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PubMedDate not supplied

Increased pain tolerance as an indicator of return to work in low-back injuries after work hardening.

OBJECTIVE: This study examined retrospective data from a multidisciplinary work-hardening program that compared patients who did and did not return to work after low-back injury. The objective of this study was to identify differences between these groups to better guide work-hardening programs and return-to-work decisions. METHOD: Retrospective data from patients with low-back injuries (n = 115) who participated in a northern California work-hardening program were analyzed. Using two-way analysis of variance, male and female patients who did and did not return to work were compared. RESULTS: No significant differences were found between men and women for any of the variables studied. Patients who did and did not return to work were not significantly different in age, length of injury, and subjective pain at the beginning or end of the work-hardening program or in activity tolerance (p = .08). Patients who returned to work perceived a significantly (p < or = . 05) greater improvement in pain tolerance by the end of the work-hardening program than those who did not return to work. CONCLUSION: The results of this study suggest that rehabilitation emphasis should not be placed on the reduction of subjective pain but, rather, on strategies to cope with existing pain while improving functional ability.

Adult↗
PubMed1987

Assessment of upper extremity-injured persons' return to work potential.

Therapists specializing in the rehabilitation of persons with upper extremity disorders--hand therapists--have developed an evaluation procedure to determine if and when an injured worker has the physical capacity to safely return to work. The Return to Work Evaluation has five components: (1) physical evaluation, (2) subjective effects of injury interview, (3) biomechanical job analysis, (4) work stimulation, (5) reevaluation. The therapist designs a work simulation based on the identification of the critical physical demand characteristics of the patient's work. After documenting the patient's response to the work simulation, the therapist formulates recommendations to the physician with regard to the patient's ability to safely return to the workplace. These recommendations may include the need for job/worker modifications or the need for a reconditioning program. The implementation of the Return to Work Evaluation has decreased the physician's liability in return-to-work decisions and has allowed injured workers to maintain optimal function after medical treatment.

Accidents, Occupational↗
PubMed1989

Return to work after percutaneous transluminal coronary angioplasty: a continuing problem.

Earlier studies have shown that return to work following PTCA is frequent; however PTCA is now performed in patients with more extensive coronary artery disease. The present study was designed to compare the vocational outcome of patients who underwent PTCA in 1980-1982 with that of patients who underwent the procedure in 1985. From 1980 to 1982, 53 of 73 consecutive patients who were employed before PTCA returned to work (73%). Return to work was related to primary success of the procedure (85% vs 40%, P less than 0.01) age (46.1 +/- 7.9 vs 49.3 +/- 6.6 years, P less than 0.05) and clinical status at follow-up (72% feeling well or very well vs 30%, P less than 0.01). In 1985, although the primary success rate had increased to 89%, the overall rate of return to work in the 91 patients employed before PTCA was 64%. The decrease was particularly striking for patients with primary success of the procedure (64% vs 85%, P less than 0.01). The patients in the 1985 group had greater incidences of previous myocardial infarction (40% vs 11%, P less than 0.01) and multivessel coronary disease (43% vs 8%, P less than 0.01); however, these factors were not related to subsequent return to work. In contrast, the age of the patients, which was an important determinant of work resumption, was significantly higher in the 1985 patients (49.9 +/- 7.3 vs 46.4 +/- 9.1 years, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Neuropsychological impairment and return to work following severe closed head injury: implications for clinical management.

AIMS: To study the rate and timing of return to work following severe closed head injury, and to compare the neuropsychological functioning of patients who successfully return to work with that of patients who fail to return to work. METHODS: The vocational status, level of cognitive functioning and personality functioning of a consecutive series of 66 patients who survived severe closed head injury was assessed between six months and three years postinjury. The level of cognitive and personality functioning of patients who returned to work were compared with that of patients who failed to return to work. RESULTS: Twenty five percent of patients failed to return to work, and a further 17% returned to work under special conditions of employment. Failure to return to work was related to the degree of neuropsychological impairment (cognitive deficit and adverse personality change), injury severity (duration of posttraumatic amnesia), and age. Multiple regression analysis found the total number of neuropsychological symptoms to be the strongest predictor of the patients' return to work. CONCLUSIONS: These findings suggest that neuropsychological symptoms are the main mechanism through which severe brain injury affects the ability to return to work. It is recommended that vocational rehabilitation of severe closed head injury patients be based on a comprehensive neuropsychological assessment.

