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PubMed1989

On-site work evaluations: desensitisation for avoidance reactions following severe hand injuries.

This study examined on-site work evaluations as an environmental exposure strategy to promote return to work in 15 recalcitrant patients who had failed to benefit from established methods of reducing post-traumatic stress disorder symptoms. Following the on-site work evaluation, 87% of these patients were able to use visualisation of the work setting to further desensitize themselves and returned to work within the next eight weeks. All 87% have continued to be employed at six and twelve month follow-ups. This approach holds promise for assisting patients with hand injuries who develop post-traumatic stress disorder and fail to respond to traditional psychological strategies.

Behavior Therapy↗
PubMed1986

Lumbar disc herniation. A comparison of the results of chemonucleolysis and open discectomy after ten years.

Using data obtained by questionnaire in a retrospective review of patients with low-back and sciatic pain (eighty-five treated by injection of chymopapain and seventy-one, by open discectomy), the results at one and ten years after treatment were analyzed. For this analysis we used six measures of pain relief, six measures of the patients' course during the ten-year period since primary treatment, and four measures of the patients' history of employment or work since initial treatment. Validity studies demonstrated that the pain-outcome measures reflected the patients' condition adequately and that all six measures were significantly related to each other (Pearson's r, p less than 0.003). The chymopapain and discectomy groups were not distinguishable on the basis of the pain-outcome measures. However, body mass was directly related to the presence of pain ten years after discectomy but not after injection of chymopapain. Analysis of the progress measures (indicators of the course of the patients' pain during the ten-year period) showed that the rates of reoperation in the two treatment groups did not differ significantly, but the discectomy patients tended to have had a higher rate of reoperation at both one and ten years after initial treatment. These measures did not show unequivocal superiority of one treatment compared with the other. Using the work measures (assessments of the patients' history of employment since initial treatment), it was found that in both treatment groups the patients who returned to work six to twelve weeks after treatment despite persistent symptoms had significantly more pain at ten years (p less than 0.04). Also, the patients who returned to work less than six weeks after treatment, while still symptomatic, showed a similar trend. On the other hand, among the patients who were still symptomatic at twelve weeks, it made no difference in the final results whether they returned to work at twelve weeks or thereafter. These findings support the notion that after either discectomy or chemonucleolysis, patients should return to work only after complete symptomatic recovery or a minimum convalescence of twelve weeks.

Adult↗
PubMed1991

Interruption of professional and home activity after laparoscopic cholecystectomy among French and American patients.

With a laparoscopic approach, patients can undergo cholecystectomy with a shorter hospitalization, minimal pain, and quicker recovery. It has not been demonstrated, however, that patients actually return to work after laparoscopic cholecystectomy faster than the traditional 4- to 6-week absence from work after a standard open procedure. A survey of 104 French and 84 American patients undergoing laparoscopic cholecystectomy revealed that postoperative discomfort was completely resolved in 2 weeks in 73% of French and 93% of American patients. All but 11 French and 5 American patients were back to normal home activities by 2 weeks after the operation. Of the 35 American and 40 French patients who had professional activity outside the home, 63% and 25%, respectively, returned to work within 14 days. Five (14%) of the American patients and 12 (30%) of the French patients returned to work 4 weeks or more after the operation. The amount of physical activity on the job correlated with the period off work, but, interestingly, at least six patients with very hard physical activity at work (including construction workers) were able to return to full work activity within 1 week. These data suggest that early return to work is possible and that pain resolves quickly after laparoscopic cholecystectomy. The economic benefit of having patients back on the job quickly, however, may be less than expected until cultural norms change with regard to leave of absence after major surgery.

Activities of Daily Living↗
PubMedDate not supplied

Comparison of laparoscopic vs open modified Shouldice technique in inguinal hernia repair.

