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PubMed1994

Work hardening and work conditioning interventions: do they affect disability?

The purpose of this article is to review the research on the effectiveness of work hardening and work conditioning programs. Twelve studies of work hardening and work conditioning programs in the United States and abroad were reviewed. One study produced convincing evidence in a randomized study that a work conditioning program was useful in producing a higher percentage of return to work and an earlier return to work in a group of patients off work for at least 2 months. Another study demonstrated that a work hardening program increased the rate of return to work by 52% in patients off work for greater than 4 months. Most of the other studies reviewed suggested positive results, but more carefully documented, randomized, and controlled studies are needed to support the efficacy of these programs and to determine the optimum and most cost-effective work hardening and work conditioning interventions.

Conditioning, Psychological↗
PubMed1999

A multidisciplinary TBI inpatient rehabilitation programme for active duty service members as part of a randomized clinical trial.

OBJECTIVE: To design and describe an effective rehabilitation programme for use in an ongoing trial on the efficacy of multidisciplinary brain injury rehabilitation for moderately head injury military service members. DESIGN: Treatment arm of a randomized control trial. SETTING: US military tertiary care hospital inpatient rehabilitation programme. PATIENTS: Sixty seven active duty military with moderate to severe TBI who were randomized to the treatment arm of the protocol. INTERVENTION: Eight week rehabilitation programme combining group and individual therapies with an inpatient milieu-oriented neuropsychological focus. Group therapies included fitness, planning and organization, cognitive skills, work skills, medication, and milieu groups, and community re-entry outings. Individual therapy included neuropsychology, work therapy, occupational therapy, and speech and language pathology. MAIN OUTCOME MEASURES: Successful return to work and return to duty. RESULTS: At 1 year follow-up, 64 patients returned to work (96%) and 66% (44/67) returned to duty. CONCLUSION: The described rehabilitation programme demonstrates one successful effort to rehabilitate active duty military service members with TBI who have the potential to return to duty.

Adaptation, Psychological↗
PubMed1992

[The prognosis of conservatively treated lumbar intervertebral disk displacement].

72 out of 120 patients who where treated conservatively for proven lumbar disc prolapse over a seven-year-period were reexamined. Questionnaires could be obtained and evaluated for 91 patients. The date of reexamination was an average of 44.5 months after the end of inpatient-treatment. Results are given for the duration of inability to work and the "return to work" (RTW)-rate. The ability to work of 54 patients was regained after an average of 11.1 weeks, 95% of patients could return to their previous workplace.

Female↗
PubMed2002

Maternal employment and infant-mother attachment security at 12 months postpartum.

This study assessed the association between aspects of mother's employment and security of infant-mother attachment, in combination with proximal (maternal sensitivity) and distal (demographic, maternal, child, child-care) factors. Participants were 145 Australian mothers and their firstborn children. Attachment security was assessed with the Strange Situation at 12 months. Results showed that mothers' prenatal attitudes to work and timing of the return to work made significant, independent contributions to attachment outcomes over and above the effects of proximal and distal predictors. Mothers who expressed more commitment to work and less anxiety about using nonfamily child care, and who returned to work earlier, were more likely to have secure infants. These findings are considered in relation to contemporary expectations about mothers' participation in paid work and other predictors of secure attachment.

Adolescent↗
PubMed1988

Physiological cost of vocational activities after myocardial infarction.

Oxygen consumption was measured during 30 min of work in 16 patients, after a myocardial infarction (anterior or posterior), and compared with 16 normal subjects, of the same age, involved in the same activities, in a steel factory. The VO2 at work of the patients was a little lower than in normals. The mean heart rate for 8 h was also a little lower in patients than in normals. The patients used a higher percentage of their residual capacity (VO2 max) as evaluated on a bicycle ergometer in the laboratory; the difference may be important between patients with a residual coronary insufficiency and controls. There are no important differences in the psychological attitudes of the two groups; the patient seems to be more motivated. From this study, based on a limited number of patients who had returned to work and had no complaints in daily life, it appears that the patients were working more 'economically' that the normals, that they are able to use a higher percentage of their residual physiological capacity and that the psychological attitude is comparable in the two groups towards work. Return to previous work should never be excluded a priori in post-infarction patients with good clinical progress.

