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PubMed2005

Predictors and modifiers of treatment effect influencing sick leave in subacute low back pain patients.

STUDY DESIGN: Modifying effects in multivariate analyses of a randomized controlled trial. OBJECTIVES: To identify prognostic factors for the effect of a brief intervention ("modifiers") at a spine clinic on return to work in patients with subacute low back pain. SUMMARY OF BACKGROUND DATA: A previous study of a brief intervention showed significant reduction of sick leave, compared with usual primary healthcare treatment. Randomized controlled trials give data only on the group as an average. Identifying prognostic factors that interact with the treatment ("modifiers") may identify specific groups requiring this or other types of treatment. METHODS: A total of 457 patients who had been sick-listed 8 to 12 weeks for low back pain were randomized into an intervention group (spine clinic with medical examination, information, reassurance, encouragement to engage in physical activity, n = 237), and a control group (primary health care, n = 220). All subjects filled out questionnaires. Logistic regression and tests for interaction were used to identify prognostic factors and modifiers for return to work in the two groups, at 3 and 12 months of follow-up. RESULTS: At 3 months of follow-up, the strongest modifying effect on return to work was the perception of constant back strain when working and beliefs about reduced ability to work. At 12 months, gastrointestinal complaints were the strongest modifier for the effect of the intervention. CONCLUSION: The spine clinic intervention seems to have a main effect on work absenteeism via interacting with the concerns of being unable to work.

Adolescent↗
PubMed1998

Perceived efficacy of pain clinics in the rehabilitation of injured workers.

OBJECTIVE: To assess the perceived efficacy of pain clinics in the rehabilitation of injured workers among four groups of professionals. DESIGN: A questionnaire was given to 351 subjects representing four professional groups: physicians, vocational rehabilitation counselors, staff at pain clinics, and employees of a workers compensation program. Subjects rated the effectiveness of pain clinics in eight specific functions, estimated the percentage of workers who return to work after pain clinic treatment, and indicated how soon after injury a worker should be referred to a pain clinic. RESULTS: Pain clinic staff consistently gave the most favorable ratings and workers compensation employees the least favorable ones. There was good agreement across professional groups regarding the need for early referral of injured workers to pain clinics and the specific functions that pain clinics carry out relatively well. Clinics were ranked as most effective in reducing workers' use of opiates, and as least effective in reducing workers' pain. Return-to-work estimates varied significantly across professional groups. Within professional groups, subjects with high estimates gave more favorable overall ratings to pain clinics. CONCLUSIONS: The results provide a profile of the perceived effectiveness of pain clinics in various functions and highlight the importance of getting accurate information about return to work rates following pain clinic treatment. They suggest that workers are not referred to pain clinics early enough.

Accidents, Occupational↗
PubMed2004

A picture of health--myocardial infarction patients' drawings of their hearts and subsequent disability: a longitudinal study.

OBJECTIVE: The aim of this study was to examine whether myocardial infarction (MI) patients' drawings of their hearts predict subsequent return to work, exercise, distress about symptoms and perceptions of recovery at 3 months. METHODS: Just prior to hospital discharge, 74 consecutive patients aged under 70 admitted with an acute MI drew pictures of their hearts. Patients' recovery was assessed at 3 months by postal questionnaire. RESULTS: Patients who drew damage on their heart while in the hospital perceived that their heart had recovered less at 3 months (P = .005), that their heart condition would last longer (P = .01) and had lower perceived control over their heart condition (P = .05) than did patients who drew no damage. The amount of damage drawn on the heart was also associated with a slower return to work (r = .37, P < .05). While patients' peak troponin-T in the hospital was associated with the amount of damage drawn (r = .41, P < .001), it was not associated with the speed of return to work or other 3-month outcomes, apart from perceived duration of heart condition (r = .26, P < .05). CONCLUSION: Patients drawings of damage on their hearts after a MI predict recovery better than do medical indicators of damage. Drawings offer a simple starting point for doctors to assess patients' ideas when discussing their heart condition and an opportunity to counter illness negative beliefs.

