was 81.2%. According to the Glasgow Coma Scale, the head injury severity was classified as mild, moderate and severe. The rate of return-to-work by severity were 86.4%, 78.6%, and 58.3%, respectively. Factors influencing return-to-work were divided into pre-injury, hospitalization, and post-discharge period. According to the study, the three influencing factors that correlated with post-injury employment status were number of productive members in family, length of stay, and physical handicap.

Adolescent↗
PubMed2002

Into work, through tailored paths: a two-year follow-up of the return-to-work rehabilitation and re-employment project.

Between the years 1996 and 2000, over 2000 projects were carried out in Finland with the aim of finding innovative measures for crossing the job threshold. Among them was the Pathway-to-Work Project, which aimed at tailoring return-to-work plans for 140 middle-aged, long-term unemployed participants with various disabilities and getting half of them into work or training. This study of the Pathway-to-Work Project had two research objectives. First, to evaluate the outcomes of the return-to-work rehabilitation project and second, to determine what combination of different measures seemed necessary and effective in the rehabilitation of long-term unemployed people with disabilities. The research design comprised three parts: a quantitative quasi-experimental part with a matched control group, a register follow-up and the collection of qualitative data. The main variables used to evaluate the outcomes were (1) the changes in the labour market situation during the 2-year register follow-up, (2) the changes in distress (measured by the General Health Questionnaire-12), perceived competence (measured by Wallston's Self-Performance Survey) and sense of coherence (measured by Antonovsky's SOC-13) during the intervention and (3) the description of the process in the project. In the 1-year follow-up, 31% of the participants were found to be at work and 37% unemployed. In the 2-year follow-up, 14% were at work and 59% unemployed. The jobs seemed to be subsidized for a period of half a year to a year. The difference between the project group and the matched control group was remarkable: at the end of the project, only 9% of the control group were at work and 86% unemployed. The participants' distress level decreased remarkably and their perceived competence increased, but their sense of coherence did not change. The results showed that even carefully tailored client work enables only some of the long-term unemployed people with disabilities to cross the job threshold and that other means of policy, strategy and intervention are needed to link the return-to-work interventions more closely with work, work places and enterprises.

Adult↗
PubMed2006

Correlates of return to work for breast cancer survivors.

PURPOSE: To identify correlates of return to work for employed breast cancer survivors. PATIENTS AND METHODS: Patients included 416 employed women with newly diagnosed breast cancer identified from the Metropolitan Detroit Cancer Surveillance System. Patients were interviewed by telephone 12 and 18 months after diagnosis. Correlates of return to work at 12 and 18 months were identified using multivariate logistic regression. RESULTS: More than 80% of patients returned to work during the study period, and 87% reported that their employer was accommodating to their cancer illness and treatment. After adjusting for demographic characteristics, health status, cancer stage, treatment, and job type, heavy lifting on the job (odds ratio = 0.42; 95% CI, 0.18 to 0.99), perceived employer accommodation for cancer illness and treatment (odds ratio = 2.2; 95% CI, 1.03 to 4.8), and perceived employer discrimination because of a cancer diagnosis (odds ratio = 0.27; 95% CI, 0.10 to 0.71) were independently associated with return to work at 12 months after breast cancer diagnosis, and perceived employer accommodation (odds ratio = 2.3; 95% CI, 1.06 to 5.1) was independently associated with return to work at 18 months after breast cancer diagnosis. CONCLUSION: A high percentage of employed breast cancer patients returned to work after treatment, and workplace accommodations played an important role in their return. In addition, perceived employer discrimination because of cancer was negatively associated with return to work for breast cancer survivors. Employers seem to have a pivotal role in breast cancer patients' successful return to work.

Adult↗
PubMed2003

Live donor nephrectomy and return to work: does the operative technique matter?

