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PubMed1996

Factors related to successful work hardening outcomes.

BACKGROUND AND PURPOSE: The purpose of this study was to identify factors that predict successful work hardening outcomes. Two measures of success were used: return to work and case closure (ie, resolution of medical treatment issues). SUBJECTS: Persons with spine-related injuries who completed a work hardening program were the subjects. One hundred fifteen subjects participated in a 3-month follow-up survey, and 111 subjects participated in a 12-month follow-up survey. METHODS: Data were collected on subject characteristics, treatment history, job factors, program payer, and program factors. Subjects were contacted by telephone at 3 and 12 months after program completion to determine work status. Logit analysis was used to identify predictors of successful versus unsuccessful outcomes. RESULTS: Three months after program completion, 68% of the subjects had returned to work and 86% had successful case closure. Twelve months after program completion, 77% of the subjects had returned to work and 90% had successful case closure. The more treatment subjects received prior to entering the program, the less likely they were to be working or achieving case closure following treatment. Subjects' work status and initial time off of work were factors predicting early return to work, but not 12 months after program completion. Subjects who were working with an attorney were less likely to achieve case closure than those who were not working with an attorney. Subjects who were satisfied with the program were more likely to have achieved case closure or return to work than those who were not satisfied with the program. CONCLUSION AND DISCUSSION: Several factors have been identified that predict successful work hardening outcomes. This information can be used to identify clients who are unlikely to benefit from work hardening.

Adult↗
PubMed1997

Factors influencing vocational outcomes following stroke in Taiwan: a medical centre-based study.

This study was aimed at identifying the factors relating to return to work for stroke patients of working age in Taiwan, adjusting for confounding factors. A retrospective cohort study was used to test the association between patients' characteristics, such as medical condition at admission and sociodemographic factors, and the degree of return to work after stroke. Two hundred and forty-eight consecutive stroke survivors discharged from the National Taiwan University Hospital participated in the follow-up survey. Variables considered likely to influence return to work were collected from the patients' hospital records. Vocational outcomes were collected via questionnaire. Return to work was classified into four levels: (I) no return to work; (II) limited return to work; (III) partial return to work; and (IV) complete return to work. Of the 248 subjects surveyed, 105 (42.7%) subjects had not returned to work, 32 (12.9%) subjects had returned to work on a limited basis, 43 (17.3%) subjects had partially returned, and 68 (27.4%) subjects had returned to work completely. Cramer's V test and stepwise logistic regression were employed to examine factors influencing return to employment. Maximum weakness and employment institution were identified as the strongest predictors of return to work. In brief, nearly three-quarters of the patients did not resume their usual work roles after stroke. Maximum weakness and employment institution were the strongest predictors of return to work following a stroke in Taiwan.

Cerebrovascular Disorders↗
PubMed2005

Work-related recovery expectations and the prognosis of chronic low back pain within a workers' compensation setting.

OBJECTIVE: We examined the association between work-related recovery expectations and return-to-work in patients with chronic back pain. METHODS: A prospective cohort of workers receiving time-loss benefits for back pain of at least 6 weeks' duration was studied. Workers completed a battery of measures, including a work-related recovery expectations questionnaire. Outcomes included surrogate indicators of timely return-to-work (days until suspension of time-loss benefits) and recovery (claim closure) censored at 1 year. Analysis included multivariable Cox and logistic regression. RESULTS: The sample was predominantly male (63%), with a mean age of 42 years. Positive work-related recovery expectations predicted a 26% faster suspension of time-loss benefits (95% confidence interval = 8-40%) and explained 7% of the variation in this outcome. CONCLUSION: Recovery expectations provide important information for predicting time to return-to-work, as measured through suspension of time-loss benefits (R approximately 7%) in patients with chronic back pain.

Adult↗
PubMed1976

Reemployment related to functional and haemodynamic changes after aortic or mitral valve replacement.