Adolescent↗
PubMed2005

Effectiveness of a return-to-work intervention for subacute low-back pain.

The effectiveness of return-to-work intervention for subacute low-back pain on work absenteeism, pain severity, and functional status was examined by means of a systematic review of randomized controlled trials. Publications in English that met the selection criteria were identified in a computer-aided search and assessed for methodological quality. A best-evidence synthesis was performed instead of statistical data pooling, because of the heterogeneity of the interventions and study populations. Five of nine studies comparing return-to-work intervention with usual care were identified as methodologically high-quality studies. Strong evidence was found for the effectiveness of return to work intervention on the return-to-work rate after 6 months and for the effectiveness of return-to-work intervention on the reduction of days of absence from work after > or = 12 months. It can be concluded that return-to-work interventions are equal or more effective regarding absence from work due to subacute low-back pain than usual care is.

Behavior Therapy↗
PubMed1990

Return to work after an acute myocardial infarction: a review.

The rate of return to work after an acute myocardial infarction (AMI) is decreased among previously working women, blue-collar workers particularly with physically strenuous jobs, and persons with emotional problems. Although more severe AMIs decrease return to work rates, psychosocial factors appear to be more prominent in their effects on the rates. Supportive psychotherapy as well as specific advice to return to work for patients with uncomplicated AMIs shortens length of convalescence. Little evidence exists, however, that current interventions largely geared to improving cardiac status have any impact on ultimate return to work. Specific interventions tailored to individuals at risk of not working may increase rates of return to work.

Convalescence↗
PubMed2005

The role of job strain on return to work after carpal tunnel surgery.

AIMS: To examine the impact of job strain (that is, high psychological job demands and low job control) on return to work and work role functioning at two months, six months, or both, following carpal tunnel release surgery. METHODS: A community based cohort of carpal tunnel syndrome (CTS) patients from physician practices was recruited between April 1997 and October 1998 throughout Maine (USA). 128 patients at two months and 122 at six months completed all relevant questions. A three level outcome variable indicated whether patients had: (1) returned to work functioning successfully, (2) returned to work functioning with limitations, or (3) not returned to work for health reasons. Two job strain measures were created: one, by combining psychological job demands and job control; and two, by dividing demands by control. Ordinal logistic regression was used to identify predictors of the three level work outcome variable. RESULTS: After adjustment, workers with high demands and high control (active work) were less likely to successfully return to work (OR = 0.22; p = 0.014) at two months. Having a job with higher demands than job control (high strain) predicted not returning to work or returning to work but not successfully meeting job demands (OR = 0.14; p = 0.001), at six months. CONCLUSIONS: The findings underscore the role of psychosocial work conditions, as defined by the Karasek demand-control model, in explaining a worker's return to work. Clinicians, researchers, and employers should consider a multidimensional and integrative model of successful work role functioning upon return to work. Moreover, since the evidence of the effects of work process changes on the reduction of CTS is very scarce, these findings point to the opportunity for collaborative workplace interventions to facilitate successful return to work.

Adult↗
PubMed1995

Return to work after stroke. A follow-up study.

