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PubMed1987

[Resumption of employment following aortocoronary bypass operation].

Between April 1981 and May 1983, 921 patients with coronary sclerosis underwent a bypass operation. Following the operation, 327 of these patients were asked to give their professional status. These were compared with the surgical result and the clinical findings. During the 22-month follow-up period 47.1% were without work. 52.9% returned to work after an average of 3.3 months. The following factors played a significant role in the decision whether or not to return to work: 1) the age of the patient (p less than 0.001); 2) the degree of physical stress to which the patient was subjected in his job before the operation (p less than 0.001); 3) the severity of the postoperative angina pectoris symptoms (p less than 0.01); 4) the improvement in the output of the left ventricle (p less than 0.05) and 5) the participation in rehabilitation treatment (p less than 0.01). By reducing the preliminary investigation period, increasing the operation capacity and making more effective use of the rehabilitation programme, more people could return to work after the operation and this in turn would increase our patients' quality of life.

Angina Pectoris↗
PubMed2000

Biopsychosocial screening questionnaire for patients with low back pain: preliminary report of utility in physiotherapy practice in Northern Ireland.

OBJECTIVE: The aim of this study was to investigate the potential utility of a new biopsychosocial screening questionnaire (Acute Low Back Pain Screening Questionnaire) by exploring the relation between it and several physical risk factors and posttreatment outcomes so as to establish a cutoff point for the local population. The relation between the screening questionnaire and valid and reliable outcome measures of pain and functional disability was also explored. DESIGN: Cross-sectional and longitudinal studies were conducted on patients referred for physiotherapy for low back pain to a large Healthcare Trust in Northern Ireland. Before initial assessment, patients completed the screening questionnaire and outcome measures, were questioned about known physical risk factors, and then received physiotherapy. At final discharge, the outcome variables--the "number of treatments" and patient's current work status ("return to work [yes/no]")--were recorded, and patients recompleted the outcome measures. PATIENTS: One hundred eighteen patients gave written informed consent to participate in this study. RESULTS: Significant associations were detected between questionnaire scores and pretreatment "leisure time exercise," "analgesic medication use," and "subjective anesthesia"; posttreatment "return to work"; and "number of physiotherapy treatments" as well as pain and functional disability measures. A cutoff "at-risk" score of 112 was calculated, which correctly classified 74% of patients who received more than six treatments and 80% of patients who failed to return to work at the end of treatment. CONCLUSIONS: The findings of this study provide preliminary evidence of the utility of this biopsychosocial screening questionnaire for future use in clinical intervention studies in the Northern Ireland National Health Service. Further comparative investigations in other health care settings are warranted.

Acute Disease↗
PubMedDate not supplied

A microtensiometer for the analysis of bioadhesive microspheres.

Bioadhesive polymer microspheres are potential vehicles for the delivery of bioactive agents to mucosal tissues. Bioadhesive delivery devices could improve drug absorption, enhance bioavailability, and increase patient compliance by minimizing dosing regimens. Identification of bioadhesive materials is the first phase in developing bioadhesive drug delivery systems. Additionally, quantification and analysis of the bioadhesive event are essential to successful development of a new generation of adhesive delivery systems. A unique, microbalance-based instrument was developed to analyze bioadhesive forces between polymer microspheres and mucosal tissue segments. A contact angle analyzer, with a custom-made physiologic tissue chamber, was linked to a computer via the serial port. Software was used to modify the microbalance operation to behave as a microtensiometer with a sensitivity of 0.1 microN. After mounting a microsphere and tissue segment in the balance and adjusting the experimental settings, the instrument performs a tensile experiment and automatically determines the following parameters: compressive deformation, peak compressive load, compressive work, yield point, deformation to yield, returned work, peak tensile load, deformation to peak tensile load, fracture strength, deformation to failure, and tensile work. Using this device the authors identified several bioadhesive materials ideally suited for orally-delivered, controlled-release systems. GI-transit studies in rats showed strong correlation between increased GI-residence time and strong bioadhesive interactions.

Adhesives↗
PubMed2002

Early discharge after core liver biopsy: is it safe and cost-effective?

