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PubMed1996

Return to Work after Laparoscopic Hysterectomy

In Australia, return to work and full activity after abdominal hysterectomy is routinely delayed until the seventh postoperative week. We conducted a telephone survey of 100 women who had undergone laparoscopic-assisted hysterectomy inquiring, among other questions, when they had returned to full duties as well as when they felt they could have returned, if these were different. The mean time to return to full activity was markedly less than the standard 6 weeks. By changing the public perception and expectations regarding recovery after laparoscopic hysterectomy, we believe the procedure can be explained better by practitioners and will appear even more attractive to patients.

Journal Article↗
PubMed1999

Return to work experience of injured workers in a case management program.

A major goal of case management programs is the worker's timely return to work. Few studies have examined return to work from the perspective of the injured worker. This article describes the findings from the case management evaluation that describe the return to work experience of workers who sustained catastrophic injuries, or who had secondary conditions or complications following the injury occurrence. Among the factors determined to affect the return to work experience were structural factors (i.e., psychosocial variables including job satisfaction and relationship with employer and coworkers, financial pressures, and system issues such as securing benefits) and process factors (i.e., interaction with service providers and with the workers' compensation system). Outcomes are described in terms of satisfaction with services and return to work.

Absenteeism↗
PubMed2002

Ineffective disability management by doctors is an obstacle for return-to-work: a cohort study on low back pain patients sicklisted for 3-4 months.

AIMS: To determine obstacles for return-to-work in disability management of low back pain patients sicklisted for 3-4 months. METHODS: A cohort of 467 low back pain patients sicklisted for 3-4 months was recruited. A questionnaire was sent to their occupational physicians (OPs) concerning the medical management, obstacles to return-to-work, and the communication with treating physicians. RESULTS: The OPs of 300 of 467 patients participated in this study. In many cases OPs regarded the clinical waiting period (43%), duration of treatment (41%), and view (25%) of the treating physicians as obstacles for return-to-work. Psychosocial obstacles for return-to-work such as mental blocks, a lack of job motivation, personal problems, and conflicts at work were all mentioned much less frequently by OPs. In only 19% of the patients was there communication between OP and treating physician. Communication almost always entailed an exchange of information, and less frequently an attempt to harmonise the management policy. Surprisingly communication was also limited, when OPs felt that the waiting period (32%), duration of treatment (30%), and view (28%) of treating physicians inhibited return-to-work. Communication was significantly associated with the following obstacles for return-to-work: passivity with regard to return-to-work and clinical waiting period; adjusted odds ratios were 3.35 and 2.23, respectively. CONCLUSIONS: Medical management of treating physicians is often an obstacle for return to work regarding low back pain patients sicklisted for 3-4 months, in the opinion of OPs. Nevertheless communication between OPs and the treating physicians in disability management of these patients is limited. More attention to prevention of absenteeism and bilateral communication is needed in medical courses.

Adolescent↗
PubMed2006

A study of factors influencing return to work after wrist or ankle fractures.

BACKGROUND: Factors associated with time to return to work are poorly understood for occupational injuries, other than those to the back. METHODS: Anonymized data on claims for work-related wrist or ankle fracture between 1/1/1998 and 12/31/2002 were identified in administrative data held by the Workers Compensation Board in Alberta, Canada. Bivariate and Cox regression analyses were used to identify factors associated with return to work. RESULTS: Increased duration of temporary disability (TD) was associated with older age, female gender, work in construction and construction trade services, smaller company size, higher industry claim rates, a fall/jump from a height, ankle fracture, and greater medical aid costs in the 30 days following injury (used as a proxy for severity). CONCLUSIONS: Factors associated with longer time off work were largely consistent with those reported following back injury. Median time to return to work was longer following ankle than wrist fracture. Although Workers' Compensation Board (WCB) administrative data provided information that could be used to identify factors affecting return to work, better information on injury severity would considerably enhance their research potential.

Adult↗
PubMed2006

Job matching and return to work: Occupational rehabilitation as the link.

Return to work after injury or illness is important for the worker and the employer. Medical providers manage and treat the worker with the illness or injury. Except in cases of focused specialists, the medical professional's role is to take care of a patient, rather than empower a worker. As much as there is promotion of the workers compensation health care system to be similar to sports medicine, there are significant dissimilarities. One major barrier is that the medical caregivers do not know the demands of jobs as they would know the details of sports. Thus, there is a gap in returning a worker to function as the medical professional cannot accurately match the worker to specific jobs. A new model of job function matching, based on research and skills of occupational rehabilitation professionals, is proposed to bridge the gap between the medical community, the employers and the workers.