BACKGROUND AND PURPOSE: Few studies have reported the longitudinal trend of return to work after stroke. The purpose of our study was to evaluate the longitudinal trend of proportion of patients who return to work after stroke and further to examine the predictors of return to work while taking follow-up periods into consideration. METHODS: We conducted a retrospective cohort study on the association between characteristics of stroke patients at admission and return to work after first stroke, taking length of follow-up period into consideration (n = 183). The patients were all younger than 65 years and were working at the time of their stroke. A follow-up questionnaire evaluated return to work and related information. Data were analyzed using the Kaplan-Meier method for curves of the proportion of return to work and Cox's proportional hazards model for odds ratios of return to work. RESULTS: The curve of proportion of return to work had two steep slopes, and the proportion was at a maximum at 18 months from patient admission. The adjusted odds ratios of return to work for patients with normal muscle strength versus severe weakness, without apraxia versus with apraxia, and with white-collar versus blue-collar occupations were 5.16 (P < .05), 4.16 (P < .05), and 1.43 (.05 < P < .10), respectively. CONCLUSIONS: The increase of proportion of return to work after stroke was nonlinear, and this trend was referable to the social security systems available to the patients included in this study. Normal muscle strength and absence of apraxia were significant predictors of return to work after stroke. White-collar occupation showed a tendency to promote return to work.

Adolescent↗
PubMed2001

Return to work after inguinal hernia repair.

BACKGROUND: There is much variation in the time when a patient returns to work after inguinal hernia repair. Most surgical research has focused on the type of operation performed, but other factors may be equally or more important. This study attempted to identify these factors. METHODS: We prospectively studied the return to work after inguinal hernia repair in a convenience sample of 235 patients who were operated on by one surgical group. Ninety-three of these subjects, who were working and had complete data, were included in this analysis. Data were gathered through personal interviews, written surveys, and medical record reviews. The main outcome measures were actual and expected return to work. RESULTS: Primary tissue repair was done in 94% of the patients. The mean age was 49 years; 90% were male. The expected return to work was 10 days; the actual mean return to work after operation was 12 days (median, 7 days; range, 2 to 60 days) and was unrelated to preoperative functional status. Bivariate analysis showed that age, educational level, income level, occupation, symptoms of depression, and the expected return to work accounted for 61% of the variation in actual return to work. CONCLUSIONS: Factors other than operative technique, including patient expectations, are strongly associated with return to work after inguinal hernia repair. Depression significantly delayed return to work. More research is needed to understand how expectations are formed and how decisions are made regarding return to work, and whether these can and/or should be influenced by surgeons, employers, or others to promote earlier return to work.

Analysis of Variance↗
PubMed2004

The prognostic value of functional capacity evaluation in patients with chronic low back pain: part 1: timely return to work.

STUDY DESIGN: Historical cohort study. OBJECTIVES: We examined the validity of the Isernhagen Work Systems' Evaluation in predicting timely return to work. SUMMARY OF BACKGROUND DATA: Functional Capacity Evaluations are used commonly to determine readiness for return to work, yet little is known of their validity. METHODS: Workers' compensation claimants undergoing Functional Capacity Evaluations following work-related low back injury were studied. Two cohorts were formed, one on which exploratory analyses were conducted and a second for confirmation. Evaluation indicators were the number of tasks in the protocol rated as failed and performance during the floor-to-waist lift task. The primary outcome investigated was time receiving total temporary disability benefits (as a surrogate of return to work) and a secondary outcome was time until claim closure in the year following Evaluation. Cox proportional-hazards regression was used to determine the prognostic effect of Evaluation crudely and after controlling for potential confounders. RESULTS: Few patients (4%) were found to pass all Evaluation tasks, yet most experienced total temporary disability suspension and claim closure within 1 year following Functional Capacity Evaluations. Better Evaluation performance was related to faster time to suspension of total temporary disability benefits and claim closure after controlling confounding factors, but explained little of the variation in these outcomes (approximately 10%). Performance on the floor-to-waist lift was as predictive as the number of failed tasks in the entire Functional Capacity Evaluations protocol. CONCLUSIONS: Better performance on Evaluation was weakly associated with faster recovery; however, the amount of variation explained was small. One task in the Evaluation was as predictive as the entire protocol.

Adult↗
PubMed1992

Return to work after an initial myocardial infarction and subsequent emotional distress.