Activities of Daily Living↗
PubMed2006

Quality of life and maintenance of improvements after early multimodal rehabilitation: a 5-year follow-up.

PURPOSE: There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up. METHOD: The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status. RESULTS: Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation. CONCLUSIONS: These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.

Adult↗
PubMed2005

Employment pathways in a large cohort of adult cancer survivors.

BACKGROUND: Employment and work-related disability were investigated in a cohort of adult cancer survivors who were working when they were diagnosed from 1997 to 1999 with a variety of cancers. Employment from the time of diagnosis through the early years of survivorship was studied, self-reported effects of cancer survival on disability and employment were quantified, and risk factors associated with cancer-related disability and withdrawal from employment were identified. METHODS: One thousand four hundred thirty-three cancer survivors were interviewed by telephone from 1 year to nearly 5 years after diagnosis. They were asked retrospectively about employment from the time of diagnosis to follow-up and about work-related disability at follow-up. They also were asked whether disabilities or reasons for quitting work were cancer-related. Return to work and quitting work were projected over time in a life-table analysis. Risk factors were identified from logit analyses. RESULTS: One of five survivors reported cancer-related disabilities at follow-up. Half of those with disabilities were working. A projected 13% of all survivors had quit working for cancer-related reasons within 4 years of diagnosis. More than half of survivors quit working after the first year, when three-quarters of those who stopped for treatment returned to work. Survivors of central nervous system, head and neck, and Stage IV blood and lymph malignancies had the highest adjusted risk of disability or quitting work. CONCLUSIONS: Cancer survival sometimes has long-term effects on employment and the ability to work. Employment outcomes can be improved with innovations in treatment and with clinical and supportive services aimed at better management of symptoms, rehabilitation, and accommodation of disabilities.

Adaptation, Physiological↗
PubMedDate not supplied

Patients with burns are successful in work hardening programs.

The W.O.R.K. Center at Tampa General Hospital is a facility accredited by the Commission on Accreditation of Rehabilitation Facilities for work hardening and specializes in assisting injured workers in returning to work. The most successful diagnostic group has been the burn injury population referred from the Tampa Bay Regional Burn Center. Eleven patients with burn injuries with an average total body surface area of 20.7% were referred to the W.O.R.K. Center for evaluation and admission to The Work Hardening Program. Ninety-one percent returned to work after discharge from the program compared with a 60% return-to-work rate for the total work hardening population at this facility. The success of the program may be attributed to an early referral process and the emphasis on rehabilitation in treating the patient with burn injuries. Work hardening provides a structured, goal-oriented approach in preparing the patient with burn injuries to reenter the work force.

Accidents, Occupational↗
PubMed2001

[Professional absenteeism and surgery for carpal tunnel syndrome. Results of a prospective series of 233 patients].

AIM: The aim of our work was to evaluate the influence of the type of patient's insurance ant the return to work interval after carpal tunnel release. MATERIAL AND METHODS: An prospective analysis of 233 patients (18-65 years old, full time workers) undergoing a carpal tunnel release between January and June 1998 was conducted to determine the interval between surgery and return to work. For statistical analysis we used the Ms Works and Status software package. The mean return-to-work intervals were determined for the following and compared for three groups. Group 1: independent worker, n = 87; group 2: wage earner, n = 90; group 3: civil servant, n = 56; and 4 others subgroups: manual workers, n = 164; non manual workers, n = 69; patients with social security insurance, n = 191; patients with workers compensation, n = 42. RESULTS: For the patients in group 1 the average return to work was 17 days (11 days for non manual workers, 29 days for manual workers). In group 2, the average was 35 days (21 days for non manual workers, 42 for manual workers). In group 3 the average was 56 days (49 days for non manual workers and 63 days for manual workers). The statistical analysis showed the civil servant took significantly longer to return to work than independent workers or wage earner (p < 0.05). The work related patients took significantly longer than patients covered by social security. The effect of occupational han (manual versus non manual) use was clear in the group 1 and 2, but there was no difference in the group 3. DISCUSSION: Our study of 233 patients demonstrated significant difference between independent workers, wage earners, and civil servants in term of return-to-work intervals. In comparing manual and non manual workers, we found a significant difference in group 1 and 2, but in civil servants group non difference were found. We cannot explain these findings on medical grounds.

