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PubMed2002

The unmet needs of young people who have had a stroke: results of a national UK survey.

BACKGROUND: Most stroke-related studies have consisted of people over the age of 65. This study examined the unmet needs of young people with stroke, living in community housing in the UK. METHOD: People with a stroke (>1 year ago), in two age bands (18-45; 46-65) were sent the Southampton Needs Assessment Questionnaire for people with Stroke. RESULTS: 315 out of 639 (49%) questionnaires were returned (mean age 55, SD 9; 189 males, 126 females). The median number of unmet needs reported was two (IQR 0-6). The most frequently reported unmet needs were: provision of information about the responders' stroke (45%); assistance with finances (24%); non-care activities (19%); and intellectual fulfillment (17%). Responders in the younger age group reported significantly more unmet needs than responders in the older age group (for a holiday, intellectual fulfillment and family support). Responders with poor mobility reported significantly more unmet needs than responders with average and good mobility for 15 unmet needs (three most pressing: respite care/short breaks; adaptations; and access to community environment). Responders who did not return to work reported significantly more unmet needs than responders who had reduced hours or changed jobs and people who returned to the same job with the same hours for seven unmet needs (three most pressing: help with finances; a holiday and speech therapy). CONCLUSION: People of younger age, with poorer mobility and those unable to return to work, report most unmet needs. Further work needs to be done within the community, with employers and professionals, in relation to education and the provision of specifically targeted information in order to facilitate participation and autonomy for people with stroke.

Adolescent↗
PubMed2003

Breastfeeding in the military: Part II. Resource and policy considerations.

Breastfeeding is widely acknowledged as the ideal form of nutrition for infants. Because of this, increasing the incidence and duration of breastfeeding is a major goal in Healthy People 2010. Part I of this series illustrated that the Department of Defense and its health care system, TRICARE, may not be meeting that goal, particularly after active duty mothers return to work. This study outlines the resources that would be required to optimally support breastfeeding after active duty mothers return to work. Selected policy implications of supporting breastfeeding are discussed, and recommendations for policy on breastfeeding are presented.

Breast Feeding↗
PubMedDate not supplied

The role of the primary care physician in reducing work absenteeism and costs due to back pain.

In many cases, the primary physician may best serve his or her patient's interests by encouraging an early return to work and avoidance of adversarial proceedings. Though data are fragmentary, it seems likely that these goals will be promoted by reassuring patients about the good prognosis of acute back pain and by avoiding alarming terminology (e.g., "injury," "ruptured disc"). Patients have a great need for explanation of their symptoms, but this can usually be met by brief, clear explanations from the physician and need not require extensive diagnostic testing. In most cases, a parsimonious diagnostic approach is appropriate, and this may reinforce the message that the illness is not serious and should be self-limited. For patients without neurologic deficits, very brief if any bed rest is necessary, and an early (if gradual) return to work is usually feasible. Many faddish treatments are widely promoted but rarely tested in a rigorous way. Anti-inflammatory drugs and intervention with adverse lifestyles (sedentariness, smoking, and obesity) provide important therapeutic and preventive opportunities.

Absenteeism↗
PubMed2002

Blind faith? The effects of promoting active sick leave for back pain patients: a cluster-randomized controlled trial.

