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PubMed1999

Referral to occupational medicine clinics and resumption of employment after myocardial infarction.

Rehabilitation after acute myocardial infarction (AMI) consists of education, exercise, and an encouragement to return to work (RTW). This study attempts to (1) determine whether the time interval between AMI and the visit at occupational medicine (OM) clinics predicts resumption of full employment, and (2) estimate the incidence of work-related recurrent AMI after RTW. We followed 216 consecutive AMI patients at a single OM clinic. The independent variables were clinical and personal data, physical workload and time between AMI, and first visit to the OM clinic. The outcome variables were full employment 24 months after the acute event and recurrent AMI during this period. Of all patients, 168 attempted RTW. Of these, 18 stopped working subsequently. Of the remaining 150 patients, 54 returned to part-time work and 96 were employed full-time after 2 years. Logistic regression indicated that a failure to resume full employment was independently associated with diabetes, older age, Q wave AMI, angina before AMI, heavy work, and a late visit to the OM clinic. For each month's delay in referral to the OM clinic, there was a 30% decrease in the chance for full employment 24 months after AMI. Six (4%) of the 150 patients who resumed employment sustained a recurrent AMI, two of them while at work. A delayed referral to the OM clinic was associated with work disability after AMI. Late referrals to OM clinics should receive a more intensive and sustained rehabilitation than early referrals. Whether an earlier referral to OM clinics will result in increased RTW rates is unknown. Patients who attempted to resume employment had a 1.2% risk of a recurrent ischemic event at their workplace.

Adult↗
PubMed2003

Occupational recovery after open-door type laminoplasty for patients with ossification of the posterior longitudinal ligament.

STUDY DESIGN: A cross-sectional survey of occupational recovery after surgery with patients who had ossification of the posterior longitudinal ligament. OBJECTIVES: To evaluate occupational recovery after open-door type laminoplasty for patients with ossification of the posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA: The literature contains numerous reports on the surgical results of laminoplasty for ossification of the posterior longitudinal ligament, but very few reports are available on postoperative quality of life, and even fewer on occupational recovery after laminoplasty. METHODS: A cross-sectional survey was conducted of 301 patients with ossification of the posterior longitudinal ligament in the cervical spine who were employed before open-door type laminoplasty. Presurgical occupations were classified into three categories: light sedentary labor, light standing labor, and heavy labor. High-rise workers and professional drivers were analyzed separately. The subjects were rated by occupational category for determining the occupational recovery ratio. Factors analyzed for impact on recovery were pre- and postsurgery severity of myelopathy, duration of myelopathy, age at surgery, gender, and type of ossification of the posterior longitudinal ligament. RESULTS: Of the 301 patients studied, 160 (53%) returned to work. Poor recovery rates were observed for heavy labor, high-rise workers, and professional drivers. The period required for return to work did not significantly differ among occupational categories. Occupation, presurgery severity of myelopathy, and postsurgery severity of myelopathy were significantly correlated with occupational recovery. CONCLUSION: Patients' occupations should be carefully considered when designing postsurgery occupational rehabilitation programs, and patients should receive postoperative advice regarding the suitability of occupation.

Cross-Sectional Studies↗
PubMed2006

[Medical assessment of psychosomatic illnesses in the field of short-term disability compensation insurance: advantages of a multidimensional structured guideline].

The aim of the medical report in the area of short-term disability claims caused by psychological and psychosomatic disorders is to make a valid prognosis on the further development of absenteeism and/or to estimate the return-to-work probability of the claimant. An analysis of the current practice of determining the validity of claims caused by psychosomatic illnesses shows that it is inadequate and unsatisfactory, mainly as a result of its reliance on a cross-sectional based judgement. The authors present a structured guideline (Multi-Axial-Psychodiagnostic for short-term disability claims, MAP-KTG), which supports, via a multi-dimensional diagnosis process, the validation of the psychological and psychosomatic symptoms of the claimant. It is also used to assess the amount of functional disability with a higher degree of accuracy. The determination of the prognosis, with regard to future work prospects, can be obtained by applying a list of empirically generated variables proven to be associated with the return-to-work probability.