Absenteeism↗
PubMedDate not supplied

Pilonidal sinus: a claim for simple track incision.

Ninety-six patients treated surgically for pilonidal sinus were examined in a two-part study. In the first part, 36 patients were randomly allocated according to the surgical techniques employed: marsupialization, incision, and excision without primary closure. Healing times and recurrences a year after operation were studied. The healing times of patients treated by excision were longer in comparison with those treated by incision or marsupialization. The recurrence rates were similar for all techniques used. In the second part of the study 60 patients were randomly allocated according to times of returning to work. Twenty-nine of these patients returned to work before their wound healed; 31 resumed work a week after epithelization of the wound. The wounds healed more quickly in patients who started working before they were closed. Incision of the sinus track, carried out using local anesthesia in the outpatient clinic, allowed the patient to return to work without pain sooner.

Anesthesia, Local↗
PubMed2006

The effect of a "training on work readiness" program for workers with musculoskeletal injuries: a randomized control trial (RCT) study.

BACKGROUND: This is a clinical randomized trail (RCT) to investigate the effects of a three-week training program on work readiness designed for musculoskeletal injured workers with long-term sick leave who had difficulties resuming their work role. The program was planned to help injured workers overcome the psychological and psychosocial problems and to facilitate their Work Readiness on Return to Work (RTW) based on the Employment readiness model. METHODOLOGY: A total of 64 injured workers were recruited and randomly assigned into the training (T) and control (C) groups. Observations were blinded between service providers and evaluators. A three-week intensive training on work readiness program was given to the T group while subjects in the C group were given advice on job placement by social workers in a community work health center. The training program was comprised of individual vocational counseling and group therapy using cognitive behavioral approach to alleviate symptoms of stress, pain and anxiety. The Chinese Lam Assessment of Stages of Employment Readiness (C-LASER), the Chinese State Trait and Anxiety Inventory (C-STAI) and the Short form of Health Survey (SF-36) were used to evaluate all subjects' psychological health status and behavioral changes on job readiness before and after the intervention. RESULTS: Subjects in the T group showed significant improvement in their work readiness (p < 0.05), level of anxiety (p < 0.05) and their self perception of health status measured by SF-36 (p < 0.02) when compared with subjects in the C group. Control of chronic pain, negative motivation, and anxiety level were some of the key behavioral changes found from the study. CONCLUSION: The TWR program appeared to improve injured workers' motivation and employment readiness. Further study on the employment outcomes of subjects is recommended.

Adult↗
PubMed1995

The reliability of depression diagnosis in chronic low back pain. A pilot study.

The variability in estimated rates of major depressive disorder (MDD) in chronic pain samples may be accounted for by sample and methodological differences. Most studies rely on a single measure of depression and lack independent or repeated measures. This study investigated the prevalence of psychiatric disorders in a convenience sample of 18 patients disabled by low back pain (LBP) referred to, evaluated, and treated in a comprehensive pain rehabilitation program specifically designed to restore work readiness and return to work. Subjects had one or more spinal conditions, had work-related back pain for more than 6 months (x = 23.8), were Caucasian, predominantly young (x = 37.5) and male (55%), and were disabled on workers' compensation and approved for rehabilitation. The performance of three diagnostic procedures, the Pain Medicine Evaluation, an independent Structured Clinical Interview for DSM-III-R (SCID), and Longitudinal Clinical Diagnosis were compared with the "gold standard" of the Final Diagnosis which incorporated information from the other three. Also, the performance of a questionnaire, The Pain & Mood Structural Interview (PMSI), designed to assess the causal relationship of pain and mood and specifically the confounding effects of physical factors, was examined. Thirteen of 18 patients (72%) were diagnosed with MDD at Final Diagnosis. MDD diagnosis was made on 4 of 18 patients (22%) on the initial Pain Medicine Evaluation and on 9 of 18 patients (50%) on the SCID, with only 1 ruled out by the confounding questionnaire, for a SCID current prevalence of 44%. Both the SCID and Pain Medicine Evaluation accurately diagnosed the MDD cases they identified; 9 of 13 MDD cases (69%) were precipitated by a physical factor other than their pain. Three episodes of MDD were ruled out by confounding. These findings are discussed in relation to their implications for assessing pain patients for psychiatric comorbidity.