Art↗
PubMed2006

Impact of opioid use on outcomes of functional restoration.

OBJECTIVES: To examine the effect of opioid use on psychological function, physical functioning, and return-to-work outcomes of a multidisciplinary rehabilitation program (MRP) for chronic pain. METHODS: The participants were 127 patients with on-the-job injuries who had completed an MRP between 2001 and 2003. Opioid use was controlled by the patients' treating physicians (who were not affiliated with the MRP) and was assessed via patient self-report at the time of admission to the program and discharge. Other measures included pretreatment and posttreatment assessments of depression, pain severity, perceived disability, and physical ability (floor-to-waist lifting capacity). Return-to-work outcomes were obtained via follow-up phone calls approximately 6 months posttreatment. RESULTS: Significant improvements from pretreatment to posttreatment were evidenced on all psychological and physical measures for both opioid users and nonusers. Further, there were no significant posttreatment differences between opioid and nonopioid users on psychological, physical, or return-to-work outcomes. DISCUSSION: The role of opioids in the treatment of chronic pain continues to be controversial. Despite a lack of definitive data on their effectiveness, opioids continue to be prescribed, and thus patients using opioids continue to present for multidisciplinary rehabilitation. Although further exploration is warranted, results of the current study suggest that opioid use during rehabilitation does not necessarily preclude treatment success.

Adult↗
PubMed2006

Impact of briefly-assessed depression on secondary prevention outcomes after acute coronary syndrome: a one-year longitudinal survey.

BACKGROUND: Patients with acute coronary syndromes (ACS) are at increased risk of further acute cardiac events. Secondary prevention aims to decrease morbidity and mortality post-ACS. Depression is related to increased risk in this population, and to poorer secondary prevention activities. However, lengthy depression assessment techniques preclude depression assessment in routine care. The present study investigated the relationship of briefly-assessed depression with secondary prevention outcomes one year post-ACS. METHODS: Following ethics committee approval, hospitals recruited patients for a national survey of ACS. Consenting patients with ACS completed a brief depression scale during hospitalisation. The predictive validity of two brief scales was independently assessed, with groups combined for the overall sample. Participants then completed a one-year longitudinal follow-up postal survey of secondary prevention activities. RESULTS: The response rate for follow-up was 86% (n = 681). Proportions taking anti-platelet (88% v 87%; p = 0.334) and lipid-lowering (83% v 84%; p = 0.437) therapies remained unchanged. Prevalence of smoking (40% v 22%; p < 0.001), and median number of cigarettes smoked (20 v 10; p < 0.001) were significantly reduced at one year. Fifty-six per cent of patients reported attending cardiac rehabilitation programmes. Of those aged < 65 years at baseline, 54% had returned to work at one year. A majority (56%) reported feeling physically better. Prevalence of depression was unchanged in those who completed a depression scale at both time points (15% v 17%; p = 0.434). Baseline depression did not predict taking anti-platelet, blood pressure or cholesterol medications (all p > 0.05), but did predict continuation of smoking (OR = 2.3, 95% CI 1.3-4.0, p = 0.003), a higher (above median) number of general practitioner visits (OR = 2.1, 95% CI 1.3-3.4, p = 0.005), failure to return to work (OR = 0.4, 95% CI 0.2-0.8, p = 0.015), and not feeling better (OR = 0.6, 95% CI 0.3-1.0, p = 0.05) at one year. CONCLUSION: Rapid depression assessment can be used to help identify patients with ACS at risk of a range of poorer secondary prevention outcomes. The results provide support for the routine screening of depression in acute settings. Strategies to increase rates of smoking cessation, return to work, general well-being and decrease health service use by depressed patients may need to incorporate some element of treatment for depression.

Acute Disease↗
PubMed2004

Long-term prognosis of ischemic stroke in young adults. Study of 272 cases.

