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PubMed2006

Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up.

OBJECTIVE: To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints. METHODS: A randomized controlled trial with a 1-year follow-up was carried out. Thirty-eight subjects were allocated to multidisciplinary treatment (intervention, n=23), or to usual care provided by occupational health services (n=15). The intervention consisted of psychological and physical sessions provided by a medical specialist, a psychologist, a physiotherapist and an occupational therapist. It aims at reconditioning, "de-medicalizing", unrestrained moving and return-to-work. The intervention process was evaluated on compliance to the protocol and the effectiveness of its components. The individual outcome variable was the severity of complaints. The societal outcomes included return-to-work and costs. Measurements were performed at baseline and after 2, 6 and 12 months. Mixed model analyses were used for analysis. RESULTS: The intervention achieves its aims: physical disabilities (P=0.039), kinesiophobia (P<0.001) and physical functioning (P=0.016) improved significantly as compared to usual care. In addition, the intervention was significantly more effective in reducing the severity of complaints than usual care. The intervention was equally effective compared to usual care in terms of return-to-work (86% in the intervention group vs. 73% in the usual care group). The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months. CONCLUSION: Multidisciplinary treatment affects individuals positively, but shows no significant difference in (cost-) effectiveness on the societal level as compared to usual care.

Combined Modality Therapy↗
PubMed2001

Pectoralis major tears: comparison of surgical and conservative treatment.

OBJECTIVES: To compare objective measures of strength and subjective functional outcomes in complete distal pectoralis major tears treated either surgically or non-surgically. METHODS: Twenty two pectoralis major tears were included in 21 patients. Ten were surgically repaired and 12 were managed non-surgically. Patients completed a standard questionnaire, and clinical examination and isokinetic dynamometry were carried out. RESULTS: In patients who had surgical repair, peak torque returned to 99% of that of the uninjured side and work performed returned to 97%. For those managed conservatively, peak torque and work performed returned to only 56% of that of the uninjured side (p = 0.003 for the difference in peak torque, and p = 0.01 for work performed). Findings were independent of the strength of the patient, whether or not the dominant arm was involved, the age of the patient, and the length of time from injury or surgery to testing. Patients were grouped into one of three subjective functional outcome groups, and those who had a surgical repair had a better functional outcome. CONCLUSIONS: Surgical repair results in greater recovery of peak torque and work performed than conservative management of patients with rupture of the pectoralis major.

Adult↗
PubMed1998

Multimodal cognitive-behavioural treatment for workers with chronic spinal pain: a matched cohort study with an 18-month follow-up.

An outpatient multimodal cognitive-behavioural treatment program (MMCBT) for chronic spinal pain was evaluated during an 18-month follow-up period. The treatment included a 1-day course for the patients' work supervisors. The aim of the study was to evaluate the long-term effect of the treatment program as well as the effect of a work supervisor-training program on the patients' return to work. The design was a matched cohort study with four repeated measures. Two groups of subjects suffering from non-specific spinal pain (treatment group n=67, no treatment control group n=29) were assessed with regard to pain intensity, sick-leave, pain coping ability and behavioural changes at work and in personal life. Recordings on supervisors attending the course and changes of supervisory behaviour were also obtained. The results show a significant between group difference in pain intensity and perceived pain coping ability at work, favouring the MMCBT group. Further, the MMCBT intervention enhances self-reported behavioural changes in areas within the subjects' own control. There is not sufficient statistical support to accept the assumption of MMCBT being superior in reducing sick-leave, either with or without the education of supervisors. Even when supervisors changed their behaviour as reported by the patient, no significant effect was found on patients' return to work. In conclusion, the MMCBT do not seem to be effective in reducing sick-leave compared to no treatment, but the MMCBT program is superior in decreasing pain intensity, enhancing self-reported behavioural changes in personal life and improving pain coping ability at work.

Adult↗
PubMed1996

Ambulatory patients with community-acquired pneumonia: the frequency of atypical agents and clinical course.

