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PubMed1998

A new approach to measuring recovery in injured workers with acute low back pain: Resumption of Activities of Daily Living Scale.

BACKGROUND AND PURPOSE: Spontaneous recovery, job satisfaction, and multiple other factors make return to work a highly problematic indicator. Available client questionnaires fail to consider what was "normal" or "usual" prior to low back injury. Based on themes described by injured persons, we suggest a new approach to determining "recovery"--the Resumption of Activities of Daily Living (RADL) Scale. SUBJECTS: Injured persons and their therapists from 8 different clinics participated in the study. METHODS: Twenty subjects completed the RADL twice, about 2 days apart, for assessment of test-retest reliability. The RADL was administered, along with other questionnaires, to a separate group of 94 subjects at clinic entry and at discharge or 3 weeks after clinic entry. Both subjects and clinicians made baseline predictions concerning return to work and global ratings of improvement and ability to return to work at follow-up. RESULTS: The RADL showed good psychometric properties (i.e., test-retest reliability, internal consistency, responsiveness to change, and discriminative abilities). CONCLUSION AND DISCUSSION: The RADL provides a new, standardized measure for assessing the extent of recovery from the time of injury to initiation of treatment, and concurrent with the course of treatment, using the individual's customary level of functioning as the benchmark.

Activities of Daily Living↗
PubMed1986

Cardiac rehabilitation exercise program: outcome assessment.

Medically supervised exercise programs have increasingly gained acceptance in management of the coronary patient. Beneficial postexercise results published include: Improved exercise and work tolerance, a decrease in frequency and severity of angina, and earlier return to work. The present retrospective study evaluates the outcome of a three-month cardiac rehabilitation exercise program with changes in exercise performance, compliance with postdischarge exercise routine, and return to work pattern. The study group included 38 patients with documented coronary artery disease and two participants free of ischemic heart disease. Thirty patients were treated with beta blocker medications, ten were not. Time of follow-up ranged from six months to two years. Pre- and postexercise performance expressed in VO2 ml/kg/min was assessed at target heart rate using a modified exercise protocol. Training resulted in statistically significant increases in median exercise performance in both patient groups: 2.38 ml O2/kg/min (range 1.33, 7.18; p 0.0068, one-tail) in the untreated group, and 3.45 ml O2/kg/min (range 2.63, 11.48; p 0.001, one-tail) in the beta blocker treated group. Fifty-seven percent of the participants complied with a postdischarge exercise routine while 7/12 (58%) patients unemployed at time of referral resumed work during or following completion of the exercise program. Such programs appear to be a valuable component in the management of the coronary patient. Further studies involving larger numbers of patients are indicated to document cost effectiveness of such programs.

Adrenergic beta-Antagonists↗
PubMed1997

A controlled trial of an educational program to prevent low back injuries.

BACKGROUND: Low back injuries are common and costly, accounting for 15 to 25 percent of injuries covered by workers' compensation and 30 to 40 percent of the payments made under that program. The high costs of injury, the lack of effective treatment. and the evidence that there are behavioral risk factors have led to widespread use of employee education programs that teach safe lifting and handling. The effectiveness of those programs, however, has received little rigorous evaluation. METHODS: We evaluated an educational program designed to prevent low back injury in a randomized, controlled trial involving about 4000 postal workers. The program, similar to that in wide use in so-called back schools, was taught by experienced physical therapists. Work units of workers and supervisors were trained in a two-session back school (three hours of training), followed by three to four reinforcement sessions over the succeeding few years. Injured subjects (from both the intervention and the control groups) were randomized a second time to receive either training or no training after their return to work. RESULTS: Physical therapists trained 2534 postal workers and 134 supervisors. Over 5.5 years of follow-up, 360 workers reported low back injuries, for a rate of 21.2 injuries per 1000 worker-years of risk. The median time off from work per injury was 14 days (range, 0 to 1717); the median cost was $204 (range, zero to $190,380). After their return to work, 75 workers were injured again. Our comparison of the intervention and control groups found that the education program did not reduce the rate of low back injury, the median cost per injury, the time off from work per injury, the rate of related musculoskeletal injuries, or the rate of repeated injury after return to work; only the subjects' knowledge of safe behavior was increased by the training. CONCLUSIONS: A large-scale, randomized, controlled trial of an educational program to prevent work-associated low back injury found no long-term benefits associated with training.