BACKGROUND: Several studies report an earlier return to work after minimal invasive kidney donation compared to open donor nephrectomy. However, this variation in outcome might be influenced by other factors than the surgical technique used, such as the advice given by the physician regarding return to work. In this study, we compare the absence from work after open (ODN), laparoscopic (LDN), and hand-assisted donor nephrectomy (HA) performed in the Netherlands, in relation to the advice given. METHODS: Questionnaires containing questions about return to work or return to daily activities were sent to 78 donors from three hospitals. In the HA and ODN hospitals, advice on full return to work was 3 months. In contrast, advice given in the LDN hospital was 6 weeks. RESULTS: After LDN, donors resumed their work after 6 weeks, 5 weeks faster compared to ODN (p = 0.002) and HA (p <0.001). Complete return to work occurred 9 weeks sooner in the LDN group compared to the ODN and HA groups (both p <0.001). In the unemployed group, there was no significant difference in length until full return to daily activities. CONCLUSION: Return to work is influenced by the advice on return to work given by the physician as well as the morbidity associated with the surgical approach.

Absenteeism↗
PubMed2005

Time to return to work and surgeons' recommendations after carpal tunnel release.

BACKGROUND: Time to return to work after carpal tunnel release is extremely variable suggesting that only a small proportion of total sick-leave is for medical reasons. AIMS: To determine factors predicting a delayed return to work. METHODS: Fifty consecutive employed patients undergoing carpal tunnel surgery were tested pre-operatively, and then at 1 month post-operatively using both questionnaires and objective testing. Further follow-up by telephone was carried out every 2 weeks up until 90 days. RESULTS: Forty-nine of the 50 workers had returned to work by 3 months. Time to return to work was extremely variable ranging from 1 to 88 days in those who returned to work. Post-operative recommendations by the surgeon also varied widely from 1 to 36 days. The surgeons' recommendations were the strongest predictors of delayed return to work [odds ratio 30.5; 95% confidence interval (CI), 3.2-288], with physical work (odds ratio 27.7; 95% CI, 1.5-507) and lack of self-rated health (odds ratio 5.0; 95% CI, 1.11-100) adding significantly to the logistic regression model, which was highly predictive (area under the receiver-operator curve of 88%). Patient symptoms and objective findings of disability did not add significantly to a logistic regression model either predicting return to work or the surgeon's recommendations. CONCLUSIONS: Our study suggests that workers will return to work in less than 3 weeks if recommended by the surgeon. A randomized controlled trial is warranted to determine if a higher proportion of workers returning in less than 3 weeks can be obtained by standardizing surgeons' recommendations.

Adult↗
PubMed2000

A facilitated early return to work program at a large urban medical center.

An Early Return to Work Program was initiated at The Johns Hopkins Hospital and Associated Schools of Medicine, Hygiene and Nursing in Baltimore, Maryland, in April 1992 as part of a comprehensive effort to control the incidence and costs of work-related illnesses and injuries. The program was similar to others that incorporate employee and supervisory training and job accommodation, but it also included an industrial hygienist trained in ergonomics to facilitate the placement of individuals with restrictions. The return to work program was studied over a 10-year period, comparing the number of lost workday cases, lost workdays, and restricted duty days before (1989 to 1992) and after (1993 to 1999) initiation of the program. A significant decrease (55%) was observed in the rate of lost workday cases before versus after the return to work program. Furthermore, the number of lost workdays decreased from an average of 26.3 per 100 employees before, to 12.0 per 100 employees after, the return to work initiative, and the number of restricted duty days went from an average of 0.63 per 100 employees to 13.4 per 100 employees (a twentyfold increase). The study suggests that a well-structured early return to work program is an integral part of a comprehensive effort to control the duration of disability associated with occupational injuries and illness. It also indicates that to be most effective, an early return to work program must include participation by medical providers, safety professionals, injured employees, and supervisors. Our work suggests that even with these elements in place, the effectiveness of return to work programs may be increased by including an individual trained in ergonomics to facilitate the job placement process.

Accidents, Occupational↗
PubMed1982

Effects of a directive return to work approach in the treatment of workman's compensation patients with chronic pain.

The incidence of work resumption of two groups of differentially treated workman's compensation patients with chronic pain was retrospectively examined. Significantly more patients who were directed to return to work during the treatment program (group II) did so (60%), than did patients in another group (group I) who were similarly treated but for whom work return was not a component of therapy (25%). At follow-up an average of 9.6 months later, 90% of the group II patients were still working. As well, patients in group II were receiving fewer compensation benefits and had received less additional treatment for their pain than group I patients.