STUDY DESIGN: A cluster-randomized controlled trial. OBJECTIVE: To evaluate the effects of two strategies to increase the use of active sick leave (ASL) among patients with low back pain (LBP) on improved return to work and quality of life. SUMMARY OF BACKGROUND DATA: Active sick leave is an option provided by the Norwegian National Insurance Administration that enables employees to return to modified duties at the workplace with 100% of normal wages. A proactive implementation strategy increased the use of ASL for LBP patients from 11.5% to 17.7% compared with a passive intervention and a control group ( = 0.006). METHODS: Sixty-five municipalities were randomly assigned to a passive intervention, a proactive intervention, or a control group. The interventions, which were designed to improve the use of ASL, were targeted at patients on sick leave for LBP for more than 16 days (n = 6179), their general practitioners, employers, and local insurance officers. The main outcome measures were the average number of days off work, the proportion of patients returning to work within 1 year, and self-reported quality of life while on sick leave. RESULTS: The median number of days on sick leave was similar in the proactive intervention group (70 days), the passive intervention group (68 days), and the control group (71 days) ( = 0.8). The proportion of patients returning to work before 50 weeks was also similar in the proactive (89%), passive (89.5%), and control groups (89.1%). Response rates for the questionnaires that were sent to patients were low (38%), and no significant differences were observed across the three groups for quality of life or patient satisfaction. CONCLUSIONS: It is not likely that efforts to increase the use of ASL will result in measurable economic benefits or improved health outcomes at the population level. The benefits of ASL for individual patients with LBP are not known.

Back Pain↗
PubMed2004

Long-term influences of a biopsychosocial rehabilitation programme for chronic pain patients.

OBJECTIVE: Chronic pain leads to high costs in the form of compensation for absence from work due to illness, production loss and health care utilization. Multidisciplinary treatment programmes at pain clinics can result in return to work and a decrease in doctor visits. The aim of this study was to evaluate the long-term influences of a rehabilitation programme in primary health care for chronic pain patients with regard to doctor visits, frequency of sick-leave and level of disability. DESIGN: A longitudinal, intervention study design was used over a three-year period. METHODS: A biopsychosocial rehabilitation programme based on ego-strengthening psychotherapy was used. An occupational therapist and a physiotherapist led the intervention, which comprised two meetings per week for six weeks. The study was performed in a primary health care area in the southwest of Sweden with 54 chronic pain patients. RESULTS: The results showed a significant decrease in the number of doctor visits as well as sick-leave days. The level of absenteeism due to occupational disability changed significantly from being on sick leave to receiving a disability pension. CONCLUSIONS: The rehabilitation programme reduced patient attendance at health care facilities but did not increase the numbers of patients returning to work.

Journal Article↗
PubMed1991

[Alleviation of pain through posterolateral spondylodesis in patients with prolonged severe backache].

In order to study the effect of posterolateral spinal fusion on pain and returning to work of patients with chronic lower back pain, a retrospective study was carried out at the University Hospital, Maastricht. Fifty-nine patients with spondylolisthesis I or II, spondylolysis, hemisacralisation, disc degeneration and pseudoarthrosis after spinal fusion were treated by posterolateral spinal fusion. A questionnaire and visual analogue scale were used to assess the pain. The mean preoperative pain level was 8.6; the postoperative pain level was 4.5; 13 patients were without pain. Before operation 41 patients had a job; after operation 34 returned to work. Sex, age, period of complaints, indication or level of operation did not significantly affect the pain score. In particular cases, posterolateral spinal fusion diminishes pain in patients with spondylolisthesis I or II, spondylolysis or hemisacralisation in whom pain does not improve after non-operative therapy. After the operation most patients return to their work.

Adolescent↗
PubMed2006

Subtle cognitive deficits after cerebellar infarcts.

The role of the cerebellum in cognitive functions has been under debate. We investigated the neuropsychological functioning of patients with cerebellar lesions (infarcts) and evaluated the significance of laterality in cognitive symptoms. Twenty-six patients with exclusive cerebellar lesions as verified by clinical and neuroradiological findings underwent a neuropsychological assessment at the acute stage and at 3 months. Their performance was compared with 14 controls, also assessed twice. The focus was on four domains: visuospatial/motor functions, episodic memory, working memory and attentional shifting/execution. Both groups improved over time. Statistical differences emerged in tests in the visuomotor domain as well as in the episodic and working memory domains. Patients with left cerebellar lesion were slow in a visuospatial task, whereas those with right cerebellar lesions had verbal memory difficulty compared with controls. By 3 months, 77% of the patients had returned to work, and only one had cognitive impairment and did not return to work. Our results indicate that cerebellar infarcts may result in subtle cognitive changes perhaps primarily related to working memory deficit. The symptoms may be mediated by the contralateral cortical hemisphere, left cerebellar infarcts producing mild right hemispheral dysfunction and right cerebellar infarct producing mild left hemispheral dysfunction.