Adolescent↗
PubMed1983

The quality of life after rectal excision for low rectal cancer.

The quality of life for patients with carcinoma of the lower two-thirds of the rectum (5-12 cm from the anal verge) treated by abdominoperineal resection (APER, n = 38) was compared with that of a similar group of patients treated by low sphincter saving resection (SSR, n = 40). Assessment was by questionnaire conducted a minimum of one year after operation. Thirty patients (75 per cent) after SSR were entirely continent and ten patients (25 per cent) had occasional episodes of incontinence. Each patient with a colostomy was incontinent and 25 (66 per cent) had leaks from their appliance (12 frequent; 13 occasional). Patients after APER avoided more items in the diet and took more medication to control their bowel habit than patients after SSR. Fifteen of the 18 patients (83 per cent) who were employed before SSR returned to work after operation; only 6 of 15 patients (40 per cent) returned to work after APER (P less than 0.05). Sexual function was impaired in 6 of 20 men (30 per cent) after SSR and in 12 of 18 men (67 per cent) after APER (P less than 0.06). Depression was significantly more prevalent after APER than after SSR. Patients with low rectal cancer who are treated by modern sphincter saving resection have a quality of life superior to those who are treated by APER.

Aged↗
PubMed2005

Concepts of rehabilitation for the management of low back pain.

This chapter develops rehabilitation principles for the clinical and occupational management of non-specific low back pain (LBP). Rehabilitation has traditionally been a secondary intervention, which focused on permanent impairment, but this is inappropriate for LBP. Most patients with LBP do not have any irremediable impairment and long-term incapacity is not inevitable: given the right care, support and opportunity, most should be able to return to work. Rehabilitation should then address obstacles to recovery and barriers to (return to) work. Rehabilitation should not be a separate, second stage after 'treatment' is complete: rehabilitation principles should be integral to clinical and occupational management. It should be possible to reduce sickness absence and long-term incapacity due to LBP by at least 30-50%, but this will require a fundamental shift in management culture.

Humans↗
PubMed2006

Psychosocial and physical impairment after mini-incision open and laparoscopic donor nephrectomy: A prospective study.

BACKGROUND: The aim of the present study was to prospectively investigate how mini-incision donor nephrectomy (MIDN) and laparoscopic donor nephrectomy (LDN) affected the donor's quality of life and fatigue. METHODS: Forty-five donors underwent MIDN and 55 donors underwent LDN. Quality of life and fatigue were recorded preoperatively and four times during one year follow-up on the Short-Form 36 (SF-36) and Multidimensional Fatigue Inventory-20 (MFI-20), respectively. RESULTS: One-year response rates were 89% and 95% following MIDN and LDN, respectively. After MIDN, all dimensions of the SF-36 significantly declined. Most dimensions returned to preoperative values at three months except for "vitality" (six months) and "bodily pain" (12 months). After LDN, the scores of the SF-36 dimensions returned to preoperative values at three months, except for "vitality" and "role physical" (both six months). Between-groups analysis revealed significantly better scores of the SF-36 dimensions "physical function" (P = 0.03) and "bodily pain" (P = 0.04) following LDN at one month postoperatively. Fatigue scores did not significantly differ between the groups at any point in time. General and physical fatigue (MFI-20) remained affected up to one year after either type of surgery. After MIDN, 4% of the donors had returned to work at four weeks postoperatively versus 28% after LDN (P = 0.04). Return to preoperative activity level was not significantly different between groups. CONCLUSIONS: Both procedures clearly impact quality of life and fatigue. The beneficial effect on the quality of life and the earlier return to work encourage us to advocate LDN as the surgical approach to be preferred.

Adult↗
PubMed1994

Endoscopic Carpal Tunnel Release.