Inguinal hernia repair has been a common procedure performed by general surgeons. Recently, a newly developed approach has been introduced using the pre-peritoneal laparoscopic repair. The laparoscopic approach allows patients to recover faster, with less pain, however, a disadvantage is the higher cost. We conducted a retrospective study of inguinal hernia repairs performed by one surgeon at the same institution, comparing the laparoscopic technique to the modified Shouldice procedure with regard to surgical time, postoperative recovery time, charge, and time to return to work and to activities. Patients undergoing laparoscopic hernia repairs were able to return to work and to activities sooner than patients undergoing the modified Shouldice procedure. The results obtained in this study showed a higher charge for the laparoscopic procedure, with longer surgical and recovery room time. The more rapid return to work and activities may outweigh the higher charge and longer surgical and recovery room time.

Adult↗
PubMed1989

[Predictive and rehabilitative perspectives in heart transplantation].

27 patients who underwent heart transplantation one to five years ago, were evaluated concerning psychological and social adjustment after heart transplantation. Prior to cardiac transplantation, predictors for good rehabilitation status were absence of psychopathology, clear motivation, good social background, advanced physical debility (being bedridden as opposed to ambulatory), absence of a history of excessive alcohol consumption. Age was not found to be a predictor of outcome. Criteria for good rehabilitation status after cardiac transplantation were absence of psychopathology, good compliance, social reintegration, return to work, psychological well-being, satisfaction with the quality of life and good exercise capacity. The criteria for good rehabilitation correlate positively with the predictors specified and with each other. Psychopathology after cardiac transplantation was related to psychopathology prior to the intervention, motivation, social background, postoperative compliance, social reintegration, return to work, psychological well-being and satisfaction with the quality of life. Compliance was related with the predictors motivation, social background, history of excessive alcohol consumption, psychopathology after transplantation and return to work. Social reintegration was correlated with social background and post-transplantation psychopathology. Return to work was related to motivation, post-transplantation psychopathology and compliance. While physical well-being was not associated with the predictors except motivation, it was related to the rehabilitation factors of post-transplantation psychopathology, social reintegration, and return to work. Satisfaction with the quality of life correlated with only the rehabilitation factors of post-transplantation psychopathology and psychological well-being. Physical exercise capacity was related to psychological well-being after transplantation.

Adaptation, Psychological↗
PubMed2001

Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity.

BACKGROUND: Forearm and wrist injuries are a common cause of morbidity and are often associated with suboptimal recovery of hand function. This study describes and compares outcome after median, ulnar, or combined median-ulnar nerve injuries. METHODS: Three hundred thirteen wrist and forearm nerve injuries operated on between 1980 and 1997 in a large university hospital were reviewed in relation to complications, return to work, and sensor and motor recovery. Of these 313 patients, 220 (age range, 5-73 years) met the inclusion criteria. RESULTS: Motor recovery, progress of sensory reinnervation, and number of severed structures were related to the type of injury (p < 0.05). Multiple linear regression analysis revealed a relation between the appearance of sensory reinnervation and motor recovery (beta = 0.02; 95% confidence interval, 0.01-0.04; p = 0.01). A probability of 24% of work loss, after a mean follow-up of 17.7 months, was found. Poor sensory and motor recovery were associated with work disability (odds ratio [OR], 2.9; p = 0.002; and OR, 2.9; p = 0.007, respectively). No relationship was found between type of injury and return to work (p = 0.47). Level of injury (OR, 2.6; p = 0.01), type of work (OR, 3.1; p = 0.002), number of complications (p < 0.001), and hand-therapy (OR, 0.24; p = 0.001) were found to influence return to work. CONCLUSION: It may be concluded that peripheral nerve injuries at the forearm level can result in substantial functional loss and have major social consequences. This study identified factors influencing return to work that can be used to optimize postoperative treatment strategy.

Adolescent↗
PubMed1997

Conservative treatment of thoracic outlet syndrome: a 2-year follow-up.