We examined how return to work predicted subsequent change in emotional distress in 143 patients who had been employed at the time of initial myocardial infarction. Ninety patients (63%) returned to work by 4 months and remained employed at 12 months. There were no differences in mental health at baseline between those who returned to work and those who did not, but emotional distress decreased significantly between 4 and 12 months only in the group who returned to work. Emotional distress declined after resuming work even when employees returned to jobs with which they reported dissatisfaction at the time of the myocardial infarction. The relationship between return to work and decreasing emotional distress remained after controlling for initial physical and psychological adjustment as well as sociodemographic and social support characteristics. The improvements in mental health associated with return to work should reassure clinicians who emphasize the emotional as well as economic value of work after an initial myocardial infarction.

Employment↗
PubMed2005

Who returns to work after heart transplantation?

BACKGROUND: Detailed information regarding the work history of heart transplant patients is limited. Therefore, the work history and factors associated with return to work at 1 year after heart transplantation were examined in 237 heart transplant patients as part of a longitudinal quality-of-life study at two university medical centers. Patient characteristics were as follows: 81% male; 89% white; mean age 54 years (range 24 to 71); mean level of education 13 years; and 84% were married. METHODS: Data were collected using the following instruments: Work History tool; Rating Question Form; Heart Transplant Stressor Scale; Quality of Life Index; Sickness Impact Profile; Jalowiec Coping Scale; Social Support Index; Heart Transplant Symptom Checklist; and Chart Review Form. Frequency distributions, chi-square, t-tests and stepwise regression were used to examine the work history of patients. RESULTS: Pre-transplant, only 17% of patients were working as compared with 26% (61 of 237) working by 1 year after transplant (p = 0.003). Pre-transplant non-working patients (n = 197) were hospitalized more frequently, were more physically disabled, had more symptom distress, and rated their health as poorer. After heart transplant non-working patients (n = 176) had more rejection, infection and medical complications and more hospital days. Patients who were working either pre- or post-transplant were more likely to hold jobs that were less physically demanding. Factors significantly associated with return to work by 1 year after heart transplant were better functional ability, higher education, fewer endocrine problems, fewer acute rejection episodes and shorter heart transplant waiting time. CONCLUSIONS: Clinical and demographic variables influence return to work after heart transplantation. Knowledge of these variables provides the health-care team with information to assist patients in securing gainful employment.

Adult↗
PubMed1995

Review of literature on heart transplant recipients' return to work: predictors and outcomes.

The article reviews research on the rate of return to work of heart transplant recipients, examines findings associated with return to work and explores the implications of those findings for social work research, practice and policy in heart transplantation programs. Findings of studies reviewed in the article support the conclusion that there are significant sources of variation in recipients' return to work other than surgical outcome. Predictors of return to work include pre-transplant factors as well as social structural factors.

Adult↗
PubMed1999

Prediction of "intent", "discrepancy with intent", and "discrepancy with nonintent" for the patient with chronic pain to return to work after treatment at a pain facility.