Adult↗
PubMed2000

Outcome after musculoskeletal trauma treated in a regional hospital.

BACKGROUND: Trauma remains the leading cause of death and morbidity in the under-35-year-old population. The majority of reports assessing outcome after trauma emanate from North American Level I trauma centers. We sought to examine outcome after trauma treated in an Irish regional unit. METHODS: All patients admitted over a 1-year period with an Injury Severity Score > or =9 were evaluated and 61 patients recruited to the study. Demographic data, medical history, and details of the mechanism and pattern of injury and treatment were collected. Patients' functional outcome was assessed using the Sickness Impact Profile (SIP), duration of hospital stay, and return to work. RESULTS: Significant residual disability was noted (mean SIP 13.63+/-14.60). Thirty-seven percent of patients had not returned to work despite a mean follow-up of 18.36 months. Factors associated with a poor outcome include increasing age, a blue-collar occupation, lower limb fractures, comorbid conditions, and the presence of complications. CONCLUSION: Optimizing primary care of the trauma victim may help to minimize consequent morbidity. A small group of patients suffer permanent disability, and vocational retraining opportunities should be made available to them.

Accidental Falls↗
PubMed1991

Patients avoiding surgery. Pathology and one-year life status follow-up.

Patients were selected for a research study to determine the outcome of patients who had demonstrated enough pathology to have been viewed as surgical candidates and had chosen to avoid surgery. The purpose of the study was to identify the diagnostic categories and to obtain follow-up data on these patients. The patient population consisted of 66 patients with the following pathologies: disc disruption (one and two levels), disc disruption (three levels), stenosis, spondylolisthesis, instability, and herniated nucleus pulposus. The patients were followed for a period of 1 1/2 years and rated on the following lifestyle status categories: Returned to Work, Retired, Retraining, Able to Increase Activity Level, or No Change from Initial Status. Of the nonoperative patients, 18% returned to work. Twelve patients (18%) were retired. Eleven patients (16%) were placed in retraining programs. Twenty patients (29%) were able to increase activity level. Eleven patients (16%) fell under the category of no change.

Activities of Daily Living↗
PubMedDate not supplied

Prognosis of patients with middle cerebral artery occlusion.

The long-term prognosis of 78 stroke patients with occlusion of the middle cerebral artery (MCA) or its branches is described. The mean age of the patients was 44 years. The mortality rate in the acute phase was 5%. The acute and total mortality rates of men were higher than those of women (p less than 0.05). Life-table analysis gave 94% probability for one year's survival, 84% for three years' survival, and 78% for five years' survival. Subsequent strokes were twice as common as cardiovascular events as the cause of death. Seventy-two percent of the survivors became fully independent in activities of daily living (ADL) , 27% required assistance, 1% was totally disabled, and 43% returned to work. Left-sided occlusion was overrepresented in those who died (p less than 0.00(1) and those who returned to work (p less than 0.05), and right-sided occlusion was overrepresented in those who required assistance in ADL (p less than 0.05).

Activities of Daily Living↗
PubMed1988

Ankle dislocation without fracture.

