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PubMed1985

Determinants of work capability and employment after coronary artery surgery.

In 120 patients subjected to coronary artery surgery we have investigated employment status and work capability in relation to age, pre-operative ventricular function and extent of coronary artery disease, peri-operative infarction and post-operative angina. The patients were followed up for 6 to 23 months (mean 10 months). Fifty-three out of 74 patients (72%) employed before the onset of angina, returned to work after operation. Return to work was more likely in patients working immediately prior to surgery and in patients less than 45 years old (P less than 0.05). Sixty patients (50%) reported a return to normal work capability, the most striking changes occurring in those less than 45 years old (P less than 0.02). Pre-operative left ventricular (LV) function and extent of coronary disease and mode of employment did not correlate with post-operative employment status but normal LV function was related to improvement in work capability (P less than 0.02). Return to work after coronary bypass surgery is mainly due to angina relief but is also related to age and pre-operative work status.

Adult↗
PubMed1995

[Occupational rehabilitation after percutaneous transluminal coronary angioplasty (PTCA)--correlation with subjective and objective parameters].

On the basis of medical criteria percutaneous transluminal coronary angioplasty (PTCA) is followed by only a short interval of work inability. This study evaluated the interval between PTCA and the return to work and the factors which may influence this interval. The study included 122 working patients with angiographically successful PTCA. Patients were followed up clinically and angiographically and completed a standardized questionnaire directly after PTCA and 4 months later. The study population comprised 87 patients (81 men, 6 women) who filled out both questionnaires appropriate for evaluation. Of these 48 (55%) had single-vessel, 27 (31%) two-vessel, and 12 (14%) three-vessel disease. Complete revascularization in terms of treatment of all lesions above 70% was achieved in 85 (98%) patients. In 30 (34%) patients restenosis developed during the observation period as evaluated by coronary angiography. At the time of the second evaluation 46 (53%) patients complained of persisting or new thoracic pain, which they understood as cardiac pain. After 4 months 68 (78%) patients returned to work, 12 (14%) were on sick leave, 3 (3%) were unemployed, and 4 (5%) were retired. The median of time on sick leave after PTCA was 14 days. The length of sick leave after PTCA was found to depend significantly on the previous intention to retire (25% vs. 75%, p < 0.01). Patients who did not return to work during study period reported more frequently of thoracic pain (55% vs. 45%, p = 0.01) and had less intention to return to work after PTCA (6% vs. 94%, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed2005

Secondary prevention of work disability: community-based psychosocial intervention for musculoskeletal disorders.

INTRODUCTION: One objective of the present research was to examine the degree to which psychological risk factors could be reduced through participation in a community-based psychosocial intervention for work-related musculoskeletal disorders. A second objective was to examine whether psychosocial risk reduction had an effect on the probability of return to work. METHODS: Participants were 215 Workers Compensation Board claimants with work-related musculoskeletal disorders who had been absent from work for an average of approximately 7 months (M = 28.8 weeks, range = 4-100 weeks) and were referred to a community-based multidisciplinary secondary prevention program in Nova Scotia, Canada. RESULTS: In the current sample, 63.7% of participants returned to work within 4 weeks of treatment termination. The percentage reductions in targeted risk factors from pretreatment to posttreatment were as follows: catastrophizing (32%), depression (26%), fear of movement/re-injury (11%), and perceived disability (26%). Logistic regression indicated that elevated pretreatment scores on fear of movement and re-injury (OR = 0.58, 95% CI = 0.35-0.95) and pain severity (OR = 0.64, 95% CI = 0.43-0.96) were associated with a lower probability of return to work. A second logistic regression addressing the relation between risk factor reduction and return to work revealed that only reductions in pain catastrophizing (OR = 0.17, 95% CI = 0.07-0.46) were significant predictors of return to work. CONCLUSIONS: The results of the present study provide further evidence that risk factor reduction can impact positively on short term return to work outcomes. SIGNIFICANCE: Outcomes of rehabilitation programs for work disability might be improved by incorporating interventions that specifically target catastrophic thinking. Community-based models of psychosocial intervention might represent a viable approach to the management of work disability associated with musculoskeletal disorders.

Adult↗
PubMed1988

Hospital pharmacy employment considerations for the chemically dependent health-care professional.