BACKGROUND: There have been few studies of the long-term prognosis of young adults with ischemic stroke. The present study aimed to evaluate the long-term clinical outcome in a large series of young adults with ischemic stroke admitted to a tertiary medical center over the last 27 years, and to identify possible predictors for mortality, stroke recurrence and poor functional recovery. METHODS: We retrospectively reviewed 272 young adults (15-45 years) with a first-ever ischemic stroke admitted to the Neurology Department of University Hospital "12 de Octubre" between 1974 and 2001. Follow-up assessments were performed by review of medical records and telephone interviews. RESULTS: Nine patients (3%) died as the result of their initial stroke and follow-up information about the status of 23 (8%) patients was not available. The remaining 240 patients (89%) were followed. Two hundred and ten of them (88%) were alive with a mean follow-up of 12.3 years and 30 (12%) died during follow-up. The average annual mortality rate was 1.4%, being notably higher during the first (4.9%) than in the subsequent years (0.9%) after the initial stroke. Ninety per cent of the followed patients were independent and 53% returned to work, although adjustments were necessary for 23% of them. The annual stroke recurrence rate during the first year was 3.6% dropping to 1.7% in subsequent years. Age over 35 years, male gender, the presence of cardiovascular risk factors and large-artery atherosclerosis in the carotid territory were predictors of negative long-term outcome after the initial stroke. CONCLUSIONS: The long-term prognosis for the ischemic stroke in the young is better than in the elderly, but the risk of mortality in young adults with ischemic stroke is much higher than in the general population of the same age. A bad prognosis is associated with an atherosclerotic risk profile, with a higher mortality and recurrent stroke rates and poorer functional recovery. The main functional limitation in the young survivors of their initial ischemic stroke occurs in work activity, since most patients are independent but almost half of them do not return to work.

Adolescent↗
PubMed1993

Good performance status of long-term disease-free survivors of intracranial gliomas.

PURPOSE: To determine the long-term impact on function of treatment for primary cerebral gliomas, Karnofsky Performance Status, employment history, and memory function were used to evaluate the status of adults who are alive and disease-free more than 1 year after cranial irradiation. METHODS AND MATERIALS: Of 30 eligible adult patients, seventeen patients had anaplastic astrocytoma, seven had a glioblastoma, four had low grade astrocytoma, one had a mixed glioma, and one had an anaplastic oligodendroglioma. Sixteen patients received partial brain irradiation only, 12 had whole brain irradiation with a partial brain boost, and two had whole brain irradiation only. The total dose ranged from 54-66 Gy, with a fraction size of 1.7-2.0 Gy. Median follow-up was 3.5 years. Eighty-three percent of patients also received adjuvant chemotherapy. RESULTS: Karnofsky Performance Status generally remained stable after the completion of irradiation. Mean Performance status was 84 at the end of irradiation and was unchanged at the time of last follow-up. The actuarial freedom from performance status decline after irradiation was 93% at 5 years. The performance status increased in two patients, both within several months of completing irradiation. Most patients (68%) returned to work after irradiation. Sixty-two percent remained at work 1 year later, and 58% were working at the time of last follow-up. No patient who did not return to work within 4 months of completing irradiation was able to work at a later date. All working patients were employed in a capacity similar to their pre-morbid position. Only one patient, with an intercurrent lung cancer, eventually developed deficits that limited self care. CONCLUSIONS: Contrary to previously published reports, long-term glioma survivors maintained a relatively good performance status in the absence of recurrence and did not experience a progressive decline in neuropsychologic function after completion of cranial irradiation. A patient's function state at the completion of irradiation is a reliable predictor of long-term functional outcome in the absence of recurrence. Although the number of patients in each subgroup is small and no significant differences could be detected, patients treated with partial brain irradiation had a higher and more stable performance status, better memory function, and superior employment history.

Adult↗
PubMed1997

A comparison of results of arthroscopic-assisted anterior cruciate ligament reconstruction between workers' compensation and noncompensation patients.