Activities of Daily Living↗
PubMed1992

Microvascular soft-tissue transplantation for reconstruction of acute open tibial fractures: timing of coverage and long-term functional results.

Seventy-two patients with Gustilo grade IIIB open tibial fractures were treated with free-tissue transfers. If successful free-tissue transfer for soft-tissue reconstruction is performed within 15 days of injury, the risk of major complications is 3.6 percent. Long-term retrospective follow-up (mean 42 months) revealed successful limb salvage in 93 percent, good aesthetic results in 80 percent, and patient satisfaction in 96 percent. However, 66 percent of patients exhibited significantly decreased range of motion of the ankle, 44 percent experienced swelling and edema requiring elastic support and activity modification, and 50 percent occasionally required an assistance device for ambulation. The long-term employment rate was 28 percent, and no patient returned to work after 2 years of unemployment. In contrast, 68 percent of amputees after lower extremity trauma over the same period returned to work within 2 years. Patients need to realize the disruptive nature of this injury on their family, job, and future.

Acute Disease↗
PubMedDate not supplied

Multidisciplinary intensive treatment for chronic low back pain: a randomized, prospective study.

BACKGROUND: Americans with low back pain have been helped to return to work by multidisciplinary intensive treatment programs. Whether this treatment method will succeed in countries with a more generous social welfare system, where the incentive to return to work might be less, is not proven. OBJECTIVES: To evaluate a Danish program of functional restoration combined with behavioral support. METHODS: Patients who had experienced at least 6 months of disabling low back pain were randomly assigned to either a 3-week intensive treatment program (n = 55) or an untreated control group (n = 51). RESULTS: Of the 106 patients randomized, 94 (89%) returned for a 4-month follow-up visit. At that time, 29 (64%) of the 45 treated patients were able to work, compared with 14 of 49 (29%) in the control group. The treated patients had used fewer days of sick leave (P < .02), had contacted health care. professionals fewer times (P < .001), and had lower pain and disability scores. CONCLUSIONS: Although such programs are expensive, they can reduce pension expenditures, sick leave days, health care contacts, and pain.

Activities of Daily Living↗
PubMed2004

Clients' experiences of a work rehabilitation process.

PURPOSE: The aim of this study was to describe clients' experiences of a work rehabilitation process. METHOD: Ten clients who had participated in work-related rehabilitation at a rehabilitation centre in the northern parts of Sweden were interviewed using a narrative approach. The interviews were analysed using qualitative content analysis focusing on clients' descriptions of the goals, contents and results of the work rehabilitation process. RESULTS: At the beginning of the rehabilitation the goal was often to confirm a diagnosis, to become healthy and able to return to work. It was hard to be forced to change the goals. When fortunate the rehabilitation provided more profound guidance and function assessment. It resulted in changes varying from practical alterations to important insights into life. It was important to get support and understanding. When the rehabilitation was not adjusted to clients' needs, feelings of disappointment emerged and life became a struggle with various authorities in order to gain understanding and other forms of rehabilitation. CONCLUSIONS: This study shows the need to develop truly client-centred practice. Therefore, we emphasized, based on this study, the importance of professionals involved in rehabilitation working on different levels and in various settings having regular discussions about what the term client-centred practice means to them. Integrating individual perceptions is essential to advancing a multidimensional approach in return-to-work research.

Adult↗
PubMed2003

Years to employment after spinal cord injury.