OBJECTIVES: To determine the etiology of community-acquired pneumonia in patients treated in an ambulatory setting, using serological methods, and to compare presenting symptoms, radiographic manifestations, and clinical outcomes of patients with pneumonia of "atypical" and undetermined etiology. PATIENTS AND METHODS: This prospective cohort study was conducted in emergency room and outpatient facilities of Victoria General Hospital, Halifax, Nova Scotia, and in offices of participating family doctors based in Halifax. One hundred forty-nine adults with acute onset of one or more symptoms or signs suggestive of pneumonia and radiographic evidence of pneumonia who provided informed consent were enrolled. Patients known to be HIV positive or who had been discharged from a hospital within the previous 10 days were ineligible for enrollment. Demographic features and clinical data were collected by direct patient interview and chart review by trained research nurses. Outcome measures included quantitative evaluation of pneumonia-specific symptoms, and responses to the Short Form 36 Health Survey at presentation and at 30 days after presentation. Information was also collected on each patient's health prior to pneumonia, as well as the time until each patient's self-reported return to work and to usual activities. The etiology of pneumonia was determined by testing acute and convalescent serum samples for antibodies to Legionella pneumophila serogroup 1, Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, Coxiella burnetii, adenovirus, respiratory syncytia virus, influenza viruses A and B, and parainfluenza viruses 1, 2, 3. RESULTS: The study population consisted of 149 patients, 54 (36%) of whom were men, with a mean age (+/- SD) of 41 +/- 15 years. An etiological diagnosis was made in 74 (49.7%) patients using serological methods. Etiological agents included M pneumoniae 34 (22.8%); C pneumoniae 16 (10.7%); M pneumoniae and C pneumoniae 5 (3.4%); C burnetii 4 (2.7%); influenza A virus 4 (2.7%); and other agents 6% (7.4%). Three patients (2%) had a conventional bacterial etiology, and 72 patients (48.3%) had pneumonia of undetermined etiology. Patients with pneumonia of known (atypical) and undetermined etiology were similar in terms of age, gender, race, education, employment, and comorbidity. Despite a higher proportion of patients with pneumonia of known etiology reporting sweats, chills, and headache at presentation, the two groups were similar for symptom severity and bother. The patients with pneumonia of undetermined etiology were more likely to have multilobar pneumonia (P < 0.02). Both patients with atypical pneumonia and those with pneumonia of undetermined etiology suffered severe deterioration of physical functioning with a marked but incomplete recovery at 30 days. Those with atypical pneumonia had higher physical functioning and general mental health scores at 30 days. CONCLUSIONS: Nearly half the cases of ambulatory community-acquired pneumonia are due to "atypical" agents. It is not possible to reliably distinguish patients with atypical pneumonia from those with pneumonia of undetermined etiology by clinical features at baseline. The outcomes in terms of resolution of symptoms, functional status, return to work, and return to usual activities are essentially similar in the two groups.

Adult↗
PubMed2000

[Development and validation of a prognosis model for predicting work capacity after rehabilitation based on routinely collected parameters].

For efficient rehabilitation it is important to identify, as early as possible, the patients likely to be successfully returned to work after rehabilitation. The aim of this pilot study was to develop a statistical model for predicting this return as reliably as possible. The model uses only information readily available at the beginning of rehabilitation. A multiple regression analysis with backward elimination was used from a routine data base and identified 8 variables of prognostic value. The model offers a comfortable possibility to predict the probability of return to work of a patient on the basis of routinely registered data. The prognosis was found correct in 68% of those returning to work after rehabilitation (sensitivity) and in 80% of those who did not (specificity). Further work to improve the model for prognosis in rehabilitation research is considered reasonable.

Adult↗
PubMed2006

Getting the at risk patient back to work--a strategy.

BACKGROUND: Achieving best outcomes in occupational injury management requires an emphasis upon identifying and managing those factors which--in addition to the medical condition--lead to progression to chronicity. The most studied common musculoskeletal workplace injury is low back pain. OBJECTIVE: While the majority of patients resume working with minimal medical intervention, this article highlights the early identification and management of factors in the workplace that can result in poorer outcomes for patients. DISCUSSION: After exclusion of serious red flag conditions, the majority of patients with musculoskeletal injuries can resume suitable work. Factors impacting adversely upon the likelihood of a durable return to work include poor quality workplace relationships, lack of a return to work culture, patient distress regarding their condition, behaviours and beliefs about the injury such as activity avoidance, reliance on passive treatment modalities, pain focus, and time off work. It is acknowledged that workplace factors may appear beyond the influence of general practitioners, but their role is crucial to preventing chronic disability, facilitating patient self management and engaging with the workplace.