Employment↗
PubMed1986

Return to work after a myocardial infarction: the influence of background factors, work characteristics and illness severity.

The relationship between return to work (RTW) within 6 months after a myocardial infarction (MI) and selected demographic factors, characteristics of prior work situation, pre-MI health status, and clinical severity of the MI has been studied in 249 patients below 67 years of age living in urban and rural areas of Western Norway. At the follow-up 8 out of 10 urban patients and 6 out of 10 rural patients were back at work. The RTW rate for the total sample was 73%. Age below 51 years, high educational and income level, working in tertiary industries, and in a job characterized by low physical activity and little psychosocial stress were all factors associated with a favourable work resumption. Multivariate analyses showed that socioeconomic or work-related factors could not fully explain the urban-rural differences in RTW. Stepwise discriminant analysis identified the following factors as important and independent predictors for RTW: Place of residence, age, education, perceived job stress, and clinical complications during hospitalization. Failure to return to work after a MI can be explained by a number of individual and social factors and only to a limited degree by the medical status of the patient. More knowledge is needed concerning the socio-cultural differences among both patients and attending physicians in attitudes towards work resumption after a MI.

Aged↗
PubMed2006

Enhanced provider communication and patient education regarding return to work in cancer survivors following curative treatment: a pilot study.

BACKGROUND: For employed cancer survivors, returning to work and maintaining employment is an important aspect of their quality of life. We developed an intervention aimed at enhancing this by means of (a) providing the patient with an educational leaflet on return to work and (b) enhancing communication between attending and occupational physicians. The purpose of this study is to test the feasibility of this intervention and to examine the relation of patient adherence to the advice of the leaflet and return to work. METHODS: A patient series of 35 employed cancer survivors was used to evaluate the intervention. Survivors completed a baseline questionnaire prior to their treatment. Survivors and occupational physicians were interviewed by telephone eight weeks following all curative treatment. Our measure of feasibility included satisfaction of survivors with the intervention, adherence to the advice, time to return to work, satisfaction of occupational physicians with the intervention, and perceived influence on their rehabilitation efforts. RESULTS: Interviews of 26 survivors and 24 occupational physicians, revealed that those groups perceived the leaflet as useful (i.e., 7 on a 0-10 scale. Also seven out of ten suggestions in the leaflet was adhered to and half of the occupational physicians perceived the guidance they provided was helpful. However there was no effect of level of adherence on actual return to work. CONCLUSION: This pilot study demonstrated the feasibility of the approach used. However level of adherence to educational leaflet was not associated with an improvement in return to work in cancer survivors.

Adult↗
PubMed1996

[Return to work following myocardial infarction. Medical and socio-professional factors].

The aim of this study was to assess the influence of medical and socioprofessional factors on return to work after myocardial infarction. The authors studied a continuous series of 174 patients with an average age of 51.3 years, all of whom were active before their illness. The average follow-up period was 33 months. One hundred and thirty of the patients (75%) returned to work. The only clinical factors predictive of not returning to work were older age short exercise time and fall in blood pressure on exercise. On the other hand, nearly all socioprofessional factors, social class, type of occupation, size of company, length of employment in their company, physical stresses related to their occupation, were related to return to work. The average time before returning to work was 5.5 +/- 1 month. Though certain immediate criteria of severity of infarction such as previous myocardial infarction or anterior wall infarction were related to a more delayed return to work. The cardiac status evaluated by complementary investigations (left ventricular ejection fraction, exercise testing and Holter monitoring) was not related to the time before return to work. Of the socioprofessional factors, only difficulties related to the patients' work (modification or change of job) were associated with a more delayed return to work. Forty-four patients (33.8%) returned to work after a change in working hours (28 patients), the tasks involved (20 patients) or position (7 patients). Only the lower socioprofessional classes, independent workers and extremes of age could benefit from these measures.

Adult↗
PubMed1990

Successful return to work following a musculoskeletal injury.