On the basis of clinical outcome measures, endoscopic carpal tunnel release is an effective operation for treating idiopathic carpal tunnel syndrome. Patients who have undergone bilateral carpal tunnel operations have routinely preferred endoscopic release over the open release. An endoscopic release allows many patients to return to work sooner. However, the benefits of more rapid functional recovery and return to work are tempered by the increased cost and higher complication rate of the procedure. Endoscopic carpal tunnel release is a technically demanding procedure with low tolerances for error. Despite its widespread use, its role is not yet clearly defined.

Journal Article↗
PubMed2000

Laparoscopic versus open appendectomy.

BACKGROUND: Laparoscopic appendectomy is commonly performed and has been presumed to offer economic benefits similar to those of laparoscopic cholecystectomy. This study was done to examine that premise. METHODS: Two surgical groups contributed consecutively operated patients with a clinical diagnosis of appendicitis. One group did all appendectomies open and the other group did them laparoscopically. Hospital expenses were compared using a single billing formula. Hospital length of stay, time to return to work, and complications were analyzed. RESULTS: Operating room times were longer for the laparoscopic group, median 80 minutes, versus median 50 minutes for the open group. Hospital length of stay and return to work were the same, median 1 day and median 10 days, respectively. Wound complications were less common in the laparoscopic group, 0 of 30, than in the open group, 3 of 18; however, there was 1 intra-abdominal abscess in the laparoscopic group. Median cost of the laparoscopic group was $2,915 versus $1,747 for the open group. CONCLUSIONS: Laparoscopic appendectomy is more expensive than appendectomy but does not reduce hospital length of stay nor change the time to return to work; however, wound complications are less common.

Absenteeism↗
PubMed2002

Evaluation of the North Country on the Job Network: a model of facilitated care for injured workers in rural upstate New York.

We describe the evaluation of a community-based program designed to facilitate access to care and return to work for injured workers in a rural, medically underserved area in upstate New York. Providers are recruited to provide easily accessible care and are oriented to concepts of transitional duty and rapid return to work as medically appropriate; companies are recruited with the agreement to provide transitional work for injured employees. Registered nurses, hired by the local hospital, serve as case coordinators to facilitate care and coordinate communications among all parties. Over 3000 injured workers received care through the program in the first 56 months, with a decline in the number of transitional days over time. The number of days that the cases remain open has steadily declined, and the number of return-to-work cases has increased. The success of this initiative provides an excellent background for continued improvement in delivery of care to injured workers and proactive efforts at improving workplace safety and health in a rural area.

Accidents, Occupational↗
PubMed2006

Evaluating treatment effectiveness: benchmarks for rehabilitation after partial meniscectomy knee arthroscopy.

OBJECTIVE: The purpose of this study was to give a detailed description of recovery benchmarks that occur in patients whose therapy after partial meniscectomy knee arthroscopy consists of a home program of exercise. These benchmarks can be used as a basis for clinicians to compare improvements to individual patients who receive supervised care. DESIGN: Thirty-nine patients (five females, mean age = 41) who underwent an uncomplicated arthroscopic partial meniscectomy were included. Test sessions occurred at 5 and 50 days after surgery. Outcome measures included: 1) Hughston Clinic knee self-assessment questionnaire; 2) EQ-5D Tariff for assessment of quality of life; 3) number of days taken to return to work after surgery; 4) knee passive range of motion; and 5) knee swelling assessed by evaluation of knee circumference. Stepwise regression analysis was used to evaluate factors that might have influenced the amount of pre- to posttest change in the outcome measures (the benchmarks) during the first 7 wks after surgery. The factors used in this analysis were: 1) age, 2) body mass index, 3) period from injury to surgery, and 4) the baseline value of the variable to be examined (except for return to work, where we used a score estimating the challenge to the knee offered by work). RESULTS: None of the factors considered (age, body mass index, period from injury to surgery, stressfulness of the work on the knee) affected the number of days taken to return to work. Baseline scores affected change in all the other outcomes, and knee girth change was also affected by body mass index. Regression equations are presented where suitable for the benchmarks presented. CONCLUSIONS: Quick recovery occurs in these patients when only a home exercise program is given. This paper highlights the utility of using historical control group data instead of test-retest analysis of measurement error in evaluating patients whose recovery with a home exercise program is rapid. Of the variables analyzed in this study, quality of life and knee self-assessment changes offer the most useful benchmarks for evaluating treatment effectiveness.

