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PubMed1999

A return to work program for injured workers: a reassignment model.

The current workers' compensation system does not encourage permanently restricted workers who are disabled due to work related injuries to return to work. Workers are often labeled permanently disabled and are released from their positions with their employers. However, according to the Americans with Disabilities Act of 1990, these individuals may be qualified to return to productive employment. This paper will describe a Reassignment Model for occupational therapy supported by the rehabilitation frame of reference. This Model presents reassignment to a vacant position as a reasonable accommodation to return injured workers to productive employment. A case study will illustrate the successful implementation of the model. The potential benefits of using this Model will be described for clients, society, employers, and the occupational therapy profession.

Journal Article↗
PubMed1989

Return to work after percutaneous transluminal coronary angioplasty.

A prospective study of 82 patients employed in the 6-month period before percutaneous transluminal coronary angioplasty (PTCA) was performed to determine the patterns of lag time in work resumption and the factors associated with early return to work. One month after PTCA, 59% of patients had resumed work whereas 87% were employed 6 months after PTCA. Patients who had a myocardial infarction in the month before PTCA, as well as those with less than 12 years of education, blue collar jobs and low levels of self-efficacy (self-confidence) for return to work had a lower probability of work resumption at every point in the 24 weeks of follow-up. Cox proportional hazards analysis revealed the psychosocial construct, self-efficacy, to be the strongest predictor of return to work 1 month after PTCA, independent of having a recent myocardial infarction, disease severity, age, job classification, gender and physician advice (p = 0.0006). Kaplan-Meier analysis for return to work after PTCA confirmed that patients with high self-efficacy estimates obtained just before hospital discharge after PTCA resumed employment earlier than those with low self-efficacy levels (p = 0.0001). The same relation was observed in those patients with and without a myocardial infarction in the month before PTCA, p = 0.0022 and 0.0012 respectively. These findings suggest that although PTCA is considered relatively safe and minimally invasive by physicians, patients may still lack confidence in their ability to return to work even when physically capable of doing so.

Absenteeism↗
PubMedDate not supplied

Return to work for a company president with traumatic brain injury.

Return to work remains a central issue for many traumatic brain injury (TBI) patients. The present literature generally ignores the complex work issues involved for high-functioning individuals, in whose hands may lie the fate of many other workers. This case discusses return-to-work challenges facing a 64-year-old high-technology company founder and president. Following a bicycling accident, he sustained intracerebral hemorrhage with an initial Glasgow Coma Scale of score 12. Although postmorbidly he still maintained a relatively high level of cognitive functioning, his case highlights special challenges during workplace rehabilitation of patients with cognitively demanding jobs, including (a) a higher potential for patient frustration given the gap between function and job expectations and (b) confidentiality issues regarding business employees and competitors. Rehabilitation health care providers can benefit from lessons learned here, including tapping into these patients' strong motivation for return to work, accessing the likely higher remaining cognitive level, and drawing upon the likely strong social and professional networks available. Finally, the importance of the role of stress-management techniques in order to cope with high frustration levels is highlighted.

Administrative Personnel↗
PubMed2004

The effectiveness of ergonomic interventions on return-to-work after low back pain; a prospective two year cohort study in six countries on low back pain patients sicklisted for 3-4 months.

AIMS: To study occurrence and effectiveness of ergonomic interventions on return-to-work applied for workers with low back pain (LBP). METHODS: A multinational cohort of 1631 workers fully sicklisted 3-4 months due to LBP (ICD-9 codes 721, 722, 724) was recruited from sickness benefit claimants databases in Denmark, Germany, Israel, Sweden, the Netherlands, and the United States. Medical, ergonomic, and other interventions, working status, and return-to-work were measured using questionnaires and interviews at three months, one and two years after the start of sickleave. Main outcome measure was time to return-to-work. Cox's proportional hazards model was used to calculate hazard ratios regarding the time to return-to-work, adjusted for prognostic factors. RESULTS: Ergonomic interventions varied considerably in occurrence between the national cohorts: 23.4% (mean) of the participants reported adaptation of the workplace, ranging from 15.0% to 30.5%. Adaptation of job tasks and adaptation of working hours was applied for 44.8% (range 41.0-59.2%) and 46.0% (range 19.9-62.9%) of the participants, respectively. Adaptation of the workplace was effective on return-to-work rate with an adjusted hazard ratio (HR) of 1.47 (95% CI 1.25 to 1.72; p < 0.0001). Adaptation of job tasks and adaptation of working hours were effective on return-to-work after a period of more than 200 days of sickleave with an adjusted HR of 1.78 (95% CI 1.42 to 2.23; p < 0.0001) and 1.41 (95% CI 1.13 to 1.76; p = 0.002), respectively. CONCLUSIONS: Results suggest that ergonomic interventions are effective on return-to-work of workers long term sicklisted due to LBP.