Adult↗
PubMed2004

Using telework to enhance return to work outcomes for individuals with spinal cord injuries.

Return-to-work is an area of critical concern for individuals with a spinal cord injury (SCI), because of the psychological, psychosocial and economic benefits of employment. Although the majority of individuals with SCI are employed pre-injury, they are impeded from maintaining those jobs due to personal, organizational and systems level barriers. Telework, which permits home-based work through the use of Information and Communication Technologies (ICT), alleviates many of return-to-work barriers for individuals with SCI, including job demands, mobility limitations, transportation needs and fatigue imposed by medical complications. For telework to fulfill its potential as a return-to-work strategy, rehabilitation professionals and employers must assess and enhance the readiness of the individual, workgroup and organization within the context of a disability management program. Strategies for successfully implementing telework as a return-to-work strategy for individuals with SCI are discussed, along with implications for future research.

Employment↗
PubMed1980

[Social fate (return to work) after coronary heart surgery and/or aneurysmectomy (author's transl)].

The "return to work"-rate of 4 groups of patients with myocardial infarction (MI) is evaluated (all coronary angiography): Group 1: 314 patients after aorto-coronary bypass operation: mean age 50.5 years. Time after infarction 28 months, after surgery 18 months. The social fate of 52% were not yet decided. 20% got pension, 25% returned to work. Group 2: 86 patients after conservative treatment of myocardial infarction: mean age 42 years. Time after MI 18 months. The social fate of 21% was not yet decided, 41% got pension, 36% returned to work. Patients with one-vessel disease returned to work in 52%, with two-vessel disease in 20% and with three-vessel disease in 12.5%. Group 3: 24 patients after aneurysmectomy: mean age 47 years. Time after infarction 28 months, time after operation 11 months. Social fate of 8 out of 24 patients was not yet decided, 7 out of 24 got pension, 5 out of 24 returned to work. Group 4: 27 patients with conservatively treated left ventricular aneurysm: mean age 43 years. Time after infarction 42 months. The social fate of 2 out of 27 patients was not yet decided, 14 out of 27 got pension, and 8 out of 27 returned to work. Exercise-tolerance is no good indicator for the work status 18 months after myocardial infarction, 18 months after aorto-coronary bypass, 18 months after aneurysmectomy and 42 months after conservative treatment of left ventricular aneurysm. Selection of patients (all were examined by coronary angiography because of limitation by angina pectoris in daily life activities) may be partly responsible for the poor long-term work status. But more important seems to be the "tied social network". Decision for "return to work" or "pension" should be made 6 months after MI or after operation.

Activities of Daily Living↗
PubMed1996

REACH: an alternative early return to work program.

One of the most frequently cited strategies for successful return to work post-injury or illness--early return to work--is often an unattainable goal for many employees. Returning injured or ill employees to an existing program outside of the company (where the injury or illness occurred) is a means of overcoming the obstacles often associated with early return to work programs. A significant reduction in workers' compensation costs was demonstrated for employees participating in the early return to work program that placed ill or injured workers in positions at workshops for the developmentally disabled. This reduction in costs was demonstrated while paying these employees 100% of their wages rather than the lesser compensation amount.

Cost Savings↗
PubMed2001

Return to work after brain injury: a self-directed approach.

For many, returning to work after a brain injury is an extremely difficult task. Many factors influence a person's decision whether or not to work. While some people with brain injury are excited to return to their old jobs, others are afraid of the physical, emotional, and financial consequences of returning to work, and some just do not want to work at all. The following manuscript provides a framework for persons with brain injury to address concerns regarding returning to work and alternatives to living productively. There are a number of ideas discussed within the framework of a self-guided therapeutic return to work program. Clinicians are encouraged to use the information provided to facilitate return to work discussions with their clients with brain injury and to adapt as necessary for use with persons with other neurological disabilities.

Attitude to Health↗