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PubMed2003

Occupational health guidelines for the management of low back pain: an international comparison.

BACKGROUND: The enormous socioeconomic burden of low back pain emphasises the need for effective management of this problem, especially in an occupational context. To address this, occupational guidelines have been issued in various countries. AIMS: To compare available international guidelines dealing with the management of low back pain in an occupational health care setting. METHODS: The guidelines were compared regarding generally accepted quality criteria using the AGREE instrument, and also summarised regarding the guideline committee, the presentation, the target group, and assessment and management recommendations (that is, advice, return to work strategy, and treatment). RESULTS: and CONCLUSIONS: The results show that the quality criteria were variously met by the guidelines. Common flaws concerned the absence of proper external reviewing in the development process, lack of attention to organisational barriers and cost implications, and lack of information on the extent to which editors and developers were independent. There was general agreement on numerous issues fundamental to occupational health management of back pain. The assessment recommendations consisted of diagnostic triage, screening for "red flags" and neurological problems, and the identification of potential psychosocial and workplace barriers for recovery. The guidelines also agreed on advice that low back pain is a self limiting condition and, importantly, that remaining at work or an early (gradual) return to work, if necessary with modified duties, should be encouraged and supported.

Disability Evaluation↗
PubMed1997

[Endoscopic pre-peritoneal prolene mesh-plasty for management of inguinal and femoral hernias].

From October 1994 to March 1996 158 inguinal or femoral hernias were repaired in 124 patients through a total extraperitoneal approach. The repairs were done with polypropylene mesh. The patients were seen 6 to 8 weeks postop; until today 57 patients were seen 12 months postop. This method favours an early return to work. Patients with unilateral hernias returned to work after an average of 14 days, patients with bilateral hernias after an average of 19 days. Complications were rare and mostly minor. So far we have seen no recurrences and no mesh related complications. We consider the laparoscopic extraperitoneal mesh repair a safe procedure for inguinal and femoral hernias.

Adult↗
PubMed1999

Activity restrictions after posterior lumbar discectomy. A prospective study of outcomes in 152 cases with no postoperative restrictions.

STUDY DESIGN: A prospective clinical trial was conducted. OBJECTIVES: To determine the feasibility of removing activity restrictions after surgery and encouraging early return to work; to ascertain the clinical and behavioral response to such a strategy; and to identify factors predictive of early return to work, preparatory to possible randomized clinical trials. SUMMARY OF BACKGROUND INFORMATION: Current practice usually entails several weeks to several months of restricted activities after lumbar discectomy to avoid disc "reinjury." Earlier work has suggested these restrictions may not be necessary. METHODS: One hundred fifty-two consecutive working patients undergoing limited open discectomy for herniated lumbar intervertebral disc were treated postoperatively with no activity restrictions. Patients were encouraged to return to full activities as soon as possible. The patients were followed for a minimum of 2 years (average follow-up time = 4.8 years). At follow-up, an independent examiner evaluated each patient and collected further postoperative data. RESULTS: One hundred forty-nine of the 152 patients (98%) returned to work. The average work loss was 1.2 weeks and 148 of 149 patients had returned to full duty by 8 weeks. Approximately one-third of the group returned to work within 1 week of surgery (32%), many the next day. Statistical analysis demonstrated very early return to work did not correlate with either recurrent sciatica, reoperation for reherniation, or ultimate clinical outcome. Seventeen patients (11.2%) had possible reherniations (recurrent sciatica) and eight underwent reoperation (5.3%). CONCLUSION: Lifting of postoperative activity restrictions after limited discectomy allowed shortened time to return to work relative to the 4 to 16 weeks commonly recommended. Complication rates appear comparable to those reported in the literature for patients under postoperative restrictions. Postoperative restrictions may not be necessary in most patients.

Adult↗
PubMed1994

Work hardening: past, present, and future--the work programs special interest section national work-hardening outcome study.