The objectives of this longitudinal study were to determine the proportion of individuals who return to work following aortic or mitral valve replacement, and to compare the functional and haemodynamic status in those who return to work with those who do not return to work. The study includes a total of 133 subjects who were all examined 12--24 months after the operation. Based on this investigation, an overall reemployment rate of 44 % was found. Return to work was more frequent in the younger group than in the older group. Furthermore, while the patient's opinion of the extent of his physical handicap was of some importance when return to work was discussed, there did not appear to be any significant relationship between the working or the non-working group and objective indices of improvement as decrease in heart volume, regression of left ventricular hyperthrophy in the electrocardiogram, increase in cardiac output and decrease in pulmonary wedge pressure. Most important was the observation that the rate of return to work was closely related to the employment status before operations. The conclusion reached was that individuals who return to work were more likely to be those who were employed up to the time of the operation, while return to work after a long period of unemployment before operation was unusual, irrespective of the surgical results.

Adolescent↗
PubMed2004

Mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits.

BACKGROUND: Recent national statistics indicate that, despite increases in the proportion of mothers who initiate breastfeeding, the proportion that continue to breastfeed their infants through 6 months of age remains below the Healthy People 2010 goal of 50%. National professional organizations recommend that clinicians routinely counsel mothers about the benefits of breastfeeding. Little is known, however, about the counseling provided during these visits and how mothers and their clinicians perceive breastfeeding counseling. OBJECTIVES: We sought to describe mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits and identify potential gaps in communication about breastfeeding and management practices. METHODS: We conducted a prospective cohort study of low-risk mother-newborn pairs and their clinicians in a large multispecialty group practice. The participating mothers completed telephone interviews at 4 and 12 weeks postpartum, and their data were linked with their obstetric and pediatric clinicians' responses to a cross-sectional mailed survey conducted during the same time period. Overall, response rates were 63% for mothers (n = 429) and 82% for clinicians (obstetric clinicians: n = 54; pediatric clinicians: n = 67). RESULTS: Of the 429 low-risk mother-newborn pairs in the study, 61% were white, 16% were black, 10% were Hispanic, and 8% were Asian, with a mean (SD) age of 32.7 (5.1) years. At 4 weeks postpartum, 319 mothers (74%) were either exclusively or mixed breastfeeding. According to the interviews, few mothers discussed breastfeeding duration with their obstetric clinicians during their prenatal visits (15%) or with their pediatric clinicians during their infants' 2-week preventive visit (24%). Among 164 mothers whose obstetric providers said they usually or always discuss breastfeeding duration during prenatal visits, only 26 (16%) of the mothers reported that the topic was discussed with them (22% agreement; kappa = -.004). Among those mothers whose pediatric clinicians said they usually or always discuss breastfeeding duration during the 2-week preventive visit, only 25% of the mothers reported that the topic was discussed (32% agreement; kappa =.05). Many of the mothers had either returned to work by 12 weeks (29%) or planned to return to work within the next few months (43%). Although nearly all the obstetric (91%) and pediatric (97%) clinicians reported that they usually or always discuss whether a mother plans to continue breastfeeding after returning to work, only approximately half (55%) of the mothers seen by the clinicians reported that the topic was discussed. Overall, few mothers reported discussing with their clinicians specific ways to continue breastfeeding after returning to work. CONCLUSION: Mothers' reports of breastfeeding advice given during routine preventive visits identified several areas in which unintentional communication gaps may occur, including specifics about breastfeeding duration and methods of breastfeeding after returning to work. Developing approaches to enhance communication with mothers during routine preventive visits could improve the support of breastfeeding.

Adult↗
PubMed2005

Clinical and radiological outcomes with the Charité artificial disc: a 10-year minimum follow-up.

This is the first report of clinical and radiologic outcomes for the CHARITE artificial disc with a minimum follow-up of 10 years. A total of 107 patients indicated for total lumbar disc replacement were implanted with the CHARITE prosthesis. Of these 107, 100 were followed for a minimum of 10 years (range 10-13.4 years). A total of 147 prostheses were implanted with 54 one-level and 45 two-level procedures and 1 three-level procedure. The prostheses were placed through a standard anterior retroperitoneal approach. Clinically, 62% had an excellent outcome, 28% had a good outcome, and 10% had a poor outcome. Of the 95 eligible to return to work, 88 (91.5%) either returned to the same job as prior to surgery or a different job. These included 63.2% (12) of those working in heavy labor employment returning to the same job. Mean flexion/extension motion was 10.3 degrees for all levels (12.0 degrees at L3-L4, 9.6 degrees at L4-L5, 9.2 degrees at L5-S1). Mean lateral motion was 5.4 degrees . In the sagittal plane, 9 (6.1%) were anterior of geometric center, 50 (34.0%) were centered, and 88 (59.9%) were posterior of center. In the frontal plane, 110 (75%) were centered, and 37 (25%) were noted to be lateral to center. Slight subsidence was observed in two patients, but they did not require further surgery. No subluxation of the prostheses and no cases of spontaneous arthrodesis were identified. There was one case of disc height loss of 1 mm. Five patients required a secondary posterior arthrodesis. A good or excellent clinical outcome rate of 90% and a return to work rate of 91.5% compare favorably with results described in the literature for fusion for the treatment of lumbar degenerative disc disease. With a minimum follow-up of 10 years, the CHARITE artificial disc demonstrated excellent flexion/extension and lateral range of motion with no significant complications.