Dislocation of the ankle without accompanying malleolar fracture has been regarded as a rare lesion, with few cases reported in the literature. To date, there has been no precedent for accurate descriptions of the mechanisms, optimum treatment, and long-term prognosis of this injury. Our goal was to evaluate these variables by a retrospective review of cases from our institution. We identified eight patients who had sustained ankle dislocation without fracture and were treated at the University of Iowa during the period 1958 to 1986. We interviewed and examined each patient and obtained ankle radiographs at an average of 11.5 years postinjury (range 2 to 24 years). After analyzing our cases and other reported in the literature, we have found that this injury is most common in young people (average age 31 years, range 10 to 73 years) and males (72%), and occurs most frequently in falls, motor vehicle accidents, and sports (86%). Medial displacement occurs most frequently (27%). Disruption of the mortise occurs variably. The most likely mechanism appears to be anterior or posterior extrusion of the talus from the mortise secondary to a force applied to the plantarflexed foot. Final displacement is then determined by the position of the foot and the direction of the force applied. Physical findings are commensurate with the deformity. Neurovascular compromise is uncommon (10%). Closed reduction is almost invariably accomplished easily unless the deformity is accompanied by posterior tibiofibular dislocation. Optimum treatment appears to be immobilization in a short leg cast for 6 weeks with no weightbearing for the first 3 weeks. Long-term follow-up revealed the following. Results were all good to excellent considering the following variables: return to work and sports activities, pain, instability, swelling, and ankle and subtalar joint motion. No patient reported instability and all returned to work and sports participation. We noted mild pain and swelling that was not severe enough to require medication in 25% of patients. Range of motion was normal in all but four patients; none of these lacked more than 10 degrees of motion in any plane. Radiographic abnormalities consisted of minor ligamentous or capsular calcification in all patients, small osteophytes in four patients, and minimal joint space narrowing in one patient. No patient had normal radiographs.

Adult↗
PubMed2005

The impact of extended leave on sleep and alertness in the Australian rail industry.

In the past, scientific studies have investigated the effects of shift timing and duration on sleep and alertness in the rail industry. To our knowledge no research has been conducted to determine the effects of extended break lengths (>48 h) on these factors. Hence, this study analyses the work and rest schedules of 304 Australian rail employees (mean age 41.3 yr, standard deviation 7.4 yr) to determine the effect of prior break lengths (12-169 h) on sleep and subjective alertness at work after periods of leave. Extended break periods (>48 h) were found to increase the length of the sleep prior to returning to work and reduce the total wake time to the end of the first shift, but did not influence levels of subjective alertness immediately prior to the commencement of the first shift. Research into the influence of longer break periods (>169 h) is needed in order to make definitive conclusions regarding sensible return to work policies after extended leave within the Australian rail industry.

Adult↗
PubMed1997

[Fear-avoidance-beliefs in patients with backpain].

INTRODUCTION: In recent years most industrialized nations have been confronted with a dramatic increase in cases dealing with back pain which, because of the associated costs, has put a strain on health care systems. Because of the tremendous costs caused by patients with chronic illnesses, there is a common interest in identifying determinants responsible for the pain becoming chronic. According to the fear-avoidance model, chronic back pain is the cause of specific patient beliefs according to their perception and appraisal of back pain and their assumptions about the connection between pain and work activities. These fear-avoidance beliefs are assumed as the main cognitive factors of adapting to chronic invalidism. In this study a German version of a self-reporting instrument that assesses fear-avoidance beliefs (FABQ, Waddell et al. 1993) is presented. METHODS: A translated version of the "Fear-Avoidance Beliefs Questionnaire" was given to 87 patients with back pain, who took part in a multimodal treatment program in an outpatient pain unit. The questionnaire was administered at different times in the therapeutic process. We examined the factor structure of the questionnaire and conducted the first examinations concerning its psychometric properties. RESULTS: The results of our data set concerning different aspects of reliability and validity conform the good psychometric properties of the questionnaire. The factor analysis revealed a three-factor solution, which accounted for nearly 60% of the variance. The first factor made up 34% of the variance. The six corresponding items dealt with "back pain caused by work". The second factor made up 13% of the variance. The content of the 5 items is focused on the patients' view about his/her probable return to work. Beliefs about physical activity in back pain (factor 3, 5 items) accounted for 12% of the variance. Correlation analysis demonstrated that all three factors are of independent value, which showed satisfactory reliability. Furthermore, we analyzed the prognostic value of the three factor dimensions. Patients completed multidisciplinary treatment according to the concept of "functional restoration". At the end of treatment, factor 1 (causation by work) was not diminished, but both other factors showed significant reductions. In a discriminant factor analysis, back-to-work could be significantly predicted by factor 3 (beliefs about physical activity) and factor 2 (patients' prognosis about their probable return to work at the beginning of treatment). Furthermore, length of time off work and age accounted for an additive classification rate of 77%. The FABfactor 1 (causation by work) was of no predictive value. CONCLUSIONS: The results suggest that primary target points for further investigation include an analysis of the patients' beliefs about their pain, with special emphasis on fear-avoidance beliefs. It is also necessary to analyze the behavioral assumptions of the fear-avoidance model in an experimental design. Furthermore, our results concerning the psychometric properties of the questionnaire should be proved in a far larger sample of back pain patients.