OBJECTIVE: To evaluate a conservative therapy program that aims to restore normal function to the upper thoracic aperture in patients with thoracic outlet syndrome (TOS). DESIGN: A descriptive study of consecutive patients with a positive TOS index seen from 1988 to 1993. After therapy, the patients were followed for a mean period of 24.6 months. SETTING: Therapy was initiated primarily in an inpatient rehabilitation ward over an 11.4-day (range 4-24 days) stay. PATIENTS: One hundred nineteen patients (28 men and 91 women) with a positive TOS index participated. At admission, 50% of the patients were employed, 48% were on sick leave or retired, and 2% were unemployed. INTERVENTIONS: The patients received instructions on how to restore the normal function of their cervical spine and upper thoracic aperture by means of home exercises. MAIN OUTCOME MEASURES: The efficacy of the treatment program was assessed by the frequency of return to work, normalization of the motion of the cervical spine and upper thoracic aperture, and subjective satisfaction with the outcome. RESULTS: At the follow-up examination, 88% of the patients were satisfied with the outcome of their treatment, and the ranges of motion of the cervical spine and upper thoracic aperture had normalized in 8 of 10 patients. Seventy-three percent of the patients returned to work after the therapy, either directly or after retraining, and 88% of the patients carried through the recommendations given at discharge during long-term follow-up. Normalized grip strength and Tinel's sign predicted patient satisfaction (p < .001) and return to work (p < .001). Return to work was more often successful if the work was sedentary rather than heavy (p < .05). CONCLUSIONS: The treatment program provides relief to most patients with symptoms of TOS. If the symptoms are not relieved, the differential diagnosis should be reviewed. Conservative therapy with the aim of restoring the function of the upper thoracic aperture is to be recommended, and long-term follow-up is advisable.

Adult↗
PubMed1999

Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy.

OBJECTIVE: We compared operative time, length of hospital stay, postoperative recovery, return to work, and costs for women undergoing laparoscopically assisted vaginal hysterectomy or abdominal hysterectomy. STUDY DESIGN: A prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy (n = 24) versus abdominal hysterectomy (n = 24) was carried out in a tertiary care setting. The main outcome variables were operative time, length of hospital stay, and return to work. Secondary outcomes were postoperative pain and return to normal activity as determined by weekly visual analog scales and daily diary. Hospital costs were calculated. RESULTS: The laparoscopically assisted vaginal hysterectomy group had longer operative times (median and quartiles, laparoscopically assisted vaginal hysterectomy 180 [139, 225] minutes vs abdominal hysterectomy 130 [97, 155] minutes), lower requirements for postoperative intravenous analgesia (patient-controlled analgesia pump, median and quartiles: laparoscopically assisted vaginal hysterectomy 22.1 [15.9, 23.5] hours, abdominal hysterectomy 36.7 [26.2, 45.0] hours), shorter length of hospital stay (median and quartiles, laparoscopically assisted vaginal hysterectomy 1.5 [1.0, 2.3] days, abdominal hysterectomy 2.5 [1.5, 2.5] days), and quicker return to work (Kaplan-Meier analysis, P =.03). Both procedures had similar hospital costs (P =.21). CONCLUSION: Laparoscopically assisted vaginal hysterectomy appears to allow patients a more rapid postoperative recovery and an earlier return to work with hospital costs similar to those of abdominal hysterectomy.

Adult↗
PubMed2005

A comparison of self-perceived physical and psycho-social worker profiles of people with direct work injury, chronic low back pain, and cumulative trauma.

This study investigated the psycho-social factors among injured workers and the influence of their psycho-social profile on the readiness of return to work. Sixty-four subjects with injuries on the upper limbs or lower limbs, low back pain, or cumulative trauma disorder were recruited. The workers' profiles (self-perceived physical health, mental health, and work readiness) together with the impact and types of work injury on the workers' perceived wellness were measured. The regression model of work readiness was constructed to develop a theoretical background for predicting work readiness based on different factors. The results showed that injured workers with chronic injury such as low back pain or cumulative trauma had poorer self-perception of physical health and psycho-social/mental health compared to those with direct trauma. The regression analysis further affirmed that self-perceived pain and physical functioning were significant factors influencing the readiness for returning to work. Workers with low back pain were found to have lower motivation for returning to work. Other factors such as the non-verbal intelligence of the injured workers, their anxiety level, and the support they received from family members were found to have some indirect impact on their ability to return to work, but this was not statistically proven.

Adult↗
PubMed1994

Factors associated with early discharge from a multidisciplinary work rehabilitation program for chronic low back pain.