OBJECTIVE: To determine if ambulatory patients who have undergone image-guided core liver biopsy with an 18-gauge needle and spring-loaded biopsy gun can be safely discharged after 1 hour of observation in the radiology department. METHODS: Fifty-four consecutive patients underwent ultrasound-guided core liver biopsy for a variety of suspected diffuse liver diseases. Post-biopsy, they were asked to grade their pain on a scale of 1-10 after 1 hour of recumbency on a hospital gurney in the department. At 2 weeks, all patients were contacted and asked about their level of pain and when they returned to normal activities. RESULTS: Of the 54 patients enrolled, 4 were lost to follow-up. Pain was the most common minor complication, occurring in 31 (62%) of patients. The average level of pain after 1 hour was 2.1 (1 = no pain) and after 24 hours, 1.5. Seven patients were admitted to a medical daycare bed for a total of 4 hours and were then discharged. The remainder were discharged after 1 hour. Forty (80%) patients were pain-free after 24 hours, 36 (90%) of the 40 patients who were working returned to work the following day, and within a week, all patients had returned to all normal activities. No patients required an inpatient hospital stay or sought assistance at an emergency department. CONCLUSION: These preliminary results demonstrate that ultrasound-guided 18-gauge liver core biopsy is a safe procedure, and, provided larger series confirm these findings, patients showing no complications can be discharged from the department after 1 hour with notable cost savings.

Adult↗
PubMed1994

Does nonsurgical pain center treatment of chronic pain return patients to work? A review and meta-analysis of the literature.

Evidence in the literature relating to return to work as an outcome variable for nonsurgical treatment for chronic pain was examined. Study selection criteria were as follows: a detailed definition of patient work status, delineation of work status pre-treatment and at follow-up, and documentation of the proportion of patients employed at follow-up. Of 171 studies reviewed, 37 fulfilled these selection criteria. Because the data were objective in nature, they were abstracted by the senior author only. For the coded variables of time to follow-up, proportion of patients working pre-treatment and at follow-up and number of patients, descriptive statistics and correlations were calculated. Change in employment status at follow-up was significant (P < .005) for all groups examined. In addition, comparisons for work outcome between treated patients versus patients rejected due to lack of insurance, and between treated patients versus patients who dropped out of treatment were both significant (P < .001). The mean difference in employment at follow-up for treated patients versus those not treated was approximately 50%. The proportion of patients working increased from 20% to 54% post chronic pain nonsurgical treatment. Correlation analyses did not find a significant trend in percent employed with time to follow-up. These results indicate that (1) chronic pain nonsurgical treatment does return patients to work; (2) increased rates of return to work are due to treatment, and (3) benefits of treatment are not temporary.

Chronic Disease↗
PubMed1998

Workers compensation. Effect of state law on treatment cost and work status.

Workers compensation legislation is regulated at a state level resulting in different benefits based on the state of employment. The negative effect of workers compensation on the results of surgical treatment has been established previously. A comparison of the results of treatment of patients receiving workers compensation from different states has not been reported. This study prospectively evaluated the effect of the difference in state workers compensation laws on the number of postoperative visits, amount of postoperative therapy, time off from work, and return to work status. The study group consisted of 275 patients. The results indicated a significant increase in the number of postoperative visits, amount of therapy, time off from work, and number of patients who remained out of work in the compensation versus the noncompensation group. A significant increase in these parameters also was present in the Pennsylvania compensation group as compared with the New Jersey compensation group. This study shows that differences in workers compensation benefits have a significant effect on the results of medical treatment, return to work status, and the cost of medical care.

Absenteeism↗
PubMed1997

Systematic reviews of bed rest and advice to stay active for acute low back pain.

BACKGROUND: In the United Kingdom (UK), 9% of adults consult their doctor annually with back pain. The treatment recommendations are based on orthopaedic teaching, but the current management is causing increasing dissatisfaction. Many general practitioners (GPs) are confused about what constitutes effective advice. AIM: To review all randomized controlled trials of bed rest and of medical advice to stay active for acute back pain. METHOD: A systematic review based on a search of MEDLINE and EMBASE from 1966 to April 1996 with complete citation tracking for randomized controlled trials of bed rest or medical advice to stay active and continue ordinary daily activities. The inclusion criteria were: primary care setting, patients with low back pain of up to 3 months duration, and patient-centred outcomes (rate of recovery from the acute attack, relief of pain, restoration of function, satisfaction with treatment, days off work and return to work, development of chronic pain and disability, recurrent attacks, and further health care use). RESULTS: Ten trials of bed rest and eight trials of advice to stay active were identified. Consistent findings showed that bed rest is not an effective treatment for acute low back pain but may delay recovery. Advice to stay active and to continue ordinary activities results in a faster return to work, less chronic disability, and fewer recurrent problems. CONCLUSION: A simple but fundamental change from the traditional prescription of bed rest to positive advice about staying active could improve clinical outcomes and reduce the personal and social impact of back pain.