Humans↗
PubMed2000

Earnings histories of SSI beneficiaries working in December 1997.

Disabling conditions previously considered to be permanent and total are no longer viewed as automatic barriers to work. Medical advances, improved accommodations in the workplace, and changes in the nature of work for the working disabled have allowed many disabled people to rejoin the workforce. The Social Security Administration (SSA) has followed those developments with a view toward encouraging people receiving disability benefits to consider returning to work. To effectively target SSA's efforts and evaluate their success, information about previous work histories of the Supplemental Security Income (SSI) beneficiary population is used to provide baseline data. This article examines the earnings histories of 300,000 disabled SSI beneficiaries--one of the populations targeted by the expanded work-incentive measure under Public Law 106-70--who were working in December 1997. The article also investigates whether beneficiaries who are working have significant lifetime earnings and whether earnings patterns exist that might assist with SSA's work-support activities. SSI program records were matched to data in the Master Earnings File to explore the characteristics and earnings patterns before and after a person applies for benefits. The article addresses several questions: What are the general characteristics of disabled SSI beneficiaries? What are their earnings histories? Did they have an earnings record when they applied for SSI? Of the SSI beneficiaries working in December 1997, most tended to be younger than other disabled beneficiaries, to have some sort of mental disability, and to have earnings well below levels that would suggest their eventual, complete independence from the SSI cash benefits program. A look at past covered earnings revealed that the vast majority of SSI workers had a history of earnings before they applied for SSI benefits. Despite their severe impairments and age at the time of first eligibility, nearly 40 percent had earnings in 11 years or more. The amounts of those earnings were quite low, however, and were usually not high enough to preclude SSI eligibility. Examining the years immediately before and after the point of application indicated whether recent pre-application earnings were consistent with post-application return to work. Results were a bit surprising. They revealed that one-third of the 1997 SSI workers had no earnings, and another 28 percent returned to work despite having no earnings in the 4-year period before application. Persons receiving SSI because of mental retardation seemed to have poorer earnings histories than other workers but were more likely to return to work after application. That may be explained by their younger ages or may reflect the outside assistance they received in responding to SSA work incentives.

Adolescent↗
PubMed1988

Rehabilitation of the patient with chronic back pain. A search for outcome predictors.

This prospective study was initiated 3 years ago to evaluate the outcome and to identify predictors of success or failure in patients admitted to a rehabilitation program for chronic low-back pain. Multiple parameters were evaluated, including psychologic data (MMPI, personal interview, pain drawing, etc.), physical measurements (flexibility, strength and endurance), and demographic data concerning the patient's home and working environment. Information was available on each patient admitted to the program prior to his admission, at completion of the program, 6 weeks following completion of the program and 3 months following completion of the program. A telephone interview was carried out 2 1/2 years following the patient's discharge from the program. Linear regression analysis was used to identify the important independent variables with regard to the dependent variables of relief of back pain, return to work and increased activities at home. Demographic data were of no value as a predictor with the exception of age and returning to work. The patients over the age of 50 returned to work with much less frequency than those less than 50. Psychologic information from the MMPI and similar tests were of no value. The personal preadmission interview of a trained psychologist, however, was a good predictor of an individual's eventual return to work and overall improvement. Worker's Compensation and other litigation was a negative factor in a patient's prognosis. The treatment team's prognosis at the time of discharge from the program was the best overall predictor of a patient's chance of success or failure in the longterm.

Activities of Daily Living↗
PubMed1991

Absenteeism and sickness absence.

The majority of time lost from work as a result of absenteeism is classified as due to sickness although only a small proportion of the total can be regarded as a result of unfitness for work for medical reasons. An occupational health service assists a business in minimizing absenteeism by promoting an early return to work, assists general practitioners and hospital specialists in tailoring return to work packages, and assists employees by liaising with both management and their medical specialists to facilitate a return to normal work.

Absenteeism↗
PubMed2000

Results of a multimodal treatment program for patients with chronic symptoms after a whiplash injury of the neck.