Adult↗
PubMed1999

Strategies in disability management. Corporate disability management programs implemented at the work site.

Managers are challenged to demonstrate all programs as economically essential to the business, generating an appreciable return on investment. Further challenge exists to blend and integrate clinical and business objectives in program development. Disability management programs must be viewed as economically essential to the financial success of the business to assure management support for clinical interventions and return-to-work strategies essential for a successful program. This paper discusses a disability management program integrating clinical and business goals and objectives in return-to-work strategies to effect positive clinical, social-cultural, and business results. Clinical, educational, social, and economic challenges in the development, implementation, and continued management of a disability program at a large corporation with multiple global work sites are defined. Continued discussion addresses the effective clinical interventions and educational strategies utilized successfully within the workplace environment in response to each defined challenge. A multiple disciplinary team approach, clinical and business outcome measures, and quality assurance indicators are discussed as major program components. This article discusses a successful program approach focusing on business process and methodology. These parameters are used to link resources to strategy, developing a product for implementing and managing a program demonstrating economic value added through effective clinical medical case management.

Accidents, Occupational↗
PubMed2004

Carpal tunnel syndrome: cross-sectional and outcome study in Ontario workers.

PURPOSE: To carry out an analytic cross-sectional study of Ontario workers with carpal tunnel syndrome (CTS) and to assess workers' symptoms, functional disabilities, recreational difficulties, and work capability 4 years after treatment of their CTS. METHODS: Data were obtained by review of Ontario Workers Safety and Insurance Board (WSIB) files and by completion of self-assessment questionnaires. Inclusion criteria included all workers registered with the Ontario WSIB who were off work with newly diagnosed carpal tunnel syndrome in 1996. RESULTS: There are 3 million workers covered by the WSIB in the province of Ontario. In 1996, 964 of them developed work-related CTS that required time off for treatment. Of these patients 53% were women and 75% had bilateral CTS. Eighty-one percent of the unilateral cases involved the dominant extremity. The average age at the time of claim was 41 years and workers were at the same job type for an average of 7.4 years (unilateral) and 8.5 years (bilateral), respectively. Thirty-nine percent of workers had a history of another tendonitis or epicondylitis. Seventy-five percent of workers had surgery and on average returned to work 3 months later. Four years after treatment, outcome was assessed by self-administered questionnaires, for which there was a 73% response rate. Forty-six percent of workers experienced moderate to severe pain, 47% had moderate to severe numbness, and 40% had difficulty grasping and using small objects. Only 14% were symptom free. Successful return to work was considered to be a return to the same job with or without modifications, and it occurred in 64% of cases. Better clinical outcome scores were found to occur with surgery and abnormal nerve conduction study results. Worse clinical outcome scores were present with repeat surgery and surgical complications. Concurrent diagnoses of either tendonitis or epicondylitis also resulted in worse clinical outcome scores and worse return-to-work outcomes. The average total cost in Canadian dollars to the WSIB exceeded $13,700 per worker for a total cost in excess of $13,200,000 per year. (In 1996, $1 Canadian = $1.365 US.) CONCLUSIONS: These outcomes indicate that Canadian workers have a large amount of permanent pain and suffering, a large loss of work productivity, and incur a considerable financial cost as a result of work-related CTS.

Adult↗
PubMed1999

[Rehabilitation and the socio-occupational reintegration of workers who have had a myocardial infarct: a pilot study].