Absenteeism↗
PubMed1996

Factors influencing failure to return to work due to traumatic brain injury.

About 63% of all traumatic brain injuries (TBI) occur in teenagers and adults aged 15-64 years, the primary working population. Since reports of failure to return to work (FTRTW) vary, understanding the factors that influence FTRTW is key to improving work outcomes for this primarily working-age population. Our study sample consists of 343 previously employed persons who were hospitalized following TBI and had either returned to work at 1 year or had failed to return to work because of their injury (injury-related FTRTW). Medical records were reviewed and participants were interviewed by telephone at 1 year post-discharge. Individuals with injury-related FTRTW were far more likely to report dependence or modified independence on the Functional Independence Measure (FIM) than those who were employed at 1 year. The joint distribution of motor and cognitive items suggests that, for a given level of cognitive function, the addition of a motor limitation will result in greater injury-related FTRTW. In addition as motor function declines, FTRTW is further increased. Injury-related FTRTW is also associated with being unmarried and not completing high school. While the importance of behavioural, economic, and psychosocial factors should not be minimized, services aimed at improving function can be expected to have an impact on RTW after TBI.

Absenteeism↗
PubMed1988

Early return to work after uncomplicated myocardial infarction. Results of a randomized trial.

To determine if an occupational work evaluation could shorten the time to return to work, 201 employed men aged 49 +/- 7 years who were recovering from uncomplicated myocardial infarction were randomized to usual care (n = 102) or to an occupational work evaluation (n = 99). The occupational work evaluation consisted of a symptom-limited treadmill test performed 23 +/- 3 days after myocardial infarction and a formal recommendation to the patient and primary physician that the patient return to work within the next two weeks. The groups did not differ in age, medical status, comorbid disease, occupation type, or years on the job. At six months, 92% of patients receiving the intervention and 88% of patients receiving usual care were working either full- or part-time. Return to full-time work occurred at a median of 51 days in patients receiving the intervention and 75 days in patients receiving usual care. This 32% reduction in the convalescence period was associated with +2102 of additional earned salary per intervention patient in the six months after myocardial infarction. One or more recurrent cardiac events occurred in 14 intervention patients (one death, one nonfatal myocardial infarction, three angioplasties, and nine coronary surgeries) and in 13 usual-care patients (two deaths, three nonfatal myocardial infarctions, six angioplasties, and seven coronary surgeries) in the six months after myocardial infarction. The early return to work of low-risk patients based on an occupational work evaluation is associated with important economic benefits.

Attitude to Health↗
PubMed1993

Factors influencing return to work after stroke in Japan.

BACKGROUND AND PURPOSE: Few studies have identified factors that predict return to work after stroke in Japan. Our aim in this study was to determine the predictors of return to work after stroke in Japan. METHODS: We performed a retrospective cohort study on the association between patients' characteristics at admission and return to work in 230 first-stroke patients, adjusting for potential confounding factors. The patients were all aged younger than 65 years and were working, students, or housewives at the time of their stroke. Return to work was evaluated by a follow-up questionnaire. Data were analyzed using forward logistic regression analysis to compute odds ratios of return to work. RESULTS: The adjusted odds ratios (and 95% confidence intervals) for patients with normal muscle strength vs severe muscle weakness, without apraxia vs with apraxia, and with white-collar vs blue-collar occupation were 4.50 (1.04 to 19.42), 4.87 (1.28 to 18.54), and 3.33 (1.34 to 8.30), respectively. CONCLUSIONS: Significant predictors of return to work after stroke were no muscle weakness, absence of apraxia, and white-collar occupation.

Adolescent↗
PubMed1978

Closed Küntscher nailing of femoral shaft fractures. A series of 100 consecutive patients.

One hundred and two fractures of the femoral shaft, including eighteen pathological fractures, in 100 patients were internally fixed by closed Küntscher nailing. Sixty-eight fractures resulted from motor vehicle accidents; ten were compound. Seventy-five patients were under the age of thirty years and thirty-four had multiple injuries. Sixty-nine fractures were nailed on the day of the accident and the operative technique is described. Complications during and after operations were few. Fifty-eight patients left hospital within four weeks and 77% of those working returned to work in less than four months. There were no wound or bone infections. The results are discussed and it is concluded that, with the correct equipment and careful attention to detail, closed nailing is a straightforward procedure with few complications. Advantages include the wide range of fractures that can be nailed, the short hospitalisation, the rapid return of function to the knee, the early return to work and the absence of infection.