Adult↗
PubMed2001

Interventions for disability management.

BACKGROUND: With an increasing prevalence of low back pain, management can include modified work, work-conditioning, or work-hardening programs. Modified work programs, or employer's worksite interventions or clinic-based programs under medical supervision, provide a gradual increase of workload. Work-conditioning programs, or unimodal physical conditioning and function activities, promote return to work. Work-hardening programs, or graded work simulations and psychological interventions, are used as part of an interdisciplinary program addressing physical and functional needs. OBJECTIVE: The objective of the review was to determine how effective modified work programs, work hardening, and work conditioning are in the management of chronic pain disability. METHODOLOGY: The literature search identified two systematic literature reviews to provide the evidence about these interventions for disability management. RESULTS: Studies of work conditioning showed methodological variability, heterogeneous subjects, variable definitions of modified work, and limited outcome measures. Using return-to-work outcomes, 8 of the 11 studies of adequate methodological quality reported positive effects of modified work programs, mostly light duty. For work conditioning and work hardening, studies showed methodological variability combined with heterogeneous subjects, including varying times out of work and varying work ethics from different countries. Most study results were uncertain, though results of three of the four medium-quality studies were positive. CONCLUSIONS: Modified work programs may improve return-to-work rates of workers with work-related injuries for 6 months or longer (level 2). There is inadequate evidence (level 4a) to determine what particular aspects of modified work programs are helpful. Work conditioning and work hardening may or may not improve the return to work of more chronically disabled workers (level 4b).

Chronic Disease↗
PubMed1989

Factors influencing return to employment after a burn injury.

Return-to-work data were prospectively obtained from 155 adult burn patients who were employed before their injuries. Average time from burn to return to work was 63 days, and average time from discharge to return to work was 42 days. Size and depth of burn, occurrence of hand burns, age of the patient, and type of job significantly influenced return to work and return to work time. These data were compared to previous reports from this burn center and other burn centers, and it was concluded that return to work time is becoming shorter. More information must be scientifically gathered in order to determine all factors which influence return to work time. Researchers should direct their attention to those factors that are amenable to intervention from the burn team.

Adolescent↗
PubMed1984

Compensation and recovery from injury.

Workers' compensation laws influence recovery from injury. They affect the "cause" of disease, access to care, diagnostic evaluation, treatment, response to treatment and residual disability. Paradoxically, financial compensation may discourage return to work, the appeal process may increase disability, an open claim may inhibit return to work and recovering patients may be unable to return to work. Physicians may help improve the prospects of returning patients to work by providing care that is medical, caring and independent. It is essential that the treatment of back pain be based on the known natural history and on the understanding that the management of acute pain differs from that of chronic pain. Increased awareness of the factors controlling return to work should motivate legislative bodies, labor and industry to alter those features of the compensation system that interfere with the return to work of injured workers.

Accidents, Occupational↗
PubMed1981

[Preliminary study on the resumption of work after aorto-coronary bypass].