Successful return to work following a musculoskeletal injury is facilitated by early intervention and rehabilitation that addresses the physical, psychosocial, and environmental factors in recovery. Job simulation and work hardening programs that involve the employee, the employer, and the health care providers are an effective approach to injured worker rehabilitation. The occupational health nurse's role can include early identification of injury, treatment coordination and follow up, matching worker abilities and restrictions to the job, and implementation of an injury prevention program. An injury prevention program should be worksite specific, and can include identification of injury hazards, preplacement testing, employee training, and ergonomic job redesign.

Accidents, Occupational↗
PubMed1990

Return to work after stroke: development of a predictive model.

Seventy-nine stroke patients who underwent a vocationally oriented, comprehensive, inpatient stroke rehabilitation program were followed up to evaluate their return to work. At follow-up, 49% had returned to work a mean of 3.1 months after rehabilitation discharge. Factors associated with success and with failure of vocational rehabilitation were then identified, and a predictive model was developed. There were positive associations between return to work and Barthel Index on admission (p = 0.0002) and discharge (p = 0.0015). Negative associations were found between return to work and aphasia (p = 0.0009), rehabilitation length of stay (p less than 0.0001), and prior alcohol consumption (p = 0.03). A step-wise multiple regression model explained 42% of the variance in return to work. Those most likely to return to work were not aphasic; they had shorter rehabilitation lengths of stay and higher Barthel Index scores on discharge; and they were lighter consumers of alcoholic beverages before their strokes. In conclusion, a set of factors predictive of return to work in younger stroke patients was identified, including, most notably, a strong negative association with aphasia and an intriguing negative association with prior alcohol consumption.

Adult↗
PubMed2001

[Multiperspective estimates on the probability of patient return to work following orthopaedic rehabilitation: findings and predictive relevance].

This article analyses various methods of predicting whether patients in orthopaedic rehabilitation will return to work. In this regard, items of patients, physicians in charge of rehabilitation and general practitioners have been collected and compared to working time lost due to illness. In total, 72 % of patients had successfully returned to work after one year. The patients whose reintegration could not be achieved could be identified best by asking if they believed that they would be in a position to work until the statutory retirement age (96 % identified) on the one hand and on the other hand by the physicians' estimate as to the degree the last gainful activity might be resumed (90 % identified). In this context, the criteria have to be laid down very restrictively in order to sufficiently filter out patients not likely to return to work. The patients likely to return to work are identified best by means of the following characteristics: lack of intention to retire early (96 % identified), planning to return to work directly after rehabilitation (88 % identified), and little working time lost due to illness prior to rehab (86 % identified). In general, a major percentage of patients not likely to return to work can be identified by these statements of patients and physicians. The statements of general practitioners are clearly less valuable for prediction and show only weak correlation with the respective statements of the physicians in charge of rehabilitation.

Adult↗
PubMed2004

[Rehabilitation and return-to-work after laryngectomy: the role of industrial otolaryngologists].

Rehabilitation and return-to-work are important problems for laryngectomized patients. Here, we report 2 cases of laryngectomized middle-aged men, and discuss the role of otolaryngologists from the viewpoint of an industrial physician. The first case is a 55-year-old post-office male clerk, who underwent radical and reconstructive surgery for hypopharyngeal carcinoma. He started light work following 3-month-rest at home after discharge, and fully returned to his previous work 3 years later. The second case is a 50-year-old mailman who also underwent radical and reconstructive surgery for hypopharyngeal carcinoma. He could not return to work because of the recurrence of tumor during rehabilitation. In such cases, comprehensive management including medical, mental and social supports is essential according to the occupational environment. Industrial otolaryngologists should play an important role in rehabilitation and return-to-work of laryngectomized patients.

Cervicoplasty↗
PubMed1994

The probability of recovery and return to work from work disability as a function of time.

This paper describes a prospective longitudinal cohort study of musculoskeletal soft tissue pain impairment following a work related injury. It focuses on specific, univariate prognostic factors indicated in previous research studies that might affect the likelihood that injured workers will return to work or remain on work disability at any point in time. These factors include gender, age, return to work attempts and site of injury. Life table analysis was used to model the probability of work disability. The results showed that different disability and return to work patterns emerged for males and females. Males were more likely to return to work; however, females had a higher probability than males of remaining at work once they returned to work. Older workers had the highest probability of being off work any given number of days after injury; were less likely to return to work, and if they did, had a higher probability of becoming disabled again. Efforts to return early to work contributed to a decrease in overall work disability. Workers with low back injuries had a greater likelihood of recurrence compared to injuries at other body sites.