This investigation compared the results of arthroscopic-assisted anterior cruciate ligament patellar tendon autogenous reconstruction in patients who received Workers' Compensation (WC) benefits with results of similar surgery in patients who did not receive such benefits, to determine if differences existed based on this variable alone. Thirty-eight patients (19 WC benefits, 19 NoWC) were matched for age, injury chronicity, number of prior operations, and months of follow-up. All had the same operation and rehabilitation. A significant difference was found between the groups in the mean number of days of lost employment preoperatively (WC, 122 days; NoWC, 3 days) and postoperatively (WC, 222 days; NoWC, 37 days). At follow-up (mean, 27 months), 17 patients in group WC had returned to work (6 with symptoms) and 2 were disabled. All patients in group NoWC had returned to work, 2 with symptoms. There was no significant difference between the groups for anterior-posterior displacements, functional limitations with daily or sports activities, patient perception of the knee condition, the overall rating score, or complications. The number of mean days of lost employment in group WC could not be accounted for from factors that normally effect anterior cruciate ligament reconstruction results. We hypothesize that other factors such as wage systems that support WC injuries long-term, inability of employers to modify job requirements, inability of employees to receive job retraining, or lack of proper immediate diagnosis and treatment of the injury, may have lead to the large number of lost working days in group WC.

Absenteeism↗
PubMedDate not supplied

Comparing outcomes of anterior cervical discectomy and fusion in workman's versus non-workman's compensation population.

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is an accepted surgical procedure to treat degenerative conditions, including disc herniations and spinal stenosis. The literature on lumbar spine surgery reports that patients with a workman's compensation claim have less successful clinical results. Regarding the cervical spine, however, different conclusions have been drawn. PURPOSE: The purpose of this study was to directly compare the functional outcomes of ACDF in patients with and without a workman's compensation claim and to determine whether a compensation claim adversely affected the clinical outcome. STUDY DESIGN: This is a retrospective study examining the long-term results of ACDF in the workman's and non-workman's compensation populations. PATIENT SAMPLE: Eighty consecutive patients undergoing ACDF were retrospectively analyzed. The patients were divided into two groups: 30 patients in Group 1 (workman's compensation) and 50 patients in Group 2 (non-workman's compensation). The average age of Group 1 was 45 years (range, 31 to 57) and Group 2 was 45 years (range, 30 to 79). The patients were followed for an average length of 4 years (range, 2 to 7 years). OUTCOME MEASURES: We evaluated the surgical results using a functional outcome scoring system (Odom's Criteria), visual analog scale and a radiographic grading scale. The questionnaire was independently administered in a standard question-answer format at the 1-year follow-up. Statistical analyses was performed using a Levene's test. METHODS: All surgeries were performed by the same attending physician. A left-sided approach and Smith-Robinson fusion technique with autograft or allograft without instrumentation was used in all cases. A hard cervical orthosis was used postoperatively for 8 weeks. Radiographic examination including lateral flexion and extension views were obtained at a minimum of 12 months postoperatively. Furthermore, radiographic analysis was performed each subsequent postoperative year. The radiographs were analyzed by two independent physicians in a blind fashion for evidence of radiographic fusion. RESULTS: At follow-up no discernible difference was noted for functional outcomes. Eighty-three percent of patients in Group 1 and 90% of patients in Group 2 noted excellent or good results. This was not statistically significant (p=.280). In Group 1, 97% of patients returned to work at an average of 18 weeks, whereas 98% of patients in Group 2 returned to work at an average of 10 weeks postoperatively. Upon radiographic evaluation, 64% of patients in Group 1 were determined to have a solid fusion (Grade 3). The fusion rate in Group 2 was 72%. This was not statistically significant. However, the fusion rate among smokers was 50%, and among nonsmokers it was 80%. This was statistically significant (p=.001). CONCLUSIONS: Workman's compensation claims did not adversely affect the functional outcome of ACDF. It should be noted that a significant increase in pseudarthroses was noted with the smoking population. Patient selection is a critical factor in determining functional outcome, with 83% good to excellent results if the pathology, clinical presentation and radiographic findings correlate

Adult↗
PubMed2002

The prognosis after multidisciplinary treatment for patients with postinfectious chronic fatigue syndrome and noninfectious chronic fatigue syndrome.