A questionnaire was sent 8 months to 3 years after aorto-coronary bypass to 98 patients who, before surgery, had had to abandon their professional activities because of ischaemic heart disease to assess the numbers who had returned to work: thirty six patients (37%) had not returned to work for medical or personal reasons; only one patient had been refused by his employee; sixty two patients (63%) had returned to work, 81% full-time and 19% with a different job. Only 19% had to stop working secondarily for medical reasons. The criteria thought initially to influence the chances of resumption of professional activity were analysed: factors not influencing the return to work were: type of work before operation (judged by the physical activity involved and the statute of salaried or independent worker), the severity of surgery (number of grafts and associated resection of aneurysm), a subjective assessment of physical condition after surgery (91% or patients not returning to work admitted to feeling well); uncontrollable factors influencing the return to work were: age of patient (average 51,7 years for those returning to work, compared to 55,1 years for the others), previous history of myocardial infarction (2,5 times more common in those not returning to work); finally, controllable factors influencing return to work were: the duration of unemployment before surgery (3,3 months for those returning full-time, compared to 16,4 months for those not returning to work); the period between surgery and resumption of activity which averaged 5 months and should not exceed 6 months. Three factors seemed to be particularly important: apart from the shortest possible period of unemployment before surgery, early physical reeducation after surgery based on chest physiotherapy and readaptation to physical activity and a psychological preparation for the return to work which should be started even before surgery.

Age Factors↗
PubMedDate not supplied

Feeling refreshed: helping RNs return to the work force.

In light of the nursing shortage, many hospitals are turning to refresher courses to meet staffing needs. To be successful, the course must be designed to meet the needs of both the participant and the hospital. Although the exact structure of the course will vary by institution, this article details steps taken at one hospital to help registered nurses return to nursing.

Education, Nursing, Continuing↗
PubMed1984

Natural history of surgically treated ventricular aneurysm.

Forty-one patients underwent resection of a postinfarction ventricular aneurysm. Thirty-seven of them had associated saphenous vein grafting procedures (average, 2.3 grafts per patient). Thirty-five patients sustained left ventricular dysfunction preoperatively. Forty patients were followed until death or for a minimum of five years (1 was lost to follow-up), and functional status was evaluated. Hospital mortality was 12%. Twenty-four patients survived five years or longer, and 20 patients were alive after a mean follow-up of 84 months. Eighty percent of the nonsurvivors died of atherosclerosis-related events. Forty-nine percent of the patients who survived the operation sustained severe atherosclerotic events postoperatively. Only 2 of 15 nonsurvivors ever regained functional status as judged by return to work. Twelve of the 20 long-term survivors returned to work. Of those patients less than 50 years old at operation, only 17% returned to work. Preoperative left ventricular function was a significant predictor of long-term functional results of aneurysmectomy and saphenous vein grafting. All patients remained at high risk for continued events related to atherosclerotic cardiovascular disease, and only 37% returned to full-time, preoperative work status. Return to productive status was especially disappointing in patients less than 50 years old.

Adult↗
PubMed2006

A comparative study of ulnar-shortening osteotomy by the freehand technique versus the Rayhack technique.

PURPOSE: To compare the results of ulnar shortening by the traditional freehand method with those achieved by the Rayhack technique. METHODS: A historical cohort of 95 patients (97 ulnas) who had ulnar shortening for the treatment of ulnar-impaction syndrome was evaluated. Forty-three patients (45 ulnas) were treated by the freehand technique and 52 patients (52 ulnas) by the Rayhack technique. Both groups were well matched in terms of age, gender, prior history of trauma, and associated injuries. The following variables were compared: duration of surgery, relief of pain, return to work, postoperative complications, time elapsed between surgery and return to work, union of the osteotomy, collinear alignment of the ulnar shaft, and alignment of the plate against the bone. These variables were compared by using the independent-groups t test, chi-square test, and Fisher exact test, as appropriate. RESULTS: Statistical analysis of the compared parameters: duration of surgery, relief of pain, return to work, postoperative complications, time elapsed between surgery and return to work, and union of the osteotomy, showed that none was significant. There were no cases of malalignment of the ulnar shaft or malalignment of the plate against bone in either group. Our calculations show that one would need a cohort of at least 300 patients in each group to show meaningful differences between the groups provided the same proportions held true. CONCLUSIONS: There was a trend toward a higher incidence of nonunion in patients who had the freehand technique although we were unable to show a statistical difference. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.

Adolescent↗
PubMed2005

Reduced productivity after sickness absence due to musculoskeletal disorders and its relation to health outcomes.