Adolescent↗
PubMed1995

Negotiating a successful return to work program.

This article has examined selected reasons why companies resist implementation of return to work programs. The reasons include many fears that companies can readily justify. Nearly all the fears can be eliminated when the occupational health nurse applies both nursing and management principles. As a specialized line manager in the company, with a specialty in people and systems management, the occupational health nurse is the most likely person to plan and implement a successful program. To design, implement, and manage the plan to a successful end, the occupational health nurse must enhance skills in language, salesmanship, and quantifying results. Success must be measured in both people and dollar terms to have relevance to the company, its bottom line, and its employees. People results, the harder of the two to measure, have value in helping to establish positive attitudes of program participants toward the company. People results also help prevent the development of disability syndrome by ill or injured employees by keeping them connected to work and productivity. People results also can be measured by the change in culture the return to work program is likely to produce among managers and employees. The resulting culture will reflect a sense of caring by the company about employees, and expectation that manipulation of the company by opportunists will be reduced, as scarce company resources will be conserved. The early return to work program is managed within employee capabilities in a therapeutic environment during the recovery process. In the long term, financial success of the return to work program can be measured by reduced costs per claim annually. Using the nursing, management, financial, and marketing principles discussed in this article, the occupational health nurse can improve chances of negotiating implementation of a successful early return to work program.

Commerce↗
PubMed2007

Motivating disability pensioners with back pain to return to work--a randomized controlled trial.

OBJECTIVE: To investigate the outcome of a brief vocational-oriented intervention aiming to motivate disability pensioners with back pain to return to work, and to evaluate prognostic factors for having entered a return to work process during the following year. DESIGN: A randomized controlled trial was conducted. SUBJECTS: Participants (n = 89) (mean age 49 years, 65% women) who had received disability pension for more than one year were randomized into an intervention group (education, reassurance, motivation, vocational counselling, n = 45) and a control group (n = 44). METHODS: Primary outcome measures were return to work or having entered a return to work process. Secondary outcome measures were life satisfaction, disability, fear avoidance behaviour and expectancy. RESULTS: The intervention had no statistically significant effect on return to work or having entered a return to work process at 1-year follow-up. Twice as many in the intervention group (n = 10, 22%) had entered a return to work process compared with the controls (n = 5, 11%). The number needed to treat was 9.2 (95% confidence interval (CI) = 3.4, Inf). Only minor differences in secondary outcome measures were demonstrated. Positive expectancy, better physical performance and less pain were related to return to work. CONCLUSION: The effort of returning disability pensioners to work by a brief vocational-oriented intervention may be of clinical relevance. The effect needs to be explored further in larger samples of disability pensioners.

Adult↗
PubMed1993

Lunotriquetral arthrodesis.

Lunotriquetral arthrodesis has been recommended for the treatment of disabling pain at the lunotriquetral joint after more conservative measures have failed. We retrospectively analyzed a series of 22 patients treated with a lunotriquetral arthrodesis for presence of fusion, method of fixation, duration of immobilization, carpal alignment, pain relief, and ability to return to work. Fixation with a Herbert screw supplemented with a Kirschner wire (K-wire) was superior to fixation with K-wires alone. Immobilization longer than 6 weeks was superior to immobilization less than 6 weeks. Combined use of a Herbert screw supplemented with a K-wire and immobilization longer than 6 weeks resulted in union in all patients, even when performed for nonunion after a prior attempted arthrodesis. Pain was improved in all patients; all patients who previously were working returned to work. Routine posteroanterior and lateral x-ray films often failed to adequately profile the arthrodesis site. We recommend using a Herbert screw supplemented with a K-wire for lunotriquetral arthrodesis and keeping the patient in a cast until fusion is documented, usually at least 8 weeks. Fluoroscopic spot views or tomograms are recommended to demonstrate bone fusion.

Adult↗
PubMed2006

Multilevel analysis of individual and contextual factors as predictors of return to work.