The prognosis after multidisciplinary treatment for patients with postinfectious chronic fatigue syndrome (CFS, n = 9) and noninfectious CFS (n = 9) was clarified. After treatment, natural killer (NK) cell activity increased in the postinfectious CFS group but did not recover to within normal range in the noninfectious CFS group. In the postinfectious CFS group, physical and mental symptoms improved, and 8 patients returned to work. In the noninfectious CFS group, symptoms did not improve, and only 3 patients returned to work. The prognosis of postinfectious CFS group was better than that of noninfectious CFS group. Classification of CFS patients into postinfectious and noninfectious groups is useful for choosing the appropriate treatment in order to obtain better prognosis.

Adult↗
PubMed1998

Interdisciplinary rehabilitation of hospital employees with musculoskeletal disorders.

At Lund University Hospital a cooperation project started in 1989 between the Rehabilitation Clinic and the Occupational Health Service Unit for the rehabilitation of 34 hospital employees with musculoskeletal problems and a median sick-listing time of 6 months, treated as day-patients by an interdisciplinary team. Evaluation instruments used were the Nottingham Health Profile (NHP), Pain Drawing, Visual Analogue Scale for pain, and the Disability Rating Index (DRI). The most prominent immediate effect was a significant increase of perceived energy and significant improvement of the total score of health-related quality of life (NHP). After 12 months, 25 out of 34 (74%) subjects had returned to work. The reference group used consisted of 57 subjects referred earlier from the Occupational Health Service Unit to the Personnel Department, for vocational rehabilitation. The groups were followed by 2-4 years using questionnaires concerning working conditions and current health status. There was a significant difference (p = 0.038) in return to work: intervention group 77%, reference group 58%.

Adult↗
PubMed1980

Postmastectomy rehabilitation in a community hospital.

The need for, operation, and outcomes of an in-hospital postmastectomy rehabilitation program are described as operating at a general community hospital, the Mt. Sinai Hospital of Cleveland. Patient outcomes in terms of range of motion (94 and 98 percent normal 90 days after discharge, right and left arm respectively); resumption of normal activities and return to work (94 percent had resumed normal activities within 90 days and 85 percent had returned to work); and emotional stress (fewer than one in ten reported moderate to severe emotional stress) are demonstrated to be indicative of good rehabilitation. These results are comparable to those reported achieved in a specialized oncology setting. This type of program can be successfully conducted in a community hospital with the limited use of regular hospital personnel, although problems related to physician resistance and assuring the regular availability of appropriate staff members for even a short time each day must be overcome.

Activities of Daily Living↗
PubMed1996

The clinical course of musculoskeletal pain in empirically derived groupings of injured workers.

The purpose of this paper is to examine the clinical course of musculoskeletal, soft tissue, work-related injury. An analysis of empirically derived sub-groupings of workers based on prognostically important pain and disability variables assessed on enrollment into the study is described. Multidimensional time-dependent profiles are used to characterize stages in the development of pain, impairment, disability and handicap. The clinical course over the 18 months of study of the three subgroups is examined. The conceptual model, used to examine the workers' changing responses over time, is based on the World Health Organization Classification of Impairments, Disabilities and Handicaps (1980). Methodologically, the study employed a prospective longitudinal design. A randomly selected cohort of workers who had not returned to work by 3 months post-injury were identified from the files of the Workers' Compensation Board of Ontario. The workers were interviewed and examined on enrollment into the study at 3 months and subsequently at 9 months, 15 months and 21 months after injury. The outcomes were return to work or continued work disability. The results are based on those 104 workers who attended all four assessment periods. K means clustering was used to identify homogenous subgroups of workers. Repeated measures ANOVAs were used to characterize the stages of development of pain, impairment, disability and handicap. Duncan's multiple range test was used to compare pairs of means at each assessment period. Cluster groupings, based on three prognostically important clinical variables, number of pain sites, pain behavior and functional disability, obtained at the initial assessment were valid predictors of the number of days to return to work and total number of days on work disability. Prognostic stratification can enhance confidence in predictive decisions of clinical practice and improve clinical trials of therapy.