Acute Disease↗
PubMed2004

Swedish Council on Technology Assessment in Health Care (SBU). Chapter 8. Sick leave due to coronary artery disease or stroke.

The assessment of the literature on sick-leave with cardiovascular diseases include only studies with sufficient scientific quality. These studies describe sick leave following stroke, myocardial infarction, coronary artery bypass grafting (CABG), or percutaneous coronary intervention (PCI). We found limited scientific evidence for the following results: After stroke, more than half of the patients of working age returned to work (RTW) during the first year following onset (higher rate for the younger patients). The consequences of brain damage, e.g. impaired ADL ability or cognitive capacity, play an important role in this respect. Also after myocardial infarction most patients RTW. PCI is a milder coronary artery intervention than CABG and RTW is more rapid. However, in the long run there are no differences in sick leave. People at higher ages or with physically demanding jobs return to work to a lesser degree. An international comparison shows that the duration of sick leave due to these conditions in Sweden is longer than in other countries although there is no scientific evidence to support this practice. It appears that the interest in research on sick leave in patients with cardiovascular diseases has waned in recent years. Developments in acute cardiological care should inspire renewed scientific involvement in this area of research.

Absenteeism↗
PubMed2005

[Occupational orientation in medical rehabilitation and measures for participation in the professional life].

Return-to-work and protection of work-related participation is stated as a primary objective of rehabilitation by the statutory pension insurance institutes. A general continuous management of work-related participation in rehabilitation is a prerequisite for optimal results in view of stay in work and return to work. This means an extended vocational orientation in medical rehabilitation, individualized occupational rehabilitation according to need and capacity in connection with closer linkages between medical and occupational rehabilitation. In the course of the "Rehabilitation Sciences" research funding programme and beyond it, quite a few research projects and scientific activities aimed at development, testing and evaluation of -new screenings and diagnostic instruments with better findings of vocational related needs in medical and occupational rehabilitation, -specific methods of therapy and models for treatment settings with immediate reference to the work related restriction and capacity, as well as -models of the organization and forms of cooperation between medical and occupational rehabilitation. This paper reviews the projects and findings in these research fields in relation to the requirements for an increase of general continuous vocational orientation in rehabilitation.

Biomedical Research↗
PubMed2003

The million visual analog scale: its utility for predicting tertiary rehabilitation outcomes.

STUDY DESIGN: A longitudinal cohort study involving 1749 patients with chronically disabling spine disorder (CDSD) who underwent tertiary rehabilitation investigated the relation between the Million Visual Analog Scale (MVAS) score and treatment outcome. OBJECTIVES: To determine whether the pretreatment MVAS rating of disability severity is associated with the ability to complete functional restoration rehabilitation, and to determine whether pre- or posttreatment MVAS disability perception is associated with 1-year posttreatment socioeconomic outcomes. The relation of the MVAS to pre- and posttreatment psychosocial measures and physical performance levels also was evaluated. SUMMARY OF BACKGROUND DATA: The MVAS yields a total functional disability score ranging from 0 to 150. Like other "disability inventories," the MVAS differs from a "pain inventory" in that the focus is on disability and function, as opposed to self-reported pain. The MVAS may currently be the most powerful functional rating scale because all its questions relate to the patient's ability to perform activities of daily living. It also has the advantage of a visual analog format, which typically is considered more effective than other commonly used self-report formats. METHODS: A large cohort of 1749 patients with CDSD who underwent tertiary rehabilitation was divided into groups by their severity of disability, rated on the MVAS, both at pre- and posttreatment assessment. The patients were divided into groups ranging from "no reported disability" (MVAS = 0) to "extreme disability" (MVAS = 131-150). The distribution into the six groups was assessed on both pre- and posttreatment MVAS ratings. The patients underwent a 3-week functional restoration program consisting of daily quantitatively directed exercise progression and multimodal disability management. Physical capacity and psychosocial assessments, performed before and after treatment, were correlated with the MVAS scores. A 1-year posttreatment clinical interview obtained information on socioeconomic outcomes, which also were correlated with the MVAS ratings. RESULTS: Mantel-Haenszel linear analyses showed a number of relations between demographic variables and both pre- and posttreatment MVAS scores. Most importantly, the findings showed that severe pretreatment MVAS scores were associated with a lower program completion rate (94% vs 89%; P < 0.001) and a higher rate of postrehabilitation health care use from a new provider (12% vs 41%; P < 0.001). Prerehabilitation scores also were linearly related to lower levels of pretreatment physical performance and higher rates of pretreatment depression. More severe posttreatment MVAS scores were associated linearly with a drop in the work return rate from 93% to 63%, a drop in the work retention rate 1 year after rehabilitation from 86% to 44%, and a drop in the financial settlement rate from 94% to 79% (P < 0.001). A linear trend also was found in the rate of postrehabilitation surgeries, with the percentages rising from 0% in the group with no reported disabilities to 12% in the group with extreme disabilities (P < 0.001). CONCLUSIONS: The current study represents the first large-scale examination of the relation between MVAS ratings and treatment outcomes in a CDSD population. These results demonstrate the effectiveness of a simple disability rating scale, such as the MVAS, for systematic disability assessment in potentially predicting treatment outcomes in patients with CDSD. Despite the popularity of other questionnaires, the MVAS is the first disability inventory with demonstrated effectiveness for this purpose in a large CDSD population.