Adolescent↗
PubMedDate not supplied

Psychologic distress in postmyocardial infarction patients who have returned to work.

OBJECTIVE: To assess the prevalence of psychologic distress in women and men returning to work after a myocardial infarction (MI) and to compare this prevalence with the prevalence observed among men and women of the general working population. METHODS: The study population was composed of 990 post-MI patients (106 women and 884 men) recruited in 30 hospitals who had returned to work after their first MI. Psychologic distress was measured with the French version of the Psychiatric Symptom Index (PSI). Adjusted mean PSI score and prevalence of psychologic distress were compared with those observed in 8829 other workers (3823 women and 5006 men), representative of the general working population. RESULTS: Mean PSI score was higher in post-MI women (30.3) than in post-MI men (20.3). This score was also higher in the post-MI population than in the general working population, both for women (30.3 compared with 17.0) and men (20.3 compared with 14.1). Psychologic distress was more prevalent in post-MI women than in post-MI men (prevalence ratio [PR], 1.62; confidence interval [CI], 1.27-2.07). This score was also higher in post-MI women and post-MI men than in the general working population (PR, 2.18; CI, 1.75-2.71 and 1.76; CI, 1.48-2.08, respectively). CONCLUSIONS: Among the presumably fittest post-MI patients, namely those who had returned to work, psychologic distress was significantly more prevalent than in the general working population, particularly among women. Further research is needed to shed light on prognosis in post-MI workers experiencing psychologic distress and on adequate intervention before and after their return to work.

Activities of Daily Living↗
PubMed2004

Supervisory behaviour as a predictor of return to work in employees absent from work due to mental health problems.

AIMS: To study supervisory behaviour as a predictive factor for return to work of employees absent due to mental health problems; and to explore the association between conditional factors and supervisory behaviour. METHODS: Eighty five supervisors of employees were interviewed by telephone. Questionnaires providing information on person related factors, depressive symptoms, and sickness absence were sent to the employees at baseline, three months, six months, and after one year. Three aspects of supervisory behaviour during the period of absence were measured: communication with the employee, promoting gradual return to work, and consulting of other professionals. RESULTS: Better communication between supervisor and employee was associated with time to full return to work in non-depressed employees. For employees with a high level of depressive symptoms, this association could not be established. Consulting other professionals more often was associated with a longer duration of the sickness absence for both full and partial return to work. If sickness absence had financial consequences for the department, the supervisor was more likely to communicate frequently with the employee. Supervisors who were responsible for return to work in their organisation were more likely to communicate better and to consult more often with other professionals. CONCLUSION: Supervisors should communicate more frequently with employees during sickness absence as well as hold follow up meetings more often as this is associated with a faster return to work in those employees.

Absenteeism↗
PubMed1985

[Rehabilitation after aorto-coronary bypass and return to work].

In Quebec, deceptively few patients who have successfully undergone coronary artery bypass have been returning to work. Those aged 55 to 64 years, blue collar workers or those who were off work for 13 weeks or more were likely not to return to work after surgery. From Jan. 1, 1983, all patients aged 64 years and younger, who successfully underwent coronary artery bypass grafting were invited to attend a 6-week rehabilitation program, starting 6 weeks after operation. The aim of the program was to improve the rate of return to work through a low-intensity physical activity course (60% to 70% maximal working capacity and calisthenics ). Up to Mar. 31, 1984, 68 patients had participated in the program. The proportion of patients returning to work was significantly (p less than 0.01) improved and the trend was observed in all age groups, and for all types of employment and length of time off work before operation.

Adult↗
PubMedDate not supplied

Return to work after ischemic stroke: a methodological review.

Despite the economic cost of lost employment, return to work after ischemic stroke has received little study. The percentages of patients working after stroke vary widely from 11 to 85%. Comparisons of these studies are difficult because they report return to work in different populations after diverse follow-up periods using variable definitions of stroke and work. Stroke severity as measured by activities of daily living was the most robust predictor of return to work. However, many factors known to influence vocational outcome after other illness (e.g., social and job characteristics) have not been examined. Directions for future studies of return to work are suggested.

Activities of Daily Living↗