The need to document cost-benefit of comprehensive work rehabilitation services represents a critical requirement for its long-term viability as a treatment option for injured workers. One approach to improving cost-benefit is to identify patients who experience difficulty completing a rigorous goal-oriented treatment approach. This study examined a set of psychological, pain, perceived work environment, and patient expectation measures in order to determine whether such factors were associated with failure to complete rehabilitation. Patients (n = 168) presenting with low back pain who participated in a multidisciplinary work rehabilitation program (physical conditioning, work conditioning, work-related pain and stress management, ergonomic consultation, and vocational counseling) were categorized into 2 groups based upon whether they completed the 4 week, 5 day per week program (n = 84) or were discharged prior to program completion (n = 84). T tests were computed for return to work expectation, pain (average pain intensity, fear of re-injury), psychological measures (somatization, dysthymia), perceived work environment (work pressure, control, supervisor support), and disability (duration of work disability, physical disability, perceived disability) variables found in previous studies to affect successful rehabilitation and return to work. The discharged group was marked by lower return to work expectations, and heightened somatization, pain intensity, and perceived disability. In addition, this group was significantly younger and had been out of work longer. The groups did not differ on gender, marital status, ICD-9 diagnoses or perceived work environment. These findings indicate that patients displaying the pattern of low return to work expectations, heightened perceived disability, pain and somatic focus experience compliance problems in an intensive work rehabilitation program.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Coping of parents and siblings with the death of a child with cancer: death after terminal care compared with death during active anticancer therapy.

Seventy pediatric patients with cancer treated at the Hospital for Children and Adolescents, University of Helsinki, Finland, died while in terminal care and 30 children of therapy-related complications during active anticancer therapy in the period 1987-92. The purpose of this study was to compare these groups and characterize the main problems of the families during the mourning process. The method of evaluation was a structured interview of every parent separately. Parents of 60/70 children after terminal care, and parents of 26/30 children who died during active anticancer therapy, were interviewed. Unexpectedly, differences were minimal between families who lost a child after terminal care and those whose child died during active anticancer therapy. Parents reported physical and/or mental problems with similar frequency (39% and 34%); average self-reported recovery times were similar (14 and 16 mo); return to work was similar in both groups, 70% returning doing so within 1 mo. However, pronounced differences were observed between the mothers and the fathers; the mothers requiring longer recovery times and returning to work later. Of the siblings, 18% in the terminal care group had problems compared with 32% in the active therapy group. These included fear, behavioral problems, problems with friends and school-related problems. In conclusion, when a child with cancer dies, the ability of the respective families to cope does not seem to differ whether the child dies after terminal care or during active anticancer therapy. The inevitable loss of the child is the major event. Most parents and siblings have the potential and ability to recover normally after the death of a child, although they will never be completely the same.

Adaptation, Psychological↗
PubMed2002

Balancing breastfeeding and paid employment: a project targeting employers, women and workplaces.

Since breastfeeding is acknowledged as the best nutrition for young babies, it needs to be protected, supported and promoted. This includes enabling mothers to continue breastfeeding even when they return to work. This paper describes a project that promotes balancing breastfeeding and paid work through the development, distribution, promotion and evaluation of suitable materials to workplaces, employers and women in Australia. Information provided in a workplace kit was based on previous successful strategies from published works in refereed journals and in consultation with employers, employees and other key people. Information for employees was further summarized and translated into Arabic, Chinese, Turkish, Spanish and Vietnamese. Over 50,000 information kits were distributed Australia-wide using a database that comprised contact details of medium to large workplaces plus employee and employer organizations, with preference given to workplaces that employed women of childbearing age and women from diverse cultural backgrounds. The translated material was also distributed to migrant resource centres and working women's centres around Australia. Promotion of the project was extensive, resulting in 20 newspaper articles, 17 radio interviews or news items, and articles in 18 newsletters and professional journals and three magazines. The project was also promoted at three conferences and one seminar. Evaluation (directed at employers) focused primarily on the distribution and content of the information kit, since the evaluation was conducted soon after distribution. The evaluation survey was sent to 1571 valid contacts (808 e-mail addresses, 1360 fax numbers). The response rate was 12.8% (n = 202). Seventy per cent of responding businesses rated the information kit as excellent. Over half anticipated the kit would be useful in their organization, while over two-thirds agreed that the kit provided sufficient information and suitable solutions to support balancing breastfeeding and work in their organization. While this project has achieved its objectives, further work is required to assist organizations to develop and implement policies and procedures for balancing breastfeeding and work, so that breastfeeding mothers who are returning to work can continue to breastfeed as long as they and their baby require it.