Adult↗
PubMed1994

Work redesign: a return to the basics.

Through a work redesign project, one hospital focuses on the root of the nursing care delivery system. The premise was simple--a return to the basics to redefine barriers, needed system changes, and role responsibilities. Successful outcomes include improved recruitment and retention as well as increased patient, staff and community satisfaction.

Delivery of Health Care↗
PubMed1996

Leave and employment in families of preterm low birthweight infants.

OBJECTIVE: To determine how employment, income and out-of-pocket expenses changed in 224 families of low birthweight infants during the first 6 months after the infant was discharged home. DESIGN: Prospective, descriptive. POPULATION, SAMPLE, SETTING, YEARS: Families of preterm, low birthweight infants. A convenience sample of families of 224 preterm (< 37 weeks gestation) low birthweight (< 2500 grams) infants was obtained from one hospital in the Northeastern U.S.A. Mothers were interviewed over the telephone at each of the data points. Years of data collections were 1990-1994. METHODS: Mothers kept logs of expenses and were interviewed about changes in employment and income at infant discharge from the hospital and 1, 3, and 6 months later. FINDINGS: All but two of the employed mothers had to leave employment early because of pregnancy complications. After delivery, fewer mothers returned to work or returned later and worked less than mothers in national studies. Families spent 2% to 4% of their income in non-reimbursed out-of-pocket expenses; transportation was a major expense. CONCLUSIONS: Having a low birthweight infant results in unexpected changes in employment and in increased and unexpected out-of-pocket expenses. CLINICAL IMPLICATIONS: Study findings support the need for longer leave for mothers who have small infants.

Adult↗
PubMed2001

Laparoscopic hernia repair enhances early return of physical work capacity.

Several researchers have documented less postoperative pain and a quicker return to daily activities after laparoscopic herniorrhaphy. However, little objective data that validates this hypothesis exists. This study compares the rate of postoperative physical work capacity with return to preoperative levels, which is measured by a standard treadmill test in patients who underwent laparoscopic and conventional open hernia repair. Patients completed a 6-minute walking test preoperatively and 1 week postoperatively using a nonmotorized treadmill. The distance walked was recorded. If the distance that a patient achieved at 1 week was not within 0.02 miles of the preoperative values of the patient, the patient was asked to return at 1 month for repeat testing. Patients were enrolled prospectively in this study from October 1997 to February 1999. Sixty-six patients participated in the study (27 laparoscopic herniorrhaphies and 39 open herniorrhaphies were performed). There was no significant difference in age, body mass index, or preoperative distance achieved among the two groups. At 1 week, patients who underwent laparoscopic repair demonstrated a mean increase of 18 meters from preoperative distance (P = 0.07). In the open group, patients demonstrated a mean decrease of 90 meters at 1 week (P = 0.001). The change in distance at 1 week between the laparoscopic and the open groups was statistically significant (P = 0.001). However, at 1 month, there was no significant difference among the two groups. Measured using treadmill walking, laparoscopic hernia repair seems to offer an early advantage to open repair in return-to-physical-work capacity.

Exercise Test↗
PubMed1995

The length dependence of work production in rat papillary muscles in vitro.