OBJECTIVES: A review of outcome research conducted between 1982 and 1992 revealed return-to-work rates for industrial rehabilitation programs that ranged from 50% to 88%. Variations in outcome statistics appeared to reflect discrepancies in factors such as type of research design, initial characteristics of the client sample, and clients excluded from the study group. METHOD: A work-hardening outcome study involving 36 programs was conducted by the Work Programs Special Interest Section to address questions left unanswered by existing studies regarding (a) rates of program nonacceptance or noncompletion, (b) basic client characteristics and outcome, (c) length of disability and outcome, (d) breakdown of client disposition after program completion, and (e) program characteristics and return to work. RESULTS: Findings included the following: (a) 11.5% of clients were not accepted into work hardening and 24.6% did not complete the program; (b) outcome was not related to client age, gender, area of injury, or physical demand level of job before injury; (c) as duration of disability increased, return to work decreased significantly; (d) at discharge, 48.2% of clients returned to the usual and customary job and 30.5% to alternate or modified work, whereas 13.6% were referred to a vocational counselor; and (e) there was no relationship between number of visits or number of professionals seen and return to work. CONCLUSION: The authors suggest a need for uniform standards in collection of outcome data to establish a basis for comparison of efficacy among programs. Recommendations include tracking comparison or control groups, grouping clients in terms of length of disability, computing success rate on the basis of number of clients who completed their program, using relevant subcategories when reporting return to work, and consistency of the postdischarge interval for follow-up.

Accidents, Occupational↗
PubMed2006

Work resumption after newly diagnosed coronary heart disease: findings on the importance of paid leave.

OBJECTIVES: Studies have demonstrated the health benefits of work resumption for adults experiencing health problems, but there are important gaps in the research examining the factors that would help these individuals return to work. This study examines if working conditions predict whether women who experience angina or a myocardial infarction (MI) return to work. METHODS: A sample of 289 employed women from the Nurses' Health Study was analyzed. Bivariate chi-square and logistic regression analyses were conducted to examine the relationship between working conditions and the likelihood of returning to work after experiencing an MI or angina. RESULTS: Seventy-nine percent of women returned to work after experiencing an MI or angina. Women who had paid leave were substantially more likely to return to work after an MI or angina episode than women without this benefit (adjusted odds ratio [OR] 2.7, p = 0.04). CONCLUSIONS: Public and corporate policies to promote paid leave for female workers who experience a serious health condition are likely to help these workers return to their jobs, thereby providing important health and economic benefits for both workers and society.

Angina, Unstable↗
PubMed1982

Length of sickness absence from work after minor fractures.

Rehabilitation professionals sometimes believe that sickness absence from work is unduly prolonged. This paper examines the implications of factors that influence the timing of return to work, among patients with minor fractures, for the appropriateness of the time at which they should return to work. Data about a consecutive series of 85 employed hospital outpatients with fractures of the wrist, hand or foot bones were collected by means of interviews with the patients and from the orthopaedic case notes. The mean length of sickness absence from work was 3 weeks. Variations were related to the site and severity of the injury. Patients with physically heavy jobs, and patients with a husband or wife at home while they were off work, were off work for longer than average (6 and 5 weeks respectively). 76 per cent of the patients said they returned to work at the right time, and 23 per cent too early. Comparable findings relating to fracture patients, appear not to have been reported in the research literature previously. The patients in the series were away from work longer than advocates of aggressive rehabilitation might consider necessary, although the patients themselves felt they had returned to work at the right time or too early. The development of explicit criteria, based on the nature of the patient's injuries, recovery and job, might enable doctors to give patients more helpful advice about the time at which they should appropriately return to work.

Absenteeism↗
PubMedDate not supplied

Intending to breastfeed and work.

Many women who return to the work force during the first year following the births of their infants plan to combine breastfeeding and work; yet little is known about the process of preparing for the transition from breastfeeding in the home to continuing to breastfeed while employed. A study was conducted to explore mothers' decision-making processes during this transition. Interviews were conducted with 61 urban Canadian mothers who intended to continue breastfeeding after returning to work. Participants revealed that, although they intended to continue breastfeeding, whether or not they actually did depended on many factors that were beyond their control. These mothers had to play it by ear. They made elaborate plans, as well as back-up plans, allowing for all possible eventualities.

Adult↗
PubMed2003

Cancer, fatigue and the return of patients to work-a prospective cohort study.