OBJECTIVE: The objective of this study was to examine if individual and contextual levels of work environment factors predict return to work (RTW). METHODS: Baseline data from 52 workplaces was linked to a national absence register. Four hundred twenty-eight persons with more than 2 weeks of sickness absence during a 2-year period were identified. Follow up was 1 year to examine three RTW outcomes. Multilevel logistic and Poisson regression models were used. RESULTS: At the individual level, significant associations were found between one psychosocial and four physical factors and RTW within 4 weeks. Two physical factors predicted RTW within 1 year. Two psychosocial and two physical factors significantly prolonged duration of sickness absence. No significant contextual level risk factors were found. CONCLUSION: At the individual level, both the psychosocial and physical work environment factors are important independent predictors of RTW.

Absenteeism↗
PubMed2004

Acromioclavicular Dislocation: Conservative or Surgical Therapy.

REFERENCE: Phillips AM, Smart C, Groom AFG. Acromioclavicular dislocation: conservative or surgical therapy. Clin Orthop. 1998;353:10-17. CLINICAL QUESTION: Among patients with acromioclavicular (AC) dislocation, does surgical intervention produce better outcomes than conservative therapy? DATA SOURCES: Studies were identified by a MEDLINE search (1966-1997) and a manual search of the reference lists of each relevant study identified. The medical subject heading of acromioclavicular dislocation was used as the primary search term. STUDY SELECTION: The search was limited to English-language journals listed in Index Medicus. Studies were included if they described severely displaced dislocations of the AC joint, mostly characterized as grade III injuries (Allman or Rockwood classification) or if there was at least 1-cm displacement of the clavicle. If more than 1 study included the same group or subgroups of patients, the study with the best assessed methods was used. Studies were divided into 4 classifications: group 1, randomized trials of surgery versus conservative therapy; group 2, nonrandomized trials of surgery versus conservative therapy; group 3, surgical trials only; and group 4, conservative trials only. DATA EXTRACTION: Data-extraction and study quality-assessment procedures were not explained in detail. The primary outcome measures were overall outcome, return to work, return to premorbid activities, complications, and radiographic features. Secondary measures were pain, range of motion, and strength. RevMan software (version 1.05; Cochrane Centre, Oxford, UK) was used for statistical analysis. MAIN RESULTS: Specific search criteria identified 600 articles for review, of which 24 met inclusion and exclusion criteria: 2 in group 2, 3 in group 3, 14 in group 4, and 5 in group 4. A total of 1172 patients were represented (surgical treatment = 833, mean = 43.7 months' follow-up; conservative treatment = 339, mean = 60.4 months' follow-up). Both surgically and conservatively treated patients reported similar overall satisfactory outcome (88% surgical versus 87% conservative). Patients with surgical treatment reported longer time to return to work and premorbid activities. Among patients treated surgically, 59% had additional surgery, 6% had wound breakdown, 20% had fixation failure, and 3% reported residual deformity. Only 1% of conservatively treated patients reported wound problems, 6% had additional surgery, and 37% reported residual deformity. In only 1 study did the authors report the incidence of posttraumatic arthritis: 25% among surgically treated and 43% among conservatively treated patients. Analysis of secondary outcomes suggests that both groups had little or no pain (93% surgical, 96% conservative) but more conservatively treated patients had normal to near-normal range of motion (95% versus 86%) and normal strength (92% versus 87%). Conservative treatment of AC dislocations is 21% more likely to result in a satisfactory outcome than surgical treatment (odds ratio = 0.79, 95% confidence interval = 0.36, 1.71). The need for additional surgery is 7.4 times more likely and infection is 3.2 times more likely with surgical management. CONCLUSIONS: These data suggest that the current evidence does not support surgical treatment of grade III AC dislocations with respect to overall patient satisfaction as well as clinical outcomes such as pain, range of motion, and strength.

Journal Article↗
PubMed2005

Return to work following whiplash and back injury: a review and evaluation.

The purpose of this study is to review the reported return-to-work rates following whiplash and back-injury. The return-to-work rates for the 71 relevant studies that were reviewed varied from 29% to 100% with a median of 67%. The results suggest considerable residual return-to-work potential for persons with whiplash and back injury. Return-to-work rates were substantially higher for motor vehicle (96%) compared to work-related (71%) studies and also considerably higher for whiplash (95%) compared to back injuries (65%). It is suggested that these indices may form potential benchmarks for personal injury claims outcomes. The purpose of this paper is to analyse the published rates of return to work following whiplash and back injury. This criterion of return to work is not without limitations or controversy and Pfingsten, Hildebrandt Leibing, Franz and Saur (1997) noted: "... a high variability exists in data on return-to-work. Results often range from either no return to a very high return rate, with an approximate average of 68% following multimodal treatment procedures...".