OBJECTIVE: We previously determined that "intent" to return to work post pain facility treatment is the strongest predictor for actual return to work. The purposes of the present study were the following: to identify variables predicting "intent"; to predict membership in the "discrepant with intent" group [those chronic pain patients (CPPs) who do intend to return to work but do not]; and to predict membership in the "discrepant with nonintent" group (those CPPs who do not intend to return to work but do). DESIGN: A total of 128 CPPs completed a series of rating scales and yes/no questions relating to their preinjury job perceptions and a question relating to "intent" to return to the same type of preinjury job post-pain facility treatment. These CPPs were part of a grant study for prediction of return to work, and therefore their work status was determined at 1, 3, 6, 12, 18, 24, and 30 months posttreatment. Preinjury job perceptions and other demographic variables were utilized using stepwise discriminant analysis to identify variables predicting "intent" and predicting membership in the "discrepant with intent" and "discrepant with nonintent" groups. SETTING: Pain facility (multidisciplinary pain center). PATIENTS: Consecutive low back pain CPPs, mean age 41.66+/-9.54 years, with the most frequent highest educational status being high school completion (54.7%) and 60.2% being worker compensation CPPs. RESULTS: "Intent" was predicted by (in decreasing order of probability) postinjury job availability variables, job characteristic variables, and a litigation variable. "Discrepant with intent" was predicted by (in decreasing order of probability) for the 1-month follow-up time point, postinjury job availability variables, pain variables, a litigation variable, and a function perception variable, and for the final follow-up time point, pain variables only. "Discrepant with nonintent" was predicted by (in order of decreasing probability) for the 1-month follow-up time point, a job availability variable, a demographic variable, and a functional perception variable, and for the final follow-up time point a pain variable and a job availability variable. The percentage of CPPs correctly classified by each of these analyses was as follows: "intent" 81.25%, "discrepant with intent" 87.01% (at 1-month follow-up) and 74.03% (final follow-up), "discrepant with nonintent" 92.16% (at 1-month follow-up) and 75.00% (final follow-up). CONCLUSIONS: CPPs intentions of returning to their preinjury jobs are mainly determined by job availability and job characteristic variables but surprisingly not by pain variables. However, the results with "discrepant with intent" and "discrepant with nonintent" groups indicate that actual return to work is determined by an interaction between job availability variables and pain variables with pain variables predominating for long-term outcome.

Adult↗
PubMedDate not supplied

Return-to-work programs following occupational hand injuries.

Return-to-work programs are no longer luxuries that only the major industries can afford to provide. Direct cost savings can be documented with the use of such programs, but just as important is the message that the company cares and looks out for the employee's best interest. The occupational medicine team's responsibility to the patient and the employer no longer ends with the provision of quality medical treatment. The ultimate goal is to return the patient to his or her job. Return-to-work programs successfully facilitate that process.

Disability Evaluation↗
PubMed1988

Return to work after a first myocardial infarction. A test of multiple hypotheses.

The relationship between return to work within one year after a first myocardial infarction and selected sociodemographic, health, psychosocial, and vocational characteristics was assessed in 151 patients aged 24 to 70 years. Seventy-two percent of the sample returned to work. Education, physical activity associated with employment, severity of myocardial infarction, perception of health status, financial incentives, socioeconomic status, treatment hospital, rated social health status, locus of control, satisfaction with work, and early entry into the job force each proved to be significantly associated with return to work in independent univariate analyses. A stepwise multivariate regression analysis identified only the first four factors as important predictors of return to work. Further analyses show that given knowledge of the patients' educational level and the physical activity associated with employment, 71% of patients who returned to work were correctly classified. Return to work proved easier to predict than work disability. More knowledge is needed about the factors that are critical to a failure to resume employment after a myocardial infarction.

Adult↗
PubMed1975

The influence of psychological factors and an early hospital follow-up on return to work after first myocardial infarction.

The factors influencing the return to work following first myocardial infarction were studied in 112 male patients, all of whom had previously been fully employed. Delay in return to work within 4 months of discharge from hospital was seen in patients who were not given an early hospital follow-up appointment and in those who attibuted their illness to aspects of their work. Encouragement by the General Practitioner to resume employment was found to be essential if an unnecessary delay was to be avoided. Positive advice of this nature was given more frequently by General Practitioners whose patients had been seen at early hospital review. Age, a tendency to neuroticism, personal knowledge of how others had fared following a similar illness, and apparent benefit from sick payments did not appear to influence the rate of return to work.

Acute Disease↗
PubMedDate not supplied

Worksite disability management model for effective return-to-work planning.

The growth of disability management programs represents a paradigm shift from traditional clinic-based rehabilitation services to worksite-based interventions that dramatically reduce lost time and costs. Supportive policies and steps in the return-to-work process are illustrated, from the point of worker injury and early intervention, through work ability assessment, return-to-work planning, job-site accommodation, and successful return to work. Creative return-to-work options, including "job banks," are discussed as practical methods to facilitate the worker's gradual return to full duty status while completing the medical recovery process. Worker, worksite, and community resource factors related to return-to-work outcomes are discussed.

Disability Evaluation↗