Fatigue is a highly prevalent and debilitating symptom in cancer survivors. The aim of this study was to assess the impact of fatigue and other cancer-related symptoms on the return to work of cancer survivors. A prospective inception cohort study with 12 months of follow-up was initiated. At 6 months following the first day of sick leave, levels of fatigue, depression, sleep problems, physical complaints, cognitive dysfunction and psychological distress were assessed, in addition to clinical, sociodemographic and work-related factors. Data were obtained from one academic hospital and two general hospitals in the Netherlands. 235 patients who had a primary diagnosis of cancer and underwent treatment with curative intent were included. The rate of return to work was measured at 6, 12 and 18 months. Hazard ratios (HRs) for the duration of sick leave up to 18 months following the first day of sick leave were calculated. The rate of return to work increased from 24% at 6 months to 64% at 18 months following the first day of sick leave. Fatigue, diagnosis, treatment type, age, gender, depression, physical complaints and workload were all related to the time taken to return to work. Fatigue scores were also strongly related to diagnosis, physical complaints, and depression scores. Fatigue at 6 months predicted a longer sick leave with a hazard ratio of 0.71 (95% Confidence Interval (C.I.) 0.59-0.85), adjusted for diagnosis, treatment type, age and gender. In a multivariate Cox regression analysis, diagnosis, treatment, age, physical complaints and workload remained the only significant predictors of duration of the sick leave. 64% of cancer survivors returned to work within 18 months. Fatigue levels predicted the return to work. This was independent of the diagnosis and treatment, but not of other cancer-related symptoms. Better management of cancer-related symptoms is therefore needed to facilitate the return to work of cancer patients.

Adult↗
PubMed2004

Ability to work and owner satisfaction following surgical repair of common calcanean tendon injuries in working dogs in New Zealand.

AIM: To report the long-term outcome (return to work and owner satisfaction) following surgical treatment of common calcanean tendon (Achilles tendon) injuries in working dogs in New Zealand. METHODS: Ten New Zealand Huntaway or Heading dogs (working Collies) with complete or partial tears of the common calcanean tendon, were treated using locking-loop suturing and casting, with (7) or without (3), a calcaneo-tibial screw. All dogs were actively in work on sheep or cattle farms at the time of injury, and return to work was the desired outcome. Ability to work and owner satisfaction were investigated using a telephone questionnaire at a mean followup interval of 14.6 months. RESULTS: Overall, 7/10 dogs returned to full or substantial levels of work. Post-operative complications occurred in two dogs that did not return to full or substantial levels of work. Moderate persistent lameness (score 3 on a scale of 0-5) was present in 2/7 dogs that returned to full or substantial levels of work, equating to a 71% good-to-excellent functional outcome within this group. Seven owners felt the financial investment in opting for surgical repair was worthwhile. A screw and cast method of rigid immobilisation was thought to be superior to casting alone. CONCLUSIONS: Surgical treatment of common calcanean tendon injury in working dogs carries a good prognosis if an appropriate tenorrhaphy technique is used and rigid immobilisation is achieved for 6 weeks. Care must be taken to limit post-operative complications. CLINICAL RELEVANCE: This study justifies the use of surgical repair of such injuries in the working dog even when return to work is the only acceptable outcome.

Journal Article↗
PubMed1999

Unemployment and health: physicians' role.

Unemployment has been documented to have detrimental impacts on a person's mental, physical and social well being. When unemployment or being out of work is due to injury or sickness, the effects are compounded by mental and social factors. In an effort to prevent prolonged unemployment due to injury or sickness, changes were made to existing disability income supplement plans to redirect their focus from basic income support to active employment measures. This is intended to reduce individual's dependency on financial assistance and encourage individuals to take personal responsibility for getting back to work. The various disability insurance plans require primary care physicians to provide opinion and participate in the recovery and safety return to work of injured or sick persons. The physician approach to medical care of the injured/sick person with employment problems should focus on return to work as a goal of treatment. The patient should be seen as part of a social or environmental system and not as an isolated individual. The physician has a significant role to play in the diagnosis, determining functional abilities and participation in the return to work plan. The physician positive participation, not only provides an intrinsic cost saving value in insurance costs, but more important, helps patients maintain gainful employment. Work often helps in regaining health. Many factors are involved in a return to work outcome and physicians need to know how to identify and track the factors that facilitate or impede return to work. The challenge for the physician is to utilize the available resources to facilitate the recovery and communicate with other parties involved in the return to work process. This paper discusses the disability insurance plans in Canada and the community expectations from physicians dealing with patients who are out of work because of injury or sickness. It is acknowledged that primary care physicians' skills are not adequate in this area and that there is a need for continuing medical education to prepare them for this new role. Relevant topics should be introduced in medical curricula.