Attitude to Health↗
PubMed1989

Outpatient treatment of patients with chronic pain: an analysis of cost savings.

To control costs, the University of Tennessee Center for Pain Management added an ambulatory pain rehabilitation program to its existing inpatient hospitalization program. The impact of this program was assessed by comparing the first 25 patients treated in 1985 (prior to the introduction of outpatient management) with the first 25 patients treated in 1987 (after outpatient management was established). Twenty of the 25 patients seen in 1985 required hospitalization, while in 1987 nine patients were hospitalized and 10 patients were placed in outpatient rehabilitation. The total cost for treating 25 patients in 1985 was $571,200 but decreased to $191,000 in 1987. Hospital charges were the greatest single cost factor in 1985 ($321,500) but were only $61,000 in 1987. Success rates as measured by a return to previous employment were not significantly changed (13 of 25 returned to work in 1985, and 11 of 25 returned to work in 1987).

Adult↗
PubMed1999

Tenosynovitis associated with longitudinal tears of the digital flexor tendons in horses: a report of 20 cases.

The paper describes a series of cases with longitudinal tears in the superficial or deep digital flexor tendons within the digital flexor tendon sheath. This appears to be a previously unreported condition. Twenty cases are described, one horse was affected bilaterally. Nineteen defects involved the deep digital flexor tendon and in 2 horses the manica flexoria of the superficial digital flexor tendon was torn. All affected horses were lame and there was marked distension of the digital flexor tendon sheaths. Ultrasonography revealed nonspecific signs of chronic tenosynovitis but not the cause. Diagnosis was established by tenoscopy in 9 cases and by open surgical exploration in the remainder. In 7 limbs, the deep digital flexor tendon lesions were treated by removal of the torn fibrils under tenoscopic control. In the remaining cases they were removed and the defects were repaired with absorbable suture material. Wound closure in all open cases included repair of the palmar/plantar annular ligament. Eleven horses became sound and returned to work, 3 improved but were lame on returning to work and 2 horses did not improve following treatment. At the time of reporting, 4 horses are sound and in controlled ascending exercise regimes. It is concluded that longitudinal tears of the digital flexor tendons should be considered in the differential diagnosis of tenosynovitis of the digital flexor tendon sheath. The results presented suggest that accurate diagnosis and specific treatment justify surgical investigation.

Animals↗
PubMed2000

Medication use in a group of aircraft mechanics.

BACKGROUND: Aeromedical studies of human factors have focused on the pilot and pilot error rather than on aircraft maintenance workers and maintenance error. This is a report of a survey on medication use in a group of U.S. Air Force aircraft mechanics. METHODS: A questionnaire was used to retrospectively examine aircraft mechanic medication use, side effects experienced, and return to work. RESULTS: Of those surveyed, 67% (26/39) returned to work while taking medication that could potentially impair job performance. CONCLUSION: For flying safety reasons, occupational medicine education for aircraft mechanics and their supervisors should address on-the-job use of prescribed medication and self-medication.

Accidents, Aviation↗
PubMed2005

[Related factors with the failed surgery of herniated lumbar disc].