Adult↗
PubMed2005

Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males: a randomized trial.

BACKGROUND: Endoscopic totally extraperitoneal inguinal hernioplasty (TEP) is an accepted technique for the repair of recurrent and bilateral inguinal hernia, but its role in the management of unilateral primary inguinal hernia remains controversial. The current randomized trial was undertaken to compare the postoperative and 1-year outcomes of day-case TEP and open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males. METHODS: From January 2002 to January 2004, a total of 200 male patients were randomized to undergo either day-case unilateral TEP or open Lichtenstein hernioplasty under general anesthesia. The primary outcome measures included postoperative pain score, time until return to work, incidence of chronic groin pain, and recurrence rate 1 year after the operation. RESULTS: All TEP procedures were successfully performed without conversion. The mean operation time for TEP (50 +/- 13.2 min) was significantly shorter than for open Lichtenstein hernioplasty (58 +/- 17.6 min) (p < 0.001). The pain score at rest was significantly lower in the TEP group than in the open group on postoperative days 0, 1, 4, 5, and 6. On the average, the patients returned to work 8.6 days after TEP and 14 days after Lichtenstein hernioplasty (p = 0.006). Postoperative recovery and morbidity rates were otherwise comparable between the two groups. The incidence of chronic groin pain 1 year after TEP (9.9%) was significantly lower than after open surgery (21.7%) (p = 0.032). None of the patients in either group showed recurrence at the last follow-up assessment. CONCLUSIONS: Day-case TEP was superior to open Lichtenstein hernioplasty for the repair of unilateral primary inguinal hernia in males. The benefits of day-case TEP included less postoperative pain, a faster return to work, and a lower incidence of chronic groin pain.

Adult↗
PubMed2006

Comparison of pullout button versus suture anchor for zone I flexor tendon repair.

PURPOSE: To evaluate the clinical outcome after repair of zone I flexor tendon injuries using either the pullout button technique or suture anchors placed in the distal phalanx. METHODS: Between 1998 and 2002 we treated 26 consecutive zone I flexor tendon injuries. Thirteen patients had repairs from 1998 to 2000 using a modified pullout button technique (group A) and 13 patients had repair using suture anchors placed in the distal phalanx (group B). Patient characteristics were similar for both groups. The same postoperative flexor tendon rehabilitation protocol and follow-up schedule were used for both groups. Evaluation included range of motion, sensibility and grip strength, failure, complications, and return to work. The Student t test was used to determine significant differences. RESULTS: All patients completed 1 year of follow-up evaluation. There were 2 infections in group A that resolved with oral antibiotics and no infections in group B. There were no tendon repair failures and no repeat surgeries in either group. At final follow-up evaluation there were no statistically significant differences for the following end points: sensibility (Semmes-Weinstein monofilament testing and 2-point discrimination), active range of motion (at the proximal interphalangeal joint, distal interphalangeal joint, or their combined motion), flexion contracture (at the proximal interphalangeal joint, distal interphalangeal joint, or their combined contracture), and grip strength (injured tendon as a percent of the contralateral uninjured tendon). The suture anchor group had a statistically significant improvement for time to return to work. CONCLUSIONS: There was no significant difference in the clinical outcome after flexor tendon repair using either suture anchors or the pullout button technique. A significant improvement was found for time to return to work for repairs using the suture anchor technique. Flexor tendon repair can be achieved using suture anchors placed in the distal phalanx, thereby avoiding the potential morbidity associated with the pullout button technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level III.

Adolescent↗
PubMed2002

Tonsillectomy by means of plasma-mediated ablation: prospective, randomized, blinded comparison with monopolar electrosurgery.