OBJECTIVES: This prospective cohort study quantified the reduced productivity of workers on full duty after sickness absence from a musculoskeletal disorder and determined the effect of health parameters such as perceived pain, functional disability, and general health on reduced productivity. METHODS: Workers were included who were returning to work from 2- to 6-week sickness absence due to a musculoskeletal disorder. Self-administered questionnaires at baseline, after return to work, and at a 12-month follow-up were used to collect information on productivity and health status. Logistic regression analyses evaluated the determinants of reduced productivity and determined the level of productivity loss shortly after return to work. RESULTS: Reduced productivity was prevalent for 60% of the workers after they returned to work, and for 40% still at the 12-month follow-up. The initial musculoskeletal disorder caused 75% of the productivity loss shortly after return to work and 60% at the follow-up. Among those with productivity loss, the median loss for an 8-hour workday was 1.6 hours shortly after return to work and also at the follow-up. Worse physical health, more functional disability, and poorer relations with the supervisor were associated with productivity loss shortly after return to work, whereas recurrent sick leave was the greatest predictor of productivity loss at the follow-up. CONCLUSIONS: Reduced productivity was common among workers returning to full duty after sickness absence due to a musculoskeletal disorder. Productivity loss illustrates the importance of the timing of return to work, especially among workers with residual functional disability after return to work. Moreover, the supervisor should be engaged early in the return-to-work process to guarantee an early, sustainable, and productive return to work for the employee.

Adult↗
PubMed2005

Can the back-to-work rate of patients with long-term non-malignant pain be predicted?

The objective of this study was to evaluate the outcome of a structured multidisciplinary rehabilitation programme regarding the return-to-work rate. Sixty-seven patients were enrolled in an 8-week, structured rehabilitation programme. The prediction of the return-to-work rate was evaluated before entering the programme. The patients' own perception of returning to work as well as their pain intensity were estimated on a visual analogue scale and their period of sick leave was also recorded. The multidisciplinary rehabilitation team made an impairment and disability evaluation and analysis (IDEA) to assess possible work ability. This evaluation was made during the first 3 weeks of the 8-week programme. The return-to-work rate was also evaluated by means of the modified somatic perception questionnaire (MSPQ) and the disability rating index (DRI) before entering the programme. The results were compared with the actual return-to-work rate 1 year after completing the programme. A comparison group of 14 patients who were rejected due to lack of space in the programme was used in this study. There was a positive, statistically significant correlation (P<0.01) between the evaluation of the multidisciplinary rehabilitation team and the actual outcome of the return-to-work rate 1 year after completing the programme. At the 1-year follow-up, 63% of the patients had returned to work or were in work-related activities. The results on MSPQ or DRI, the patients' own perception of returning to work, the pain intensity, age or the period of time out of work did not predict the return-to-work ability. This study has shown that 63% of the patients with long-term non-malignant pain were back to work or in work-related activities 1 year after completing the rehabilitation programme. The IDEA made by the rehabilitation team was crucial in predicting the return-to-work rate in this patient group. The MSPQ and DRI questionnaires, the patients' own prediction, pain intensity, age and time out of work had a low value for predicting the return-to-work rate following a structured multidisciplinary rehabilitation programme.

Adult↗
PubMed1993

Multidisciplinary rehabilitation of chronic work-related upper extremity disorders. Long-term effects.

The prevalence of work-related upper extremity disorders has significantly increased in the past decade. Persistent pain, loss of function, and associated work disability in patients with work-related upper extremity disorders appears to be affected by multiple factors including physical capabilities in relation to work demands, ergonomic risk factors on the job, and psychological factors related to worker traits, psychological readiness to return to work, and ability to manage symptoms. The complex nature of these disorders suggests the utility of a multidisciplinary program targeted at these factors. The present study is an investigation of the long-term vocational outcome of a multicomponent rehabilitation program that includes physical conditioning, work conditioning, work-related pain and stress management, ergonomic consultation, and vocational counseling/placement. Two groups equivalent on measures of duration of work disability, pain severity, fear of reinjury, psychological distress, perceived work environment, age, and education level were exposed to either the comprehensive work rehabilitation intervention (n = 19) or usual care (n = 15). Return-to-work status was determined at an average of 17 months posttreatment (range, 3 to 35 months) for the treatment group and an average of 18 months postevaluation (range, 5 to 30 months) for the usual care group. Findings indicated that 74% of the treatment group returned to work or were involved in state-supported vocational training in contrast to 40% of the control group (P < .05). For those who returned to work, 91% of the treatment group were working full-time in contrast to 50% of the control group (P < .05). Although the treatment group demonstrated a higher return-to-work rate than controls, the work reentry rate was not as high as similar approaches with work-related low back pain (80% to 88% return-to-work rate). These findings suggest the need to modify treatment components to facilitate an increased return-to-work rate. Areas that may prove useful include a greater emphasis ergonomic modifications at the workplace to reduce the risks of repetitiveness, force, awkward posture, and insufficient work/rest cycles, as well as efforts to modify work style directly in order to reduce the impact of ergonomic stressors on the ability to perform essential job tasks. In combination with traditional work hardening efforts directed at improving strength and flexibility of the upper extremities and work-related pain and stress management training, these ergonomic and work-style modification efforts may contribute to increases in the percentage of work disabled cases who successfully return to competitive work.