INTRODUCTION: The surgery for herniated disc is the most common operation at the level of the lumbar spine. The failed surgery rates range between 10% and 40%, conforming what is known as Failed Back Surgery Syndrome (FBSS). Return to work after surgery occurs in 70-85% of the cases. There are a few studies analysing the quality of life after the operation. The aims of this study are to know the incidence of the herniated disc lumbar failed surgery in our area, identify those factors influencing its development, and study behavioural parameters as the return to work and the quality of life at a middle term after surgery, also its relation with the success or failure surgery. MATERIAL AND METHODS: A descriptive transversal study of 117 patients operated for herniated lumbar disc during the first six months of the year 2003 is reported. In order to evaluate the incidence of failed surgery and the related factors, the clinical records were retrospectively analyzed. Ninety one patients were interviewed by phone using the Health Questionnaire SF-36, in order to analyze the non clinical factors related to FBSS, such as labour reincorporation, satisfaction with surgery, realization of rehabilitation treatment and quality of life after surgery. For the statistical analysis of the results, we used the program SPSS 11.01. RESULTS: In a sample in which the proportion between both sexes was 1/1, and the middle age was over 45 years [35-54], in which the most frequent clinical symptom was right sciatica, lasting more than 6 months, correlated to disc herniation at L5-S1 level, 37.9% of the patients presented FBSS. Although there were a few patients with reoperation in our study, the incidence of FBSS in these patients was higher (52.9%) than in patients who suffered this surgery for first time (32%). The predictive clinical factors of an unfavourable result in patients operated on for first time were bilateral sciatica, the presence of stenosis associated to herniated disc and comorbidity factors. On the other hand the sociolabor factors identified were a low culture level and those working as drivers, building and service sectors. Return to work occurred in the 64% of the active workers before surgery. Only around 10% of patients were dissatisfied with surgical result and there was a significant relationship between this and the physical function, pain, vitality and emotional status in the SF-36 with the FBSS. CONCLUSIONS: One out of three patients operated of herniated lumbar disc in our area presented failed disc surgery and the return to work occurred in 2 out of three patients active before the operation. The failed surgery patient suffers from pain, that interferes and limits the labour and home activities. Furthermore, the patient presents frequent sensation of fatigue and exhaustion and also emotional problems that contribute to interfere with work and activities of the daily life.

Adult↗
PubMed1995

Adjuvant chemotherapy does not affect employment in patients with early-stage breast cancer.

OBJECTIVE: To assess the impact of adjuvant chemotherapy for the management of breast cancer on subsequent patient employment. DESIGN: Retrospective cohort study. SETTING: University-affiliated community hospital cancer center. PATIENTS: Patients who were 18 to 65 years old and were diagnosed as having breast cancer stages 0, I, II, and IIIa between January 1986 and January 1991 were contacted and asked whether they had been employed at the time of the diagnosis. The 145 patients who had breast cancer and who had been working at the time of diagnosis completed a questionnaire, which included questions regarding demographic characteristics, employment history, and the reasons for any period of unemployment. The 76 patients who had received adjuvant chemotherapy were compared with the 69 who had not. MEASUREMENTS AND RESULTS: The main endpoint was return to work by one, three, six, and 12 months after surgery. Of the 76 patients who had received chemotherapy, 70 (92%) had resumed work by 12 months after treatment began. Of the 69 who had not been treated with chemotherapy, 65 (94%) had resumed work in 12 months. The proportions of patients who had returned to work by one, three, and six months were similar in the two groups. Regression analyses demonstrated no significant confounding or interaction of adjuvant treatment with age, menopausal status, marital status, years of education, or type of job in regard to return to work. CONCLUSIONS: Adjuvant chemotherapy does not delay or prevent return to work in women treated for early-stage breast cancer.

Adult↗
PubMed1991

[Chronic backache and occupational rehabilitation: prognostic factors].

The professional outcome in 65 patients with chronic low back pain who stayed in the Invalidity Insurance Medical Observation Center from 1982 to 1987 was studied retrospectively. The group studied was composed of 51 males and 14 females aged 28 to 61 years. Thirty-one out of 65 patients (48%) returned to work, 4 to full time employment (active group), whereas 34 did not return to work (inactive group). Data established during our initial observation served to compare the 2 groups by means of a logistic regression. No significant difference was found between the 2 groups of height, weight, age, family situation, severity of the X-ray findings and the existence of an associated psychiatric diagnosis were compared. On the other hand, the absence of professional training, female gender and the presence of a radicular syndrome significantly decreased the proportion of patients returning to work. If these 3 risk factors were absent, the chance of resuming work was 72%; if one was present it was 50%, and if there were 2 or 3 risk factors it was 28%.

Adult↗