Experiences and decisions of a pharmacy services management team involving two chemically dependent individuals, one an existing pharmacist employee and the other a pharmacist applicant, are described. Because our standing on chemical dependency was to rehabilitate rather than terminate, we chose to develop a systematic approach to dealing with this problem in our employees. In the case of the existing pharmacist employee, we decided to initiate rehabilitation by intervention, a process that involved direct confrontation of the individual by his spouse and mother, immediate supervisor, a certified alcohol and drug abuse counselor, and a representative from the hospital's employee assistance program. The employee was treated by psychological/behavioral therapy on an inpatient basis. After discharge, the employee returned to work under specific terms outlined in a return-to-work contract covering the first 24 months; support structures at the workplace to guard against relapse were also instituted. Factors that might precipitate relapse were identified, and a policy for dealing with relapsing employees was developed. The pharmacist applicant was assessed like any other applicant, but a few other factors relevant to her recovering status, such as the length of continuous abstinence she had attained, were considered. An employment contract resembling the return-to-work contract also was developed. Experience with the chemically dependent employee led to the creation of a model for dealing effectively and fairly with employees afflicted with the disease of chemical dependency. We continue to support our institutional decision to rehabilitate and not terminate such employees.

Humans↗
PubMed1987

Relative mechanical load on shoulder and elbow muscles in standing position when handling materials manually. A study of packing work.

When a patient with a musculoskeletal disorder returns to work after rehabilitation, the work-station should be designed so that the impaired muscle groups are less exposed to load. The work posture desirable for a particular muscle group might impose higher load on another muscle group. Since the shoulder muscles usually are stronger than the elbow muscles, a direct comparison of the loads is difficult. To make comparisons possible, the load moment about the investigated joints were divided by the counteracting maximum muscular moments, and a Muscular strength Utilization Ratio (MUR) was obtained. Using this principle, the muscular load on the shoulder and elbow was investigated in 72 different packing work postures. Different combinations of box size, box angle, edge height and weight of object handled were studied. There was a higher relative load on the shoulder than on the elbow. The concept of relating joint load to strength may serve as a guideline for how high a patient's strength should be before returning to work to avoid further injuries.

Adult↗
PubMed1992

Epidemiology of low back pain.

At present, although there have been many epidemiological studies of risk factors for low back pain, there are few risk factors established in prospective studies; and our understanding of them remains relatively crude. Individuals in jobs requiring manual materials handling, particularly repeated heavy lifting and lifting while twisting, are at increased risk of back pain leading to work absence. In addition, exposure to whole-body vibration and job requirements for static postures are associated with back pain. Individual trunk strength has not been consistently demonstrated as associated with back pain; although there is some suggestion that when work requirements for heavy lifting exceed individual capacities, back pain is more likely to occur. The pattern of peak age at onset in the 20's is consistent with back pain development early in working life. Among other individual characteristics, only cigarette smoking has consistently been associated with back pain; and the biological mechanism for this finding is not understood. Evidence with respect to spinal flexibility, aerobic capacity, educational attainment and other variables is suggestive but not consistent. There is some evidence that the individual's relation to work, expressed as job satisfaction or supervisor rating, is also related to work absence due to back pain. While it is possible to describe, however crudely, the characteristics placing people at risk for back pain leading to work absence and/or medical attention, the problem of predicting chronicity and thus identifying patients for more intensive clinical intervention remains unresolved. At this time, only age of the patient and certain clinical features of the back pain such as the presence of sciatic symptoms, duration of the current episode, and history of prior episodes are consistently demonstrated predictors. In chronic patients, there is suggestive evidence that spinal flexibility, trunk strength, and certain psychological characteristics such as coping skills, fear and avoidance of pain or movement, job satisfaction, attribution of fault and hysterical or hypochondriacal features are associated with treatment failure. In addition, there is suggestive evidence that the availability of alternative work placement may allow for earlier return to work than otherwise. While the availability of disability compensation in excess of usual wages may serve as a disincentive to return to work. The latter-cited remain to be verified, while findings in chronic patients remain to be tested in acute. Further, the role of physical demands of work in duration of back pain episodes has not been well studied.

Adult↗
PubMed1993

Clinical effectiveness of behavioral signs for screening chronic low-back pain patients in a work-oriented physical rehabilitation program.