OBJECTIVE: To evaluate in a pilot study some psychosocial impacts of a multidisciplinary rehabilitation program on work reintegration of postmyocardial infarction (MI) patients. PATIENTS AND METHODS: Two groups of 19 workers among public and governmental enterprises of the greater Quebec city area admitted to hospital for uncomplicated MI where recruited for the study. One group received multidisciplinary cardiac rehabilitation intervention and a structured return to work program. The second group received the usual care post-MI (no organized rehabilitation program). Over a period of 15 months, the following variables were measured patients' perception of their loss of autonomy, and loss of capacity to manage their emotions, physical work capacity and their capacity to meet work requirements. The impact of the intervention on convalescence time and patients' stability at work were also evaluated. RESULTS: The rehabilitation group showed a better development than the usual care group of capacity to manage emotions (P=0.004) and of capacity to return to work (P=0.006). Furthermore, the patients in the intervention group reintegrated their work environment following a convalescence of 84.32+/-35.39 days compared with 151.39 +/-75.53 days for the usual care patients (P=0.0007). CONCLUSION: A multidisciplinary rehabilitation program and a structured return to work program are beneficial for sociovocational reintegration of post-MI patients.

Adaptation, Psychological↗
PubMed2001

[Coronary intervention and occupational rehabilitation--a prospective, randomized intervention study].

Coronary catheter revascularisation is less costly than bypass surgery due to lower direct (medical) and indirect costs (loss of work). Many studies show that the time patients stay out of work following coronary intervention is much longer than necessary. This leads to a considerable increase of indirect costs, which can far exceed the medical costs of the treatment. This prospective randomised study was done to determine whether specific information to patient and family doctor results in an earlier return to work. After catheter revascularisation 100 working patients (mean age 52.4 years) were randomised either to the intervention group (information to patient and family doctor) or to the control group (no specific information about return to work). Four months later 81 patients had returned to their previous jobs (mean sick leave 18.9 +/- 24.8 days) while 19 were still out of work. In the control group, the rate was 79% and the mean sick leave was 16.4 +/- 22.0 days (median 7); in the intervention group 83% had returned to work after a mean of 21.5 +/- 27.4 days (median 10). There was no significant difference between the two groups, neither according to the rate of returned workers nor to the duration of sick leave. In the subgroup of patients with a private insurance (23% of all) 96% started to work again (mean sick leave 5.7 +/- 5.1 days median 3.5), while the rate was 77% in the group of panel patients (mean sick leave 23.7 +/- 27.4 days, median 11). The difference in sick leave between these two groups was highly significant (p = 0.0003). Specific information to the patient and family doctor has no effect on the time patients stay out of work following catheter revascularisation. It seems that the observed delay depends on social and psychological factors that cannot be influenced directly.

Absenteeism↗
PubMedDate not supplied

Laser-assisted arthroscopic ulnar shortening.

The purpose of this study is to evaluate arthroscopic ulnar shortening with the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for the treatment of ulnocarpal abutment syndrome (UAS). This is a retrospective review of the experience of a single surgeon using this technique between 1994 and 2000. Unloading the ulnocarpal joint is the recognized treatment of UAS. Ulnar shortening via a diaphyseal osteotomy and plating (USO) has been used with good results; however, nearly 50% of patients will require hardware removal. Researchers have reported similar results between open distal ulnar resection (the wafer procedure) and USO for the treatment of UAS. Researchers have also reported similar results with mechanical arthroscopic distal ulnar resections (arthroscopic wafer distal ulnar resection [AWP]) for UAS. Eleven patients who underwent Ho:YAG laser-assisted arthroscopic distal ulnar resection were retrospectively evaluated. The average follow-up time was 31 months, with a range of 7 to 61 months. Evaluation using Darrow' s criteria revealed 64% excellent (7 of 11), 18% good (2 of 11), 9% fair (1 of 11), and 9% poor (1 of 11) results. The average return to work time was 4.7 months, with a range of 1.5 to 16 months. Complications included 1 repeat surgery for ulnocarpal scar formation, 2 cases of transient tendonitis, and 1 portal site erythema without drainage that was treated with antibiotics. One patient (the one with a poor result) has not returned to work for unrelated reasons. chi- square analysis (P <.05) was unable to identify a statistical difference between the reported results of arthroscopic wafer procedures, USOs, and open wafer procedures. We concluded that Ho:YAG laser-assisted arthroscopic ulna shortening procedures show similar results to those reported for arthroscopic wafer procedures, open wafer procedures, and USOs. Return to work times are similar to those reported by other researchers, as is the return to preoperative occupation rate. There is no need for late removal of hardware, as is sometimes associated with USO. Our experience has been that the Ho:YAG laser removes hyaline cartilage and subchondral bone rapidly and with little debris, and thus facilitates the ulna shortening procedure.