Adult↗
PubMed2006

Arthroscopic management of the painful snapping scapula.

PURPOSE: The aim of this study was to evaluate the results of the arthroscopic management of the snapping scapula syndrome. TYPE OF STUDY: Case series. METHODS: Thirteen patients underwent surgery for painful scapular snapping that had not responded to adequate conservative treatment. They had no evidence of anatomic abnormalities on plain radiographs. All patients underwent bursectomy and resection of bands of fibrous tissue at the superomedial angle. Bone was resected from the superomedial angle only if it appeared to be prominent during arthroscopy. This occurred in 3 cases. The patients' outcomes were assessed subjectively by their ability to return to work and their return to leisure, as well as the Constant score. RESULTS: At the time of follow-up, 9 patients (69%) reported an improvement in their symptoms. Their median Constant score was 87 (range, 95 to 58). Four patients felt that their symptoms were unchanged or worse. Their median Constant score was 55 (range, 66 to 32). Of 9 employed patients, 8 returned to their previous careers. This group included 2 patients with physically demanding jobs. Of 9 patients who played sports regularly, 6 returned to their presymptomatic level of sporting activity. There were no complications. CONCLUSIONS: Subscapular bursectomy is a safe procedure with a low rate of morbidity. In the absence of a definable anatomic abnormality, arthroscopic bursectomy for the painful snapping scapula can result in satisfactory outcomes in approximately 70% of patients. More clearly defined indications for and contraindications against surgery are required to avoid poor results. Complete resolution of the snapping in the subscapular bursa is not necessary to obtain a satisfactory result. LEVEL OF EVIDENCE: Level IV, case series, no control group.

Adult↗
PubMedDate not supplied

The 360-degree evaluation: increased work with little return?

OBJECTIVE: To test a 360-degree resident evaluation tool on our trauma/critical care services to determine if multiple raters yielded equivalent information compared with traditional faculty evaluations. DESIGN: Prospective evaluation. PARTICIPANTS: Residents, nurses, faculty, and staff at an academic medical center. METHODS: The evaluation tool was developed based on extensive qualitative analysis of 13 major medical specialties' Residency Review Committee (RRC) criteria relative to the ACGME competencies and then revised with content specific to surgery. The evaluation contained 19 items divided into ACGME competency areas. Each item was scored on a 1 to 9 Likert scale: 1 = not meeting expectations and 9 = exceeding expectations. Residents on the trauma and surgical intensive care unit rotations evaluated themselves, and they were also evaluated by chief residents, surgical intensive care unit fellows, faculty, surgical intensive care unit nurses, trauma nurse clinicians, and nurse practitioners. Multiple analyses of variance were used to compare ratings by rater groups. RESULTS: Ten residents were evaluated on the trauma service from April to August 2003. Between 74 and 106 evaluations were obtained per resident per competency area. Average scores across the competencies were remarkably similar, ranging from 6.18 for practice-based learning and systems-based practice to 6.54 for professionalism. Although there was variability within rater groups, ratings were not statistically different between groups for any ACGME competency. CONCLUSIONS: The 360-degree evaluation provide limited new information compared with traditional faculty ratings. Follow-up studies are required to confirm this finding with larger samples of residents and surgical specialties.