This prospective study investigated the relationship between behavioral sign scores (from Waddell) and the return to work status of chronic low-back pain patients who completed a work-oriented physical rehabilitation program without formal facility-related psychologic or social services. Further, the authors monitored the effect of this program on changing these scores. The program consisted of physical reconditioning through resistive exercises, flexibility and aerobic training, posture and body mechanics education, and progressive work simulation tasks and activities of daily living. One hundred eighty-three nonworking or partially disabled low-back pain patients with an average duration of 8.7 months' disability were included in the study. The presence of each of eight behavioral signs was tested for on entry and again on completion of the program. Analysis showed a significant drop in behavioral sign scores for patients who successfully returned to work. There was no significant reduction in scores for patients who did not return to work. The results suggest these signs may predict the effectiveness of treating chronic low-back pain patients in a return-to-work physical rehabilitation program. Conversely, screening for behavioral signs may identify low-back pain patients who would benefit from intensive behavioral and psychiatric testing and intervention efforts.

Activities of Daily Living↗
PubMed1984

The effects of education and group discussion in the post myocardial infarction patient.

An education and group discussion program administered to a randomly selected group of post myocardial infarction subjects failed to produce any differences in a large number of behavioral and psychological measures. These included smoking behavior, health status, social and recreational status, family and marital life and vocational activities, as well as measures of anxiety, depression, and health locus of control. Treated subjects were slower to return to work than controls and were less likely to have returned to work by the end of the study. More individuals in the treatment group were receiving compensation and this may have been a factor in delaying return to work. Since the majority of our subjects had a very optimistic attitude toward their eventual recovery, there was limited room for improvement. We suggest that cardiac rehabilitation be directed only at those patients with "negative" attitudes, and with more than usual anxiety and depression.

Adaptation, Psychological↗
PubMed1994

Economic aspects of capacity for work after severe traumatic brain lesions.

During 1981-84,310 patients with severe traumatic brain lesions were treated at the Department of Neurosurgery in Lund, Sweden. A total of 161 patients were treated after the introduction of a more aggressive management protocol in 1983. In this first part of a long-term follow-up study we concentrate on the economic aspects. Two questions were addressed: first, what was the vocational outcome after severe head injuries? and second, what were the long-term effects of the new protocol? Out of 147 patients classified as good recovery/moderate disability (GR/MD) 6-months after injury, 106 patients agreed to participate in the study. Five to 8 years after injury 70 patients were classified as capable of working: 57 of these patients were actually at work, nine were studying and four were unemployed. Twenty-two patients had received disability pension and 14 patients had retired because of old age. In the age groups up to 60 years, 70% of patients had returned to work or school. The number of patients who returned to work was significantly higher after introduction of the more aggressive management protocol: 38 of 57 patients who had returned to work were in the group treated between 1983 and 1984. Mean income for patients who had returned to work was close to the average for the corresponding age groups in Sweden. Mean sick leave 5-8 years after severe head injuries was only slightly higher than average in Sweden. Our data show that a majority of the patients classified as GR/MD 6 months after severe traumatic brain lesions have the capacity to return to work. The improvements in the primary management of patients with severe head injuries introduced in 1983 increased the number of patients who work and thus increased the number of patients who favourably contributed to the economy of the community.

Absenteeism↗
PubMed2004

An older worker's decision to "push or protect self" following a work-related injury.

UNLABELLED: This study highlights the return-to-work experience of older workers on worker's compensation as there is a dearth of research in this area. METHOD: Qualitative research methods delineated the experience of four older workers who had sustained work-related musculoskeletal injuries. RESULTS: "Push or Protect Self" emerged as the core category with three themes, including the level of employer support and degree of flexibility in work; continued health problems; and financial distress. These themes influenced each worker's decision to either "push self" to meet their pre-injury work demands, or "protect self" and accept a job post-injury that was less physically demanding, but was at a lower pay level. The four workers sustained financial difficulties subsequent to being off work, and reported continued health problems related to their injuries after being discharged from the worker's compensation system. CONCLUSION: Degree of employer support in providing flexibility in work demands varied, where low support and inflexibility in job tasks contributed to difficulty in returning to work or in sustaining the work demands of the job.

Cross-Sectional Studies↗
PubMed2004

Distribution and determinants of health and work status in a comprehensive population of injury patients.