Canada↗
PubMed2005

Vocational training integrated into inpatient psychosomatic rehabilitation--short and long-term results from a controlled study.

PURPOSE: The aim of this study was to determine the impact of a vocational training programme on short- and long-term results after psychosomatic rehabilitation. METHOD: 1,590 inpatients were screened for vocational integration. A high-risk group of 266 patients was randomly assigned to the vocational training programme plus psychosomatic treatment; treatment- as- usual served as a control condition. An occupational training was conducted at local companies, closely integrated into psychosomatic treatment. Vocational attitudes and adjustment were studied at intake, discharge, three, 12 and 24 month follow-ups. RESULTS: More than half of the study participants were unemployment and/or long-term work-disabled harbouring strong negative attitudes toward return to work. Forty-six percent of the intervention group declined from participation, but complied with follow-up investigation. At discharge, participants of the vocational training programme had become more optimistic regarding resuming work. One year following discharge, participants of the training programme reported less absence from work. After 24 months, vocational adjustment had improved considerably among programme participants, and declined among controls and refusers. CONCLUSION: An intensive vocational training programme is effective in promoting positive attitudes to work, reducing work disability and promoting return-to-work. However, a randomized design may be not optimal; evaluation necessitates long-term follow-up.

Adult↗
PubMed1985

A review of employment patterns of industrial amputees--factors influencing rehabilitation.

More than 1,000 industrial amputees at the Ontario Workers' Compensation Board were reviewed. The study investigated the current employment status of amputees and the factors that influenced successful return to work post-amputation. The data obtained from a mailed questionnaire was analysed by the Statistical Analysis System. The results revealed that 89% of amputees returned to work after an amputation. The average follow-up post-amputation was 14 years with a range of one to 64 years. At the time of review the current employment status of amputees was as follows: 51% full time employed, 5% part-time employed, 25% retired and 8% unemployed. The remainder were engaged in a vocational activity, still recovering or were not seeking work. The data revealed that amputees typically changed jobs when returning to the work force. Amputees returned to jobs that were less physically demanding, but required greater intellectual skills in occupations such as clerical and service industries. Factors including prosthetic use, vocational services, and a younger age at the time of amputation were identified as being positively associated with a return to work. Those factors that were negatively related to successful employment included stump and phantom limb pain and multiple limb amputations. The study concluded that the majority of the amputees reviewed were successful in returning to work. The authors suggest that amputees benefit from treatment programmes that include medical, prosthetic and vocational services.

Accidents, Occupational↗
PubMed1999

Videotapes in evaluating work-related upper extremity symptoms.

Thirteen patients with upper extremity symptoms that were claimed to have occurred in the course of employment were evaluated to determine the role of videotapes in their evaluation and management. Videotapes were of two types: work demonstration by patient or coworker (8 tapes) and surveillance tapes obtained by a private investigator (5 tapes). Four of eight work station videotapes demonstrated significant repetitive motion that could have contributed to their symptoms. Four of eight work station videotapes demonstrated that the tasks were neither forceful nor repetitive in nature. Return to work recommendations were made based on both clinical grounds and job site information provided on tape. After viewing five surveillance videotapes, two fraudulent claims were settled soon after medical opinions were rendered. Two patients were declared able to return to work; one returned to work and the other was dismissed. The videotape of patient No. 13 was not crucial for the decision and he was authorized to have surgery. The opinions formed concerning the causality of alleged claims of injury were often altered by viewing the content of the videotapes. Videotapes are a valuable tool and useful adjunct in the overall management of the workers with upper extremity symptoms.

Adult↗
PubMed2001

The impact of physical function and pain on work status at 1-year follow-up in patients with back pain.

STUDY DESIGN: A randomized, controlled trial. OBJECTIVE: To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. SUMMARY OF BACKGROUND DATA: Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. METHODS: Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). RESULTS: At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. CONCLUSIONS: Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.

Adult↗
PubMed1997

Reemployment of patients with surgical salvage of open, high-energy tibial fractures: an outcome study.