Arm Injuries↗
PubMed2003

Clinical and workplace factors associated with a return to modified duty in work-related upper extremity disorders.

Return to work following treatment for a work-related upper extremity disorder (WRUED) is affected by a variety of medical, workplace, and personal factors, and returning to modified duty may ease the transition to normal work activities. This study surveyed 165 federal government employees (127 females, 38 males) who were unable to resume their normal work after filing a workers' compensation claim for a WRUED (<90 days from claim filing) and who volunteered for a randomized study of alternative case management strategies. Before randomization, participants completed a baseline survey of upper extremity (UE) symptoms, functional limitations, and workplace factors. At baseline, 58 participants (35%) were working modified duty and 107 participants (65%) were not working. Compared with participants working modified duty, those who were not working were more likely to report: (a). a diagnosis of mononeuropathy, odds ratio (OR)=3.16 (95% confidence interval (CI)=1.37-7.14) versus enthesopathy, (b). higher pain ratings, OR=1.43 (95% CI=1.01-2.01), (c). greater functional limitations, OR=1.63 (95% CI=1.11-2.38), and (d). higher level of ergonomic stressors, OR=1.62 (95% CI=1.09-2.43) in a multivariable logistic regression. Measures of high risk work styles (fast pace and working despite pain) were associated with greater perceptions of ergonomic exposure, but not with work status. The model had 87.9% sensitivity and 43.1% specificity to correctly classify those not working (overall classification 72.1% correct). The results suggest that modified duty for workers with persistent WRUEDs may be enhanced by assessing perceived functional limitation and ergonomic exposure as well as the type and severity of symptoms.

Arm Injuries↗
PubMed2004

Work-related outcomes after a myocardial infarction.

STUDY OBJECTIVE: To evaluate work-related outcomes of patients at 7 months after a myocardial infarction and to identify patient, disease, and intervention characteristics associated with these outcomes. DESIGN: Cross-sectional survey analysis. SETTING: Large Midwestern academic health system. PATIENTS: Eighty-nine patients with the discharge diagnosis of acute myocardial infarction during a 1-year index period. INTERVENTION: Work performance questionnaire administered by telephone, and medical record review. MEASUREMENTS AND MAIN RESULTS: Seven months after discharge, 232 patients were interviewed by telephone to determine work status before and after myocardial infarction, work-related outcomes (absenteeism and perceived work performance, assessed by the Work Performance Scale [WPS] of the Functional Status Questionnaire), and health-related quality of life. Univariate analyses were used to determine the association between individual characteristics and work-related outcomes. Of the 89 patients who had worked before the index myocardial infarction, 21 (23.6%) did not return to work. Variables associated with the outcome of not returning to work were past myocardial infarction (before the index myocardial infarction), coronary artery bypass graft surgery, heart failure, positive stress test, and low score on the Physical Component Summary (PCS-12) scale of the Short Form-12. Patients who did not return to work also tended to have more comorbidities and take more prescribed drugs than those who returned to work. Median WPS scores were higher for patients who had higher ejection fractions at discharge, had not experienced a myocardial infarction before the index event, underwent a percutaneous revascularization intervention at the time of hospitalization, and had not recently been absent from work. Workers reporting absences had lower PCS-12 scores than their counterparts or reported a rehospitalization before the survey. CONCLUSION: Preexisting cardiac disease and poorer physical functioning were consistently related to worse work-related outcomes. This small study demonstrates the need for a larger, broader study that includes health beliefs, treatment, and other job and patient factors that may influence work-related outcomes.

Absenteeism↗