BACKGROUND: Insight into the distribution and determinants of both short- and long-term disability can be used to prioritize the development of prevention policies and to improve trauma care. We report on a large follow-up study in a comprehensive population of injury patients. METHODS: We fielded a postal questionnaire in a stratified sample of 4,639 nonhospitalized and hospitalized injury patients aged 15 years and older, at 2, 5, and 9 months after injury. We gathered sociodemographic information, data on functional outcome with a generic instrument for health status measurement (EuroQol EQ-5D+) and data on work absence. RESULTS: The response rates were 39%, 75%, and 68% after 2, 5, and 9 months, respectively. The reported data were adjusted for response bias and stratification. The 2-month health status of nonhospitalized patients was comparable to the general population's health when measured by the EQ-5D summary score, although considerable prevalence of restrictions in usual activities (24.0%) and pain and discomfort (34.8%) were reported. Hospitalized patients reported higher prevalences of disability in all health domains. Their mean EQ-5D summary score increased from 0.62 at 2 months to 0.74 at 5 months but remained below the population norm at 9 months, particularly for patients with a long hospital stay. Patients with injuries of the spinal cord and vertebral column, hip fracture, and other lower extremity fractures reported the worst health status, also when adjusted for age, sex, and educational level. Age, sex, type of injury, length of stay, educational level, motor vehicle injury, medical operation, intensive care unit admission, and number of injuries were all significant predictors of functioning. Nonhospitalized and hospitalized injury patients lost on average 5.2 and 72.1 work days, respectively. Of nonhospitalized patients, 5% had not yet returned to work after 2 months, and 39%, 20%, and 10% of hospitalized patients had not yet returned to work after 2, 5, and 9 months, respectively. In a multivariate regression analysis, length of stay, type of injury, level of education, and intensive care unit admission appeared to be significant predictors of absence duration and return to work. CONCLUSION: Injury is a major source of disease burden and work absence. Both hospitalized and nonhospitalized patients contribute significantly to this burden.

Adolescent↗
PubMed2002

Rehabilitation after lumbar disc surgery.

BACKGROUND: Although several rehabilitation programs, physical fitness programs or protocols regarding instruction for patients to return to work after lumbar disc surgery have been suggested, little is known about the efficacy and effectiveness of these treatments. There are still persistent fears of causing re-injury, re-herniation, or instability. OBJECTIVES: The objective of this systematic review was to evaluate the effectiveness of active treatments that are used in the rehabilitation after first-time lumbar disc surgery. SEARCH STRATEGY: We searched the MEDLINE, EMBASE and Psyclit databases up to April 2000 and the Cochrane Controlled Trials Register 2001, Issue 3. SELECTION CRITERIA: Both randomized and non-randomized controlled trials on any type of active rehabilitation program after first-time disc surgery were included. DATA COLLECTION AND ANALYSIS: Two independent reviewers performed the inclusion of studies and two other reviewers independently performed the methodological quality assessment. A rating system that consists of four levels of scientific evidence summarizes the results. MAIN RESULTS: Thirteen studies were included, six of which were of high quality. There is no strong evidence for the effectiveness for any treatment starting immediately post-surgery, mainly because of lack of (good quality) studies. For treatments that start four to six weeks post-surgery there is strong evidence (level 1) that intensive exercise programs are more effective on functional status and faster return to work (short-term follow-up) as compared to mild exercise programs and there is strong evidence (level 1) that on long term follow up there is no difference between intensive exercise programs and mild exercise programs with regard to overall improvement. For all other primary outcome measures for the comparison between intensive and mild exercise programs there is conflicting evidence (level 3) with regard to long-term follow-up. Furthermore, there is no strong evidence for the effectiveness of supervised training as compared to home exercises. There was also no strong evidence for the effectiveness of multidisciplinary rehabilitation as compared to usual care. There is limited evidence (level 3) that treatments in working populations that aim at return to work are more effective than usual care with regard to return to work. Also, there is limited evidence (level 3) that low-tech and high-tech exercises, started more than 12 months post-surgery are more effective in improving low back functional status as compared to physical agents, joint manipulations or no treatment. Finally, there is no strong evidence for the effectiveness of any specific intervention when added to an exercise program, regardless of whether exercise programs start immediately post-surgery or later. None of the investigated treatments seem harmful with regard to re-herniation or re-operation. REVIEWER'S CONCLUSIONS: There is no evidence that patients need to have their activities restricted after first time lumbar disc surgery. There is strong evidence for intensive exercise programs (at least if started about 4-6 weeks post-operative) on short term for functional status and faster return to work and there is no evidence they increase the re-operation rate. It is unclear what the exact content of post-surgery rehabilitation should be. Moreover, there are no studies that investigated whether active rehabilitation programs should start immediately post-surgery or possibly four to six weeks later.