English Abstract↗
PubMed2004

Repair of acute rupture of the Achilles tendon: a new technique using polyester tape without external splintage.

INTRODUCTION: A new method of treating acute rupture of the Achilles tendon using polyester tape is reported. This requires no postoperative splintage, allows earlier mobilisation and prompt return to work and sport. PATIENTS AND METHODS: Thirty patients were reviewed prospectively and at a mean of 3 years from surgery. RESULTS: The average time of return to work, full weight-bearing and to driving was 40 days, 45 days and 49 days, respectively. The average time for return to sport was 122 days. Three patients required further surgery, two for infected wounds and one for scar release. There was one sural nerve injury. Twenty-two patients regained a normal range of ankle and subtalar movement, with the mean power of plantar flexion 84% of the opposite side. Of the 22 patients who played sport, 14 were still performing at the same or a higher level. There were no re-ruptures over this period. CONCLUSIONS: The technique is straightforward and avoids splintage. It also conveys other short- and long-term advantages over more established methods.

Achilles Tendon↗
PubMed1980

[Changes in work status in a French-Canadian population after aorto-coronary bypass surgery].

Work status after aortocoronary bypass surgery was evaluated in 1 320 male patients who were less than 60 years old at the time of their operation. The percentage of working patients is maximal two years after surgery (66.5 p. 100) and decreases gradually (53 p. 100) at five years. This percentage remains lower than the 84 p. 100 and 69 p. 100 which were observed twelve and six months before the operation. Multivariate analyses showed that the length of the period of pre-operative inactivity had a preponderant role in predicting work status after surgery. The second best predictor was the type of work in patients aged 45 or more and the educational level in younger patients. All other variables-duration of illness, functional class, other illness, postoperative complications, marital status, annual income, age-had a lesser role. Variables predictive of continued employment (greater than or equal to 2 ans) after surgery were similar. Univariate analyses on postoperative factors showed a negative correlation between recurrence of angina and return to work. A majority of patients who never returned to work after surgery kept a stable income (65.5 p. 100) and 83 p. 100 of them received financial aid from the government.

Coronary Artery Bypass↗
PubMed1994

Occupational asthma due to heated polypropylene.