Clinical Competence↗
PubMed2005

[Repair of primary inguinal hernia: Lichtenstein versus Shouldice techniques. Prospective randomized study of pain and hospital costs].

INTRODUCTION: Hernia is one of the most widely studied processes, and the search for excellence has become the final aim. However, many controversies remain to be resolved. The objective of the present study was to analyze postoperative pain and costs using two techniques of primary inguinal hernia repair. PATIENTS AND METHOD: We performed a prospective, randomized study of 54 patients who underwent surgical repair of inguinal hernia through either the Lichtenstein or the Shouldice technique between June 2001 and May 2002. The following variables were analyzed: age, location and type of hernia, evaluation of tolerance to local anesthesia, surgical technique, operating time, pain at days 1, 3 and 5 after surgery, analgesic consumption, days until driving could be resumed, days off work, and occupation. RESULTS: The patient groups were similar, with no significant differences in age, location or type of hernia. For Lichtenstein hernioplasty, operating time was lower (p < 0.01); pain evaluation showed no significant differences on days 1 and 3 after surgery but was higher on day 5 (p = 0.064). No significant differences were found in analgesic consumption, time before driving could be resumed, or days off work. Freelance patients returned to work earlier, independently of the surgical technique performed. The cost of the Lichtenstein technique was 235 euros compared with 180 euros for the Shouldice technique and this difference was statistically significant (p < 0.05). CONCLUSION: In the hands of expert surgeons, the Shouldice technique is the procedure of choice in the repair of primary hernias. The results are just as satisfactory as those obtained with Lichtenstein hernioplasty and hospital costs are lower.

Hernia, Inguinal↗
PubMed2002

Anterior cervical discectomy without interbody fusion.

BACKGROUND: The use of an interbody bone graft during anterior cervical discectomy remains a controversial topic. This study presents the outcome of 64 consecutive patients who underwent anterior cervical discectomy without an interbody fusion. METHODS: Sixty-four consecutive patients underwent anterior cervical discectomy without interbody fusion by one surgeon at Indiana University School of Medicine between April 1994 and February 1998. A retrospective analysis of these cases was performed to evaluate outcome of this procedure. Outcome was determined using the criteria of Odom and Finney. RESULTS: In our series of patients, the mean age was 49.4 years, and the mean time of follow-up was 8.5 months. The presentation was as follows: 69% radiculopathy alone, 23% combined myelopathy and radiculopathy, and 8% myelopathy. Although 31% of the patients had symptoms for more than 1 year, the mean duration of symptoms of the remainder of patients was 3.2 months. The majority of patients had single-level disease (77%); however, 25% underwent 2 level discectomies, and 2% underwent 3 level discectomies. Twenty-four patients (38%) had soft disc herniation, and 40 patients (62%) had hard disc herniation. Of the 64 patients, 91% had either good or excellent outcomes, 9% had satisfactory outcomes, and none had a poor result. Ninety-six percent of the patients with soft disc herniation had good or excellent outcomes, whereas 88% of the patients with hard disc had good or excellent outcomes (p = 0.217). Ninety-one percent of the patients who worked before surgery returned to work after their operation. None of the patients required reoperation at the operative level or exhibited instability at the operative level. Postoperative complications included transient intrascapular pain (13%), kyphotic deformity (3%), transient vocal cord paralysis (2%), and temporary dysphagia (2%). No significant difference in age or outcome existed when comparing males to females. CONCLUSION: Satisfactory results can be attained by discectomy without an interbody fusion in the surgical management of cervical disc disease.

Adult↗
PubMedDate not supplied

Surgical treatment of full-thickness rotator cuff tears in patients 40 years of age or younger.