OBJECTIVE: To compare plasma-mediated ablation (PMA) with monopolar electrosurgery (MES) for pediatric tonsillectomy. DESIGN: Prospective, randomized, blinded study. SETTING: Academic children's hospital. PARTICIPANTS: Thirty-four children, aged 4 to 7 years. INTERVENTIONS: Tonsillectomy by means of PMA (n = 17) or MES (n = 17). OUTCOME MEASURES: We measured surgical efficacy, estimated blood loss, and surgical time during tonsillectomy and morphine use, immediate postoperative pain, and recovery scores after tonsillectomy. Parents recorded recovery of normal diet and activity and their own return to work for 10 days after surgery. Histopathologic evaluation of excised tonsils was performed. We reviewed medical records and attempted follow-up telephone contact. RESULTS: With no significant difference in blood loss compared with MES, PMA was effective for tonsillectomy. Performance of PMA took longer (24 vs 16 minutes; P =.002). Results of histopathologic evaluation showed less thermal injury with PMA than with MES (P =.03). Morphine consumption, pain, and recovery scores were equivalent between groups. We found no significant difference in recovery of normal diet and activity or parental return to work. Patients undergoing PMA had a greater number of perioperative complications than those undergoing MES, including 2 patients in the PMA group (compared with none in the MES group) who required unplanned admission for postoperative airway obstruction. CONCLUSIONS: Plasma-mediated ablation for pediatric tonsillectomy resulted in less histopathologic thermal injury than MES, but did not show a statistically faster recovery to normal activity and diet or parental return to work. In addition, PMA took longer to perform, and had more complications. Therefore, PMA should not replace MES for pediatric tonsillectomy. The reduced thermal injury with PMA supports investigation into other means of using plasma ablation to treat tonsillar hypertrophy.

Child↗
PubMed1998

Results of suture of the radial, median, and ulnar nerves after missile injury below the axilla.

OBJECTIVE: To evaluate the functional outcome and return to work after suture of upper extremity nerves after low-velocity missile injury. METHODS: Forty-one patients had suture of the radial, median, and/or ulnar nerves between the wrist and axilla, 3 to 17 weeks after low-velocity missile injury. Postoperative functional outcome was good if no supplemental techniques (permanent splints, tendon or muscle transfer, fusion) were required, fair if supplemental techniques were required to restore a functional hand, and poor if the hand was severely deformed. The follow-up period was 14 to 38 months. RESULTS: Supplemental techniques followed the suture of 11% of radial, 45% of median, 72% of ulnar, and 100% of combined median and ulnar nerve injury. After suture +/- supplemental techniques, patients returned to work in 100% of radial, 55% of median, 57% of ulnar, and 0% of combined median and ulnar nerve injuries. CONCLUSION: Nerve suture between the wrist and axilla and supplemental techniques achieve functional recovery in the majority of patients after missile injury with good expectations for return to work, except in combined median and ulnar nerve injuries.

Absenteeism↗
PubMed2006

A psychosocial risk factor--targeted intervention for the prevention of chronic pain and disability following whiplash injury.

BACKGROUND AND PURPOSE: The objective of this study was to determine whether the addition of a psychosocial intervention improved return-to-work rates beyond those associated with participation in a functional restoration physical therapy intervention. Subjects who had sustained whiplash injuries participated in the Progressive Goal Attainment Program (PGAP), which is a 10-week psychosocial intervention program that aims to increase activity involvement and minimize psychological barriers to rehabilitation progress. SUBJECTS AND METHODS: A sample of 60 subjects enrolled in a functional restoration physical therapy intervention were used as a historical cohort comparison group. Subjects who received the functional restoration physical therapy intervention were compared with a sample of 70 subjects who received PGAP in addition to physical therapy. RESULTS: Participation in PGAP plus physical therapy resulted in a higher return-to-work rate (75%) than participation in physical therapy alone (50%). Differences between treatment conditions were most pronounced for the subgroup of subjects who had the largest number of psychosocial risk factors. DISCUSSION AND CONCLUSION: The findings suggest that a psychosocial risk reduction intervention can be an effective means of improving function and facilitating return to work in people who are at risk for prolonged pain-related disability.

Adult↗