Between January 1, 1988, and December 31, 1990, 36 patients with 37 type III high-energy open tibial shaft fractures were treated at Lehigh Valley Hospital. Patients with primary amputations were excluded. All patients with high-energy open tibial fractures with an intact posterior tibial nerve, protective sensations of the plantar surface of the foot, and warm ischemia time of less than 6 hours were considered salvageable. A retrospective review of the charts was completed. Twenty-eight patients with 29 fractures were interviewed for work status, an average of 39 months after treatment. Twenty-five patients with 25 fractures were working at the time of the accident. Three patients with four fractures were not working at the time of the accident. Nineteen of 25 patients (76%) returned to work. Sixteen of 25 patients (64%) returned to work at a similar level of manual labor. The average delay between injury and return to work was 11 months (range, 3-18 months). Two of the 36 patients (5.5%) required secondary amputations. Twenty-five of 28 patients (89%) interviewed reported one or more subjective complaints. The two amputees reported no subjective complaints.

Adolescent↗
PubMedDate not supplied

The role of social support in facilitating postpartum women's return to employment.

PURPOSE: More than half of mothers with infants under 1 year are employed. This study explored the role of social support in facilitating women's return to employment during the 1st year postpartum. DESIGN: Analysis of existing longitudinal, repeated-measures questionnaire data gathered at 4 and 12 months postpartum. PARTICIPANTS: 94 postpartum women who were married or partnered, employed, and residing in a large urban area in the northwestern United States. OUTCOME MEASURES: Satisfaction with decision to return to work, role performance, work-family balance. RESULTS: Relationships between indicators of social support and return-to-work experiences were absent to modest. Satisfaction with child care was related to satisfaction with the decision to return to work. Workplace support was related to work-family balance at 12 months postpartum. CONCLUSIONS: Satisfactory child care arrangements and supportive relationships in the workplace are the most significant facilitators of women's return to work postpartum.

Adaptation, Psychological↗
PubMed2001

Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations.

OBJECT: Far-lateral (extraforaminal) and foraminal disc herniations comprise up to 11% of all herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial. Accessing these lateral disc herniations endoscopically via a percutaneous transforaminal approach offers several theoretical advantages over the more traditional procedures. The object of this study was to assess the safety and efficacy of treating patients with far-lateral and foraminal disc herniations via a percutaneous transforaminal endoscopic approach. METHODS: A retrospective analysis was performed of 47 consecutive patients who underwent surgery via this approach. All procedures were performed after induction of a local anesthetic on an outpatient basis. Outcome was measured with Macnab criteria and by determining a patient's return-to-work status. The median follow-up period was 18 months (range 4-51 months). Excellent or good outcome was obtained in 40 (85%) of 47 patients. Of the 38 patients working before the onset of symptoms, 34 (90%) returned to work. Five patients (11%) experienced poor outcomes and subsequently underwent open procedures at the same level. Of the 10 recipients of Workers' Compensation, Macnab criteria indicated a significantly worse outcome (70% excellent or good), but an excellent return-to-work status was maintained (90%). There were no complications. CONCLUSIONS: Transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of far-lateral and foraminal disc herniations.

Adult↗
PubMed2006

Early predictors of long-term work disability after major limb trauma.

BACKGROUND: A better understanding of the factors influencing return to work (RTW) after major limb trauma is essential in reducing the high costs associated with these injuries. METHODS: Patients (n = 423) who underwent amputation or reconstruction after limb threatening lower extremity trauma and who were working before the injury were prospectively evaluated at 3, 6, 12, 24, and 84 months. Time to first RTW was assessed. For individuals working at 84 months, the percentage of time limited in performance at work was estimated using the Work Limitations Questionnaire. RESULTS: Estimates of the cumulative proportion returning to work at 3, 6, 12, 24, and 84 months were 0.12, 0.28, 0.42, 0.51, and 0.58. Patients working at 84 months were, on average, limited in their ability to perform the demands of their job 20 to 25% of the time. In the context of a Cox proportional hazards model, differences in RTW outcomes by treatment (amputation versus reconstruction) were not statistically significant. Factors that were significantly associated (p < 0.05) with higher rates of RTW include younger age, being White, higher education, being a nonsmoker, average to high self efficacy, preinjury job tenure, higher job involvement, and no litigation. Early (3 month) assessments of pain and physical functioning were significant predictors of RTW. CONCLUSIONS: Return to work after severe lower extremity trauma remains a challenge. Although the causal pathway from injury to impairment and work disability is complex, this study points to several factors that influence RTW that suggest strategies for intervention.

Adolescent↗