The influence of length on work production was investigated for rat papillary muscles using the work loop technique. Active and passive length-force relationships were first determined under isometric conditions and the length for maximum force production (Lmax) was derived. Starting from different lengths within the physiological range, a series of work loops was generated using the stimulation phase shift, strain amplitude and cycle frequency previously found to be optimal for power output at 37 degrees C. The relationship between muscle length and net work was used to determine the length at which work output was maximal (Lopt). In order to examine the dynamic passive properties of the muscles, unstimulated muscles were subjected to the same regime of sinusoidal oscillation as used for the active loops. From the hysteresis loops, lengthening work (work done to extend the passive muscle), passive shortening work (work returned during shortening) and net energy loss (hysteresis) could be measured. The decline in net work production at lengths greater than 95% Lmax could largely be attributed to the rapid and non-linear increase in muscle stiffness and the increase in net energy loss over this range of lengths. The physiological significance of the length-work relationship is considered and the mechanical properties of active and passive papillary muscles are discussed with reference to sarcomere length and cardiac muscle ultrastructure.

Animals↗
PubMed1986

Employment after myocardial infarction amongst previously healthy men.

A postal questionnaire was sent to 55 men 18 months after their first myocardial infarction; information obtained was supplemented by interview with two of the authors (PW and GC). Fifty-three men had been in full-time employment prior to their illness, 38 of them in manual work. Their return to work and changes in employment were examined and, in addition, enquiries were made about subsequent health, assistance from trade unions and the local Disabled Resettlement Officer (DRO). Details of attitude to subsequent physical exercise and sexual activity were also recorded. Eighteen months after myocardial infarction, only 35% of these men were employed and 27% asymptomatic. Patients in heavy manual work were largely unable to return to their previous job and little assistance was obtained from trade unions. Even when patients were made aware of the existence of the DRO, few approached him for advice. A counselling service is needed for patients recovering from an infarct to encourage them to return to an active and profitable life.

Counseling↗
PubMed2003

Disability and chronic pain after open mesh and laparoscopic inguinal hernia repair.

Proponents of laparoscopic inguinal hernia repair maintain that the associated costs and risks are offset by faster recovery and less postoperative pain. It was our hypothesis that the incidence of chronic pain in both groups of our patients was not as high as reported in the literature. Patients for the study were identified from a community hospital medical record database. A total of 229 patients were available and agreed to participate in the study. Data collected included the patient's current pain level at the hernia site, pain medication currently used, narcotics currently used, return to normal work, and return to normal activity. Overall, 19.7 per cent of patients complained of mild pain, but only 2.2 per cent classified this as moderate or severe. Mild pain was noted more often in the open repair patients compared with the laparoscopic group. However, there was no difference in the frequency of moderate or severe pain. The time to return to work was longer in the open repair group than the laparoscopic repair group, but there were large ranges in both groups. The inability to return to full preoperative activity was infrequent and equivalent in both open and laparoscopic hernia repair groups. In our study of 229 patients undergoing elective open or laparoscopic inguinal hernia repair at a community hospital, we have found a low incidence of moderate or severe chronic pain. In addition, we found that this procedure did not interfere with return to work at 6 months or return to daily activities in either the laparoscopic or open repair group.

Activities of Daily Living↗
PubMed1995

[Occupational therapy in cardiac rehabilitation].

The occupational therapy in cardiac rehabilitation is aimed to decrease the physiologic and psychologic patient overwork, allowing the work return. It shows a more ergonomic way to do those dangerous tasks without risk. It is necessary because there are differences between the work done in the effort tests and his lifetime. The cardiac rehabilitation is an efficient share in coronary patient treatment and occupational therapy is a significant complementary procedure.

Combined Modality Therapy↗
PubMed2002

Industrial medicine and acute musculoskeletal rehabilitation. 5. Effective medical management of industrial injuries: from causality to case closure.

UNLABELLED: This self-directed learning module highlights the physician's role in treating industrial injuries, from the initial causality determination to the eventual case closure. It is part of the chapter on industrial medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The article reviews important factors in determining whether an injury is work-related, particularly in the presence of preexisting, underlying conditions. The article addresses the roles of functional capacity examinations and work-hardening programs in facilitating successful return to work. Interactions are outlined between work return and nonwork activities of daily living, as well as financial and psychologic barriers that may impede work return. Legal issues regarding independent medical examinations and depositions are reviewed. Guidance is offered for identifying those relatively few injured workers who may require referral for surgical or other consultations. OVERALL ARTICLE OBJECTIVES: (a) To review the important medical, administrative, and legal challenges involved in treating injured workers and to describe strategies that physiatrists use to overcome effectively these challenges.

Acute Disease↗