Exercise Therapy↗
PubMed1996

Long-term outcomes after lower extremity trauma.

Previous studies have shown that over one-quarter of patients who were working before a severe lower extremity fracture had not returned to work by 12 months after injury. Disabilities also persisted in household management, recreation, and social interaction. The objective of this study was to determine whether recovery extended beyond 12 months. Three hundred nineteen patients who were previously working and were treated at three level I trauma centers for a severe lower extremity fracture were prospectively followed at 3, 6, and 12 months after injury. Patients were queried at each follow-up about their work status and completed the Sickness Impact Profile (SIP) at 6 and 12 months. The SIP is a widely used and well validated measure of general health status; it was used in this study to measure functional recovery across several domains of daily living. Patients who had not recovered by 12 months (i.e., 204 who were not working, working with limitations, or had limitations in performing other daily activities as measured by elevated scores on the SIP) were contacted again at 30 months and asked to complete an interview and the SIP. At 30 months, an estimated 82% of the study patients had returned to work (compared to 72% at 12 months). SIP scores improved only slightly from 6.4 at 12 months to 5.7 at 30 months. At 30 months, 64% of the patients had no disability (SIP scores less than 4), 17% had mild disability (SIP scores of 4 to 9), 12% had moderate disability (SIP scores of 10 to 19), and 7% had severe disability (SIP scores of 20 or higher). Although the majority of patients with persistent disabilities at 30 months had residual physical impairments at 12 months, the extent of impairment did not fully explain why some people had and had not recovered at 30 months after injury. The results confirm those of other studies that conclude that overall, outcomes after serious trauma are good when appropriate trauma and rehabilitation care are rendered. However, a minority of patients still report limitations at 30 months after injury, with one-fifth not returning to work.

Adolescent↗
PubMed2002

Is disability underreported following work injury?

Existing national data may underreport the full burden of occupational injuries and illnesses. This study sought to provide more complete reporting and to assess disability that persisted following return to work. Workers (n = 205) with a musculoskeletal injury resulting in 5 or more days of lost time or restricted duty were recruited from three employers. Data on work status and functional limitations were derived from multiple sources including administrative records, medical records, and patient interviews at baseline and 6 months. Results indicate that many workers reported continuing difficulties functioning at work following return to full duty. Measures of health-related quality of life improved over 6 months, but bodily pain and physical functioning scores remained lower than expected based on national averages. Sixteen percent of workers were reinjured within a year following initial injury. Following return to work, many workers experienced reinjury or reported persistent limitations in function 6 months following injury. Based on study findings the conclusion is drawn that OSHA logs may provide accurate measures of initial episodes of time loss from work but may under-represent the full magnitude of lost time following work injury.

Accidents, Occupational↗
PubMed2004

Predicting work status following interdisciplinary treatment for chronic pain.

The effectiveness of interdisciplinary treatments for chronic pain is well established. In general, these treatments decrease psychosocial distress and increase physical abilities. Further, return to work rates following interdisciplinary treatment tend to be quite high. Previous studies have highlighted a number of factors that individually influence return to work rates; however, there is a need for more comprehensive and unified models that allow an evaluation of the inter-relations among these factors. The present investigation examined how demographic and treatment outcome variables interacted to influence post-treatment return to work rates in a sample of individuals with chronic pain following interdisciplinary treatment. Results indicated that patient age, lifting ability, pain duration, depression level, and reported disability were individually related to return to work; however, when these variables were evaluated relative to one another, level of depression and patient age had the best ability to predict post-treatment work status. These results add to the literature by specifically highlighting post-treatment factors that best discriminate patients who had returned to work from those that had not. Furthermore, they provide evidence that general emotional distress is perhaps the most important predictor of work status following treatment.

Adult↗
PubMed2006

[Long-term efficiency of orthopedic rehabilitation in chronic back pain--the integrative orthopedic psychosomatic concept (IopKo)].