Adult↗
PubMed2000

Nd:YAG laser surgery for the excision of pilonidal cysts: a comparison with traditional techniques.

BACKGROUND AND OBJECTIVE: Nd:YAG laser photothermal ablation has been accepted as a treatment modality for hemorrhoidal disease. There is little reported on its use in treating pilonidal disease. We hypothesized that laser would be an excellent tool for pilonidal cystectomy, facilitating improved outcome and patient satisfaction. STUDY DESIGN/MATERIALS AND METHODS: A 5-year retrospective study was performed comparing Nd:YAG laser to the standard surgical technique. A telephone questionnaire addressing the length of time the cyst was debilitating both preoperatively and postoperatively as well as length of convalescent time before return to work was administered. Pain was assessed by using an analog pain scale. RESULTS: Operative time for the traditional pilonidal cystectomy was 20 minutes longer than Nd:YAG laser cystectomy. Postoperative hospital stay was similar. Laser patients returned to work an average of 2.4 days earlier, and their postoperative pain was less than those treated traditionally. CONCLUSION: In an era when the medical consumer makes decisions based on the efficacy of treatment by using criteria such as pain, length of hospitalization, and speed of return to work, Nd:YAG lasers have emerged as a surgical tool that can fulfill these criteria for certain procedures. Patient postoperative satisfaction after laser excision was greater when compared with those who had traditional excisions. Postoperative pain was less, as was the pain experienced during the first week of recovery. Cost for both was comparable.

Absenteeism↗
PubMed1999

Administration and application of the Worker Role Interview: looking beyond functional capacity.

Assessing factors beyond the functional capacity of the injured worker is challenging, yet essential for deriving a more complete understanding of the worker. Insight into a worker's perceptions of abilities and limitations, commitment to the worker role, perception of the impact of the injury on non-work roles, ability to adjust habits and routines, and perception of the work environment allows the therapist to identify and address barriers to return-to-work. The Worker Role Interview (WRI), based on the Model of Human Occupation, is designed to assist the therapist in obtaining this information. The therapist's ratings on a four-point scale provide a picture of the factors which support and interfere with successful return-to-work. This paper describes the WRI and discusses its clinical application. A case example illustrates how the information gained from the WRI can be used for treatment planning.

Journal Article↗
PubMed2001

Randomized clinical trial comparing totally extraperitoneal inguinal hernia repair with the Shouldice technique.

BACKGROUND: The optimal technique for inguinal hernia repair remains contentious. This study compared the Shouldice repair with the totally extraperitoneal endoscopic (TEP) method in a randomized clinical trial, with quality of life (QoL) and cost analysis. METHODS: Two hundred patients were randomized to Shouldice or TEP repair. Patients were assessed after operation by questionnaire to determine operative outcomes, complications, QoL, and return to work and normal lifestyle. RESULTS: There were 117 TEP and 115 Shouldice repairs. Median operating time was longer for TEP repair (70 versus 56 min; P = 0.0001), but patients were discharged earlier (68 versus 48 per cent within 1 day; P = 0.0065), and had a quicker return to work (14 versus 30 days; P = 0.0001) and normal lifestyle (21 versus 35 days; P = 0.0001). Open repair was nearly 40 per cent cheaper. Late follow-up in 171 patients (86 per cent) at a median of 1.3 years found that TEP repair led to fewer complications at 1 year (9 versus 21 per cent; P = 0.05) and was associated with significant improvement for the QoL components of work performance and satisfaction, physical symptoms and sense of well-being. CONCLUSION: TEP repair results in fewer complications and an earlier return to work and normal lifestyle, but is more expensive and takes longer to perform.

Costs and Cost Analysis↗