Back Injuries↗
PubMed1997

Impact of chronic pain patients' job perception variables on actual return to work.

OBJECTIVE: To examine the impact of preinjury job perceptions on chronic pain patients (CPPs) return to work after pain facility treatment. DESIGN: A total of 128 CPPs completed a series of rating scales and yes/no questions relating to their preinjury job perceptions and a question relating to "intent" to return to the same type of preinjury job following pain facility treatment. These CPPs were part of a grant study for prediction of return to work, and therefore their work status was determined at 1, 3, 6, 12, 18, 24, and 30 months after treatment. The preinjury job perceptions and other demographic variables were used to predict return to work. Stepwise discriminant analysis was used to predict return to work at the 1-month and final time points utilizing the above variables. Stepwise regression analysis was used to predict mean employment status (at all time points) also using the above variables. SETTING: Multidisciplinary Pain Center. PATIENTS: Consecutive CPPs. RESULTS: For the 1-month time point, employment status was predicted by "intent," educational status, work dangerous perception complaint, job stress, job physical demands, job liking, and job role conflicts. Here, 79.49% of the CPPs were correctly classified. For the final time point, employment status was predicted by the first three predictors for the 1-month time point (in the same order) and age, job stress, and gender. Here, 74.58% of the CPPs were correctly classified. Mean employment status was predicted by "intent" and educational status. CONCLUSIONS: There is a relationship between preinjury job perceptions and actual return to work after pain facility treatment. Voiced "intent" not to return to the preinjury type of job is highly predictive of not returning to work after pain facility treatment.

Accidents, Occupational↗
PubMed1994

Return to work after myocardial infarction: results of a longitudinal population based study.

Return to work was studied in all men who had entered the infarct register in the city of Ghent between 1983 and 1988 because of a first myocardial infarction before the age of 60 years. Information on work resumption was collected in 1991 using a postal survey; 78% of the 295 eligible subjects participated. Sixty-nine percent of all responders and 85% of all those who were at work before the infarct returned to work. Age, the perceived importance of the job, support from friends and the participation in a comprehensive cardiac rehabilitation programme were significantly related to work resumption.

Belgium↗
PubMed2003

[Return to work after cardiologic rehabilitation].

OBJECTIVES: The objectives of the present study were to determine prospectively return to work and its predictors in patients after cardiac rehabilitation. METHODS: Patients were enrolled at admission to inpatient cardiac rehabilitation centres (n = 18). Primary indications for admission were myocardial infarction, coronary artery bypass grafting or percutaneous transluminal coronary angioplasty. RESULTS: We included 2441 consecutive patients (1907 men, mean age: 60 +/- 10 years; 534 women, mean age: 65 +/- 10 years). A total of 43% of all patients had been actively employed before the event. Of these patients, 65% had returned to work six months and 67% 12 months after cardiac rehabilitation. Successful return to work after 12 months was significantly predicted by younger age, non-manual work, self-employment, a higher physical and mental quality of life, and a better exercise ECG result. CONCLUSION: Return to work is predicted by sociodemographic factors, quality of life, and the exercise ECG at the rehabilitation centre. The determination of early predictors for return to work may aid to identify patients particularly at risk for failure to return to work.

Adult↗
PubMed2002

Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors.

Return to work after injury or illness is a behavior influenced by physical, psychological, and social factors. Disability research lacks a conceptual framework for combining these factors in the study of the return-to-work process. Two extant theoretical models within the social context are considered as they apply to the behavior of returning to work: 1) the Readiness for Change Model originating from the field of health promotion and addressing the issue of motivation for behavior change, and 2) the Phase Model of Disability developed for the epidemiological study of occupational disability addressing the developmental and temporal aspects of disability. A new Readiness for Return-to-Work Model is proposed focusing on the interpersonal context of the work-disabled employee. Employee interactions with the workplace, the health care, and insurance systems are considered as they impact the three defining dimensions of change--decisional balance, self-efficacy and change processes. The evidence for their impact on return-to-work is examined within the framework of the Phase Model of Disability, which puts forth the phase-specificity of symptoms, risks, and interventions for disability. The Readiness for Return-to-Work Model has the potential to account for individual variation in optimal stage-specific timing of interventions based on an individual's readiness for return-to-work. The model therefore complements the Phase Model of Disability by allowing for an individual-level staging of the disability and recovery process within the broader group-level-derived framework of occupational disability phases. This link between the two models needs to be empirically tested in future research.

Accidents, Occupational↗