UNLABELLED: Chronic diseases of the musculoskeletal system rank first as causes of early retirement in Germany. Therefore orthopaedic rehabilitation has to identify patients with work-related problems and to promote return to work through differential treatment and vocational counselling. In the framework of the IopKo-Project such measures were developed and evaluated. These measures encompass: (1) an intensive and multiprofessional diagnostic pathway which allows early detection and treatment of mental disorders and job related problems; (2) homogeneous treatment groups based on multiprofessional diagnostics; (3) differential treatments, among these a multidisciplinary programme for patients with chronic low back pain or high risk of chronification (Rückenfit); (4) interactive training modules which mediate principles of performance and disability expertise, the legal bases of retirement pensioning, and measures to support occupational rehabilitation; and (5) a work hardening training programme. METHOD: To evaluate the effects of these measures in comparison to a control group with usual care, a prospective longitudinal study was conducted. A total of 307 patients were assigned to the multidisciplinary in-patient treatment programme, whereas 176 patients in the control group had a standard rehabilitation programme. RESULTS: The results show positive moderate and strong effects in the intervention group concerning function, pain, psychic strains as well as the number of sick days and return to work rates 10 months after discharge. The effects in the intervention group exceeded the effects achieved in the control group. PATIENTS WITH HIGH RISK OF CHRONIFICATION: Beside the full sample, a subgroup of patients with chronic pain or high risk of chronification was analyzed, who had received a multidisciplinary functional restoration treatment. Also for this subgroup we found moderate and strong effects of treatment for function, psychic strains and sick days superior to those in the control group. CONCLUSION: By this study we were able to show that orthopedic rehabilitation in a multimodal and multidisciplinary setting with a focus on activating and motivating therapy can have sustainable positive effects on pain, function and psychic well-being as well as on economic parameters. We interpret these persistent and superior effects in the treatment group (1) as a result of multiprofessional diagnosis and assignment which helps to subdivide the inhomogeneous group of patients with unspecific back pain into more homogeneous and thus more effective subgroups, (2) as a result of increased motivation by closed treatment groups, (3) as a result of intense and multilevel counselling of work related problems, (4) as a result of work hardening modules, and (5) as a result of direct and efficient treatment of psychic strains. The results also demonstrate the significance of inpatient rehabilitation, which will be efficient if differential treatment - adequate to the problems of the patient - is offered.

Adult↗
PubMed1994

Work efforts of disabled-worker beneficiaries: preliminary findings from the new beneficiary followup survey.

This article represents a preliminary investigation of factors influencing the decision of disabled-worker beneficiaries to look for employment and to return to work. Using the New Beneficiary Followup Survey and the special add-on frame of beneficiaries who had earnings, the article analyzes the impact of vocational rehabilitation (VR), work incentives, and employer workplace accommodations on the decision to return to work. Also examined are the reasons beneficiaries gave for deciding to look for work, job search methods, and the types of jobs that they were looking for. The research indicates that most beneficiaries look for work for financial reasons, for example, out of economic necessity or to improve their standard of living. Only 1 in 4 reported that they had received VR services and most indicated that it did not help them on the job. Most beneficiaries (80 percent) were unaware of work incentive provisions at the time they returned to work. Nearly half (42 percent) reported receiving workplace accommodations from their employer. Further research is planned to help assess the return to work experience.

Adolescent↗
PubMedDate not supplied

Relationship between depression and work outcomes following liver transplantation: the nursing perspective.

About 15% of Americans will experience a major depressive disorder during their lives (Stuart, 1994). Depression is defined by the daily persistence of depressed mood throughout the day, or the marked and regular loss of interest in regular daily activities (Stuart). Research indicates persons with chronic illnesses have higher rates of depression than the general public. Recent evidence indicates individuals who have undergone liver transplantation often have significant psychiatric morbidity, including depression (Merz, 1998). A consequence of depression is often the inability to work or attend school. The effect depression has on posttransplant return to work, however, is not fully understood.The purpose of this study was to describe the relationship between depression and work outcomes among adult liver transplant recipients. Laffrey's (1986) conception of health was the theoretical framework used to guide the study. The study was part of a larger cross-sectional survey that examined return to work following liver transplant (Newton, 1997). The findings indicated that depression following liver transplant seriously impacts recipient return to work. Nursing implications related to depression and work outcomes posttransplant are also addressed.

Adult↗