A 35 year-old nonatopic woman was referred to the hospital for possible work-related asthma. She had worked as an operator, at a plant producing polypropylene bags, for the previous four yrs. Her main complaint was a productive cough with dyspnoea and wheezing, as well as rhinitis over the past 3 yrs. She had been absent from work for 6 months on maternity leave, and had improved greatly. She was on a beta 2-adrenergic agent and had to take it at least four times daily. Baseline spirometry whilst at work showed marked airflow obstruction (forced expiratory volume in one second (FEV1) of 43% predicted (pred). After two months away from work FEV1 improved to 89% pred; provocative concentration of histamine causing a 25% fall in FEV1 (PC20) was 3.6 mg.ml-1 (mild airway hyperresponsiveness). Return to work resulted in a marked deterioration in FEV1, and serial peak expiratory flow (PEFR) values. PC20 was 0.11 mg.ml-1 (severe airway hyperresponsiveness) one week after she had returned to work. Specific inhalation challenges with polypropylene heated to 250 degrees C resulted in a late asthmatic reaction. As formaldehyde is one of the degradation products of heating polypropylene, we exposed her to it for up to 2 h, but we elicited no bronchospastic reaction. We conclude that heated polypropylene should be listed as one of the agents that causes occupational asthma.

Adult↗
PubMed2002

Risk for early ischemic event after acute myocardial infarction in working males.

We attempt to predict ischemic events in the weeks following the hospital discharge after acute myocardial infarction (AMI) in order to aid occupational physicians in taking return-to-work decisions. Included in the study were 1299 AMI patients from 14 coronary care units in Israel who had been employed before hospitalization and were seen after discharge 1, 2, 4, 6, 9 and 12 months after the first AMI. Cardiovascular accidents included death from cardiovascular disease, recurrent infarction or hospitalization due to congestive heart failure or unstable angina. The rate of a first recurrent cardiovascular accident decreased rapidly over the first few weeks. The risk in the third week was still 51 per 1000 person-months, 13.4 (95% CI: 9.2-19.5) times higher than that after 10 weeks when the incidence reached a low steady state. The major predictors in a logistic regression model for an event were: older age, past history of a cerebrovascular event, and congestive heart failure during the course of hospitalization, but the area under the receiver-operator curve was only 64.4%. We conclude that after acute myocardial infarction, the major risk for a recurrent event is a lapse of time from discharge but not other clinical variables. This should be taken into account when considering a proper timing of return-to-work after an acute myocardial infarction.

Absenteeism↗
PubMed2006

Broken or dislodged poly-L-lactic acid bioabsorbable tacks in patients after SLAP lesion surgery.

PURPOSE: To document the complication of bioabsorbable poly-L-lactic acid (PLLA) tack breakage and repair failure after arthroscopic stabilization of SLAP lesions. METHODS: Six patients (average age, 38 years) were referred to the senior author because of persistent postoperative pain and disability after arthroscopic stabilization of an unstable SLAP lesion was performed with bioabsorbable PLLA tacks. A total of eight tacks were used in the six patients, and the time from index procedure to evaluation at our facility averaged 9.5 months (range, 8 to 12 months). Three patients experienced an identifiable reinjury an average of 4 months after the index procedure was performed. Magnetic resonance imaging (MRI) revealed a broken or dislodged tack in all cases. All patients were taken to the operating room for arthroscopic evaluation of the biceps anchor, tack fragment removal, and restabilization of the SLAP lesion as needed. RESULTS: At repeat arthroscopy, all shoulders were found to have minimal healing of the SLAP lesion with failure of the bioabsorbable tack. Chondral injury was noted in 2 cases. In all cases, revision SLAP repair was performed with the use of arthroscopic suture repair. At an average follow-up of 14 months (range, 8 to 17 months), all patients reported alleviation of symptoms. Five patients had returned to work with no or minimal symptoms. One patient experienced significant improvement in function and range of motion but did not return to work. CONCLUSIONS: Bioabsorbable PLLA tack breakage or dislodgement is a potential postoperative complication after SLAP lesions are arthroscopically stabilized. This event may result in postoperative reports of pain or mechanical symptoms. Surgeons who use these devices must be aware of the potential complications when they evaluate postoperative patients with persistent complaints. MRI may be helpful in identifying tack fragments. Subsequent arthroscopy to evaluate biceps anchor healing, remove tack fragments, and restabilize the labral lesion may be indicated. LEVEL OF EVIDENCE: Level IV, case series.

Absorbable Implants↗