STUDY DESIGN: A descriptive case series pre- and post-treatment design, including a 6-month follow-up. OBJECTIVES: The objective of this study was to document the improvements of patients with chronic symptoms after a "whiplash" injury of the neck, who attended a 4-week multimodal treatment program at the Rug AdviesCentra Nederland. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, no studies have been conducted on the effectiveness of multidisciplinary treatment of chronic symptoms after whiplash injury. METHODS: Twenty-six patients who experienced Quebec type 1 or 2 lesions of the neck (whiplash) with persisting symptoms of longer than 6 months' duration participated in the study. The measures included were pain intensity (according to the visual analog scale), number of painful sites (determined by pain drawing), self-reported disability Quebec Back Pain Disability Scale; and symptoms of somatic and psychological distress and cognitive symptoms (according to selected Minnesota Multiphasic Personality Inventory-2 scales). Furthermore, objective outcome criteria were used regarding return to work, medication, and medical and paramedical treatment. Statistical and clinical significance of treatment results were both assessed. RESULTS: The patients' symptoms improved significantly on nearly all self-report measures. Their scores for objective outcome criteria reported during the 6-month follow-up evaluation were: complete return to work (65%); complete or partial return to work (92%); no use of analgesics in the past 6 months (58%); and no medical or paramedical treatments in the past 6 months (81%). CONCLUSION: These early results indicate that a multimodal treatment program has the potential to be an effective treatment for patients with chronic symptoms after a whiplash injury of the neck--a group of patients who have in the past been considered intractable or, at the very least, puzzling.

Activities of Daily Living↗
PubMed1994

Disability syndrome: the effects of early vs delayed rehabilitation intervention.

1. Disability syndrome occurs when an individual with a work related injury or other disability chooses not to work when it has been medically determined that they are capable of doing so. 2. A possible contributor to the development of disability syndrome includes systems reinforcers or rules that discourage return to work. For example, many attorneys discourage early return to work or modified duty. 3. Early intervention by rehabilitation counselors at the time of injury can facilitate a positive attitude and empower the worker to resist the negative effect of systems reinforcers that discourage early return to work.

Absenteeism↗
PubMed1993

Factors affecting the clinical outcome of injuries to the superficial digital flexor tendon in National Hunt and point-to-point racehorses.

Ultrasonographic examination was used to define the severity of injuries to the superficial digital flexor tendon in 73 National Hunt or point-to-point racehorses and the factors influencing the outcome of the cases were examined. Thirty-four of the horses (46 per cent) returned to work with an average time out of training of 13.5 months. The rate of recurrence of the injury was 35 per cent. The severity of the lesions was related to the outcome; all the mildly affected horses returned to work, with 63 per cent of them racing and an average time out of training of 10.2 months; 50 per cent of the moderately affected horses returned to work, and 30 per cent raced with an average time out of training of 11.3 months; 30 per cent of the severely affected horses worked, and 23 per cent raced with an average time out of training of 18.3 months. The differences in outcome between unilateral and bilateral injuries within each severity group were not statistically significant. Seventy-six per cent of horses treated with polysulphated glycosaminoglycans returned to work, compared with 46 per cent of conservatively managed horses and 50 per cent of horses treated with laser therapy. However, these differences were not statistically significant and the rate of recurrence of the injury in the horses treated with polysulphated glycosaminoglycans was 50 per cent compared with only 31 per cent in the conservatively managed horses. Seventy per cent of the mares and 47 per cent of the geldings were retired from racing.

Age Factors↗
PubMed2001

Comparison of three methods in surgical treatment of pilonidal disease.

BACKGROUND: The present study was designed to compare three methods that are still used for the surgical treatment of pilonidal disease: marsupialization, primary midline closure and skin flaps. METHODS: One hundred and one out of a total of 203 pilonidal disease patients underwent excision and marsupialization, while 82 patients had excision and primary closure and the remaining 20 were treated with excision and skin flaps. The minimum and maximum follow-up periods for the aforementioned surgical methods were 4 and 5 years, respectively. All patients were reviewed for in-hospital stay, return to work, wound infection and recurrence rates. Student's t-test and Fisher's exact test were used for statistical analysis. RESULTS: Average hospital stays for marsupialization, primary closure and skin flaps were 2.84 +/- 0.13, 2.62 +/- 0.12 and 5.95 +/- 0.52 days, respectively. Hospital stay for the skin flaps method was longer than that for the other two methods. The average time to return to work after marsupialization was 5.42 +/- 0.08 weeks; but the time needed to return to work after undergoing the primary closure or the skin flaps methods was much shorter: 2.15 +/- 0.05 and 2.90 +/- 0.20 weeks, respectively (P < 0.001). There was no difference in wound infection rate (P = 1.000) or recurrence rates. CONCLUSION: The fact that there were no differences in terms of wound infection or recurrence rates between the three groups, and the relatively shorter period for returning to work, emphasize the usefulness of the excision and repair techniques in the surgical treatment of pilonidal disease.