Full-thickness tears of the rotator cuff are uncommon in the first 4 decades of life. A retrospective analysis was conducted of 19 consecutive patients who were 40 years of age or younger and had been treated surgically for a full-thickness tear of the rotator cuff. Sixteen patients (84%) recalled an acute injury that heralded the onset of symptoms. Five of the patients had sustained an initial glenohumeral dislocation. At an average follow-up of 5.7 years, all patients were evaluated with regard to pain, function, range of motion, strength, return-to-work status, return-to-sport status, and overall postoperative satisfaction. After operation, 15 patients (79%) reported diminished pain relative to their preoperative level, and 12 (63%) of 19 were able to function with the extremity above shoulder level. Fourteen patients (74%) returned to full-time employment, and half returned to sporting activities. Thirteen patients (68%) reported subjective improvement with regard to daily functional activities after surgical intervention. The most favorable results were seen in those patients who had sustained an acute glenohumeral dislocation in conjunction with a full-thickness rotator cuff tear and underwent combined stabilization and repair. The outcome for patients who received worker's compensation was less favorable.

Adult↗
PubMedDate not supplied

Evaluation and analysis of patient outcomes with an intrasegmental fixation system in lumbar spinal fusion.

BACKGROUND CONTEXT: A new spinal fixation system with polydirectional screws and modular links with interconnecting radial serrations has been developed. The system allows the linking of multiple points of fixation, two points at a time (intrasegmental fixation), thus eliminating the need for intraoperative contouring of rods or plates. PURPOSE: Evaluation of this new type of spine system was done through biomechanical studies, analysis of lumbar lordosis preservation postoperatively, and multicenter review of patient outcomes with a minimum of 1 year follow-up. STUDY DESIGN/SETTING: Biomechanical studies of the spine system were performed according to American Society for Testing and Materials (ASTM) standards. To evaluate the maintenance of lordosis, radiographs from the first 119 patients were reviewed by the authors. Analysis of patient outcomes consisted of a review of the first 259 patients who underwent spinal fusion surgery with the new spine system. PATIENT SAMPLE: Evaluation of patient outcomes consisted of 122 men and 137 women with an average age of 50+/-13 years (range, 22-96 years) and a mean follow-up of 20+/-6 months (range, 12-54 months). The patient population was at high risk for fusion failure, with 127 smokers (49%), 141 who had previous spine surgery (54%), 22 with osteoporosis (8%), 63 were obese (24%), and 32 with diabetes (12%). One hundred two patients (39%) had a one-level fusion, 105 patients (41%) had two levels fused, and 52 patients (20%) had three or more levels fused. The majority of patients (66%) were covered under workers' compensation. OUTCOME MEASURES/METHODS: Radiographic fusion was deemed successful when the presence of trabecular bridging bone from transverse process to transverse process was observed, as well as no fixation failure nor radiographic evidence of screw loosening. Clinical success was rated excellent, good, fair, or poor depending on the patients pain level, function, and pain medication intake. RESULTS: Biomechanical studies of this intrasegmental fixation system have shown it to be strong under both static and fatigue testing, with exceptional strength in compression bending. In evaluating preservation of lumbar lordosis, no statistically significant loss of lordosis was observed. Overall, radiographic fusion was noted in 229 of 259 patients (88%) and did not differ significantly (p>.10) by the number of levels fused. Clinically, 69 patients (27%) had an excellent result, 111 patients (43%) had a good result, 50 patients (19%) had a fair result, and 29 patients (11%) had a poor result. The high rate of successful patient outcomes did not differ significantly (p>.10) by the number of levels fused, or other patient or surgical variables, except for the satisfaction level of workers' compensation versus nonworkers' compensation. One hundred of 118 patients (85%) who were working before surgery returned to work at an average 9+/-4 months postoperatively (range, 2-20 months). The use of direct current (DC) stimulation in this population was reserved for patients with one or more risk factors for fusion failure and was noted to be of benefit. There were no recorded intraoperative complications, but postoperatively 5 device and 19 non-device-related complications (9%) were noted, which is comparable to other lumbar fusion series. CONCLUSIONS: The results of these analyses show consistent patient outcomes regardless of the number of levels fused with an intrasegmental system. This may be attributable to the increased biomechanical strength of the system at each segment, coupled with the ability of intrasegmental fixation to maintain sagittal plane balance through preservation of the patient's lordotic curve.

Adult↗