Adolescent↗
PubMed1988

Work capacity after myocardial revascularization: factors related to work resumption.

For patients with coronary artery disease the ability to retain or resume a normal occupation must be one of the goals of myocardial revascularization procedures. Provided myocardial revascularization is sufficiently complete and left ventricular function is not severely impaired, this goal should be achieved in virtually all cases. The rates of return to work after coronary surgery, however, are often lower than what could be expected. Analysis of the factors related to work resumption after coronary surgery shows that non-medical preoperative parameters (age, educational level, type of occupation, and, most of all, length of preoperative unemployment) are major predictors of subsequent re-employment, whereas medical preoperative factors have little or no influence on return to work. In contrast, re-employment following coronary surgery is strongly influenced by the success of the revascularization procedure, with much fewer patients resuming work in case of poor exercise capacity or persisting angina after surgery. Percutaneous transluminal coronary angioplasty is usually given to patients with less extensive coronary artery disease, and rates of return to work higher than after surgery are observed; re-employment after PTCA is also influenced by the initial result of the procedure. Recognition of the factors negatively influencing return to work after myocardial revascularization is important in an attempt to improve work resumption by appropriate medical, psychological and social measures.

Angina Pectoris↗
PubMedDate not supplied

Segmental instrumentation for thoracic and thoracolumbar fractures: prospective analysis of construct survival and five-year follow-up.

BACKGROUND CONTEXT: Segmental instrumentation systems have replaced nonsegmental systems in all areas of spine surgery. Construct patterns for fracture stabilization have been adapted from deformity experience and from biomechanical studies using nonsegmental systems. Few studies have been completed to validate the use of these implants in trauma or to assess their relative strengths and weaknesses. PURPOSE: To substantiate the safety and efficacy of segmental spinal instrumentation used to treat patients with unstable spinal fractures and to identify successful construct strategies and potential pitfalls. STUDY DESIGN: A prospective, longitudinal single cohort study of patients treated with segmental instrumentation for fractures of the spine. Minimum 2-year follow-up. PATIENT SAMPLE: Seventy-five consecutive patients with unstable fractures of the thoracic, thoracolumbar and lumbar vertebrae, admitted to a level 1 trauma center. All patients sustained high-energy injuries: fifty-five (79%) were injured in motor vehicle accidents, 27 (38%) sustained two or more major additional injuries and 39 (56%) had neurological injuries. OUTCOME MEASURES: Perioperative morbidity and mortality, blood loss, surgical time; postoperative recovery, neurological recovery, complications, thromboembolic and pulmonary disease; long-term outcome measures of fusion, sagittal spinal alignment, construct survival, patient pain and function measures, and return to work and activity. METHODS: A longitudinal, prospective study of surgical outcome after segmental spinal instrumentation. Multifactorial assessment was carried out at prescribed intervals to a mean follow-up of 5 years (range, 2 to 8 years) from the time of surgery. Seventy patients were included in the final analysis. There were 17 thoracic, 36 thoracolumbar and 17 lumbar fractures. RESULTS: At 52 months mean follow-up, 57 of 62 patients (92%) had solid fusion with acceptable spinal alignment. Perioperative complications and mortality were less than expected, based on historical controls matched for injury severity. Rod and hook constructs had 97% good to excellent functional results, with no hardware complications. Six of 11 (55%) patients with short-segment pedicle instrumentation (SSPI) with no anterior column reconstruction had greater than 10 degrees of sagittal collapse during the fracture healing period. Twenty six of 36 neurologically injured patients (72%) experienced (mean) 1.5 Frankel grades recovery after decompression and stabilization. Residual neurological deficit determined return to work: 43 patients (70%) returned to work, 33 without restrictions, 10 with limitations. Five other patients (8%) were fit but unemployed. Fifteen percent experienced some form of hardware failure, but only three (5%) required revision. Hardware complications and fair to poor outcomes occurred after pedicle instrumentation without anterior reconstruction. Patients with anterior reconstruction had 100% construct survival, no sagittal deformity, and less pain. CONCLUSION: Segmental instrumentation allowed immediate mobilization of these severely injured patients, eliminating thromboembolic and pulmonary complications, and reducing overall morbidity and mortality. Segmental instrumentation produced a high rate of fusion with no rod breakage or hook failure. Pedicle screw constructs had a high rate of screw complications associated with anterior column insufficiency, but revision was not always necessary. Eighty percent of these severely injured patients were capable of returning to full-time employment, and 70% did so.

Accidents, Traffic↗
PubMed2003

Long-term outcome in ICU patients: what about quality of life?

OBJECTIVE: Analysis of mortality and quality of life (QOL) after intensive care unit (ICU) discharge. DESIGN: Prospective, observational study. SETTING: Mixed, 31-bed, medico-surgical ICU. PATIENTS: Consecutive adult ICU admissions between June 25 and September 10, 2000, except admissions for uncomplicated elective postoperative surveillance. INTERVENTIONS. None. MEASUREMENTS AND RESULTS: Age, past history, admission APACHE II, SOFA score (admission, maximum, discharge), ICU and hospital mortality were recorded. A telephone interview employing the EuroQol 5D system was conducted 18 months after discharge. Of 202 patients, 34 (16.8%) died in the ICU and 23 (11.4%) died in the hospital after ICU discharge. Of the 145 patients discharged alive from hospital, 22 could not be contacted and 27 (13.4%) had died after hospital discharge. Of the 96 patients (47.5%) who completed the questionnaire, 38% had a worse QOL than prior to ICU admission, but only 8.3% were severely incapacitated. Twenty-three patients (24%) had reduced mobility, 15 (15.6%) had limited autonomy, 24 (25%) had alteration in usual daily activities, 29 (30.2%) expressed more anxiety/depression, and 42 (44%) had more discomfort or pain. Twenty-eight (62.2% of those who worked previously) patients had returned to work 18 months after ICU discharge. CONCLUSIONS: Comparing QOL after discharge with that before admission, patients more frequently report worse QOL for the domains of pain/discomfort and anxiety/depression than for physical domains. Factors commonly associated with a change in QOL were previous problems in the affected domains, prolonged hospital length of stay (LOS), greater disease severity at admission and degree of organ dysfunction during ICU stay.

Adult↗
PubMed1996

Differences between employed and nonemployed dialysis patients.

Three hundred fifty-nine chronic dialysis patients (85 employed and 274 nonemployed) were surveyed to identify/verify those characteristics which differentiate between employed versus nonemployed status. Education emerged as a significant correlate of employment, as noted by previous investigators, whereas, unlike previous research, neither mode of dialysis, length of time on dialysis, number of comorbid conditions, nor cause of renal failure (eg, diabetes) were associated with employment status. Measures of functional status (MOS SF-20 and Karnofsky) were positively associated with employment. Furthermore, patients' perceptions that their health limited the type and amount of work that they could do were negatively associated with employment. In addition, using a series of de novo items, we found subjects' beliefs about dialysis patients' ability to work to be a "self-fulfilling prophecy" with regard to employment status. That is, patients who themselves believed that dialysis patients should work and had this notion reinforced by significant others were more likely to be employed. Interestingly, 21 percent of unemployed patients reported that they were both able to work and wanted to return to work. Because it is consistently reported that only a small percentage of dialysis patients are employed, targeting the patients who are both willing and able to work for vocational rehabilitation might significantly increase the numbers of employed dialysis patients.

Adolescent↗
PubMed2002

Occupational upper extremity conditions: a detailed analysis of work-related outcomes.

While work-related upper extremity conditions (WRUECs) cause almost 25% of lost time cases in the US, little is known about their long-term occupational consequences. A self-report survey was mailed to New Hampshire workers reporting a WRUEC one year prior to the study. Of the 72 (52%) valid respondents, 60% had lost > or = 1 week of work and 90% had returned to work. Almost 70% reported acute injury onset, and 26% had experienced a recurrence of their WRUEC. Both gradual-onset injuries and recurrences had worse outcomes. Recurrence was related to shorter job tenure, lower job satisfaction, and less satisfaction with medical care and insurer responses. Results imply that a single measure is insufficient to assess occupational outcomes subsequent to a WRUEC. The importance of secondary prevention was highlighted. There is a need for focus on gradual-onset injuries, as well as those acute-onset injuries with risk for recurrence.

Absenteeism↗