OBJECTIVE: To identify factors related to the length of time between spinal cord injury (SCI) onset and return to work among 259 participants with SCI, all of whom have worked at some point since SCI onset. DESIGN: All data were cross-sectional and collected by survey methodology. SETTING: A midwestern university hospital and private hospital in the same metropolitan area. PARTICIPANTS: Participants were identified from outpatient records of 2 participating hospitals. They met 4 exclusion and inclusion criteria: (1) traumatic SCI; (2) 18 years of age or older; (3) a minimum of 2 years postinjury; and (4) had been employed at some time since SCI. The 259 participants' average age was 46.4 years at the time of the study, with an average of 23.5 years having passed since SCI onset. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Years from injury onset to beginning first postinjury job, years to the first full-time postinjury job, and the Life Situation Questionnaire. RESULTS: Participants averaged 4.8 years from the time of SCI onset to their first postinjury job and 6.3 years until their first full-time postinjury job. However, these figures varied greatly depending on whether the individual returned to the preinjury job, was working as a professional at the time of injury, had a noncervical injury, and the amount of education by the time of injury. CONCLUSION: There are 2 general tracks to employment after SCI-a fast track where people return to their preinjury job or preinjury profession and a slower track that is generally associated with needs for further reeducation and training. Working to return the individual to the preinjury job or to a position related to their preinjury occupation may substantially shorten the interval to return to work. In cases where this is not possible, counselors must work with individuals to understand the timeline of return to work and identify realistic educational goals that fit both the individual's interest pattern and postinjury abilities.

Adult↗
PubMed1990

Treatment of posttraumatic stress disorder after work-related hand trauma.

Posttraumatic stress disorder frequently accompanies severe work-related hand trauma and, when a patient attempts to return to work it can potentially be as debilitating as the hand injury. Four techniques were examined for their effectiveness in the treatment of the symptoms of posttraumatic stress disorder. Confronting and reprocessing of intrusive thoughts, combined with coping skills training, effectively reduced all symptoms except avoidance reactions. An early return to the worksite was useful with those patients who experienced mild avoidance reactions, although many patients were not able to use this. Graded work exposure was a highly successful technique for those patients with moderate avoidance reactions. For those with severe avoidance reactions, on-site job evaluations were used with good success. We believe that actual exposure to the worksite greatly enhances the ability of occupationally hand-injured patients to return to work for their previous employer. An algorithm for treatment is proposed.

Employment↗
PubMed1998

Medically certified work loss, recurrence and costs of wage compensation for back pain: a follow-up study of the working population of Jersey.

The 1 yr incidence, prevalence and wages compensation costs of work loss due to medically certified back pain in the working population of Jersey were identified by analysis of the Social Security database for the year 1994. A total of 2291 subjects absenting due to back pain during this period were followed for up to 3 yr to identify return to work rates and subsequent absences. Incidence and prevalence rates were 5.6 and 6.3%, respectively. The cost of wages compensation was 1.29 million pounds or 10.5% of such benefits paid. Work loss was greater for the second absence. The rate of return to work was broadly in line with that suggested by the Clinical Standards Advisory Group (CSAG), but the number still absent at 1 yr was less, suggesting that the CSAG figures for long-term absence may have been overestimated. The influence of compensation systems and unemployment on work-related absence due to back pain is highlighted.

Absenteeism↗
PubMed2003

[Outcome parameters for clinical studies: change of paradigm?].

In the context of comparative clinical studies in surgery and in orthopedic surgery different therapies, techniques, or implants have been compared. Recent scientific publications mainly mention clinical outcome measurements such as fracture union, ROM, infection rate, as well as patient-related criteria such as pain or return to work (RTW) in order to evaluate the success of the treatment. It becomes obvious that more often than not the term "return to work" is not clearly defined. It is not mentioned who measures which criteria at which point in time, nor are part-time occupation, job change, or training on a new job part of the considerations.

Follow-Up Studies↗
PubMed2004

Cervical disc herniations and percutaneous laser disc decompression: a case report.

OBJECTIVE: This is a report on 178 herniated cervical discs in 93 patients treated with percutaneous laser disc decompression (PLDD) using the Nd:YAG laser at the Laser Spine Center from November 1994 to October 2003. MATERIALS AND METHODS: Patients with MRI documented disc herniations in the cervical spine who had failed conservative treatment and were sufficiently symptomatic to require surgical intervention were included in the study. A Seldinger needle was inserted under fluoroscopic guidance and local anesthesia into the offending cervical disc from an anterolateral approach until the tip was just beyond the annulus. Through an optical fiber connected to an Nd:YAG laser, 300 joules were delivered to the disc. A dressing was applied and the patient sent home, to return to work the following day. RESULTS: According to the MacNab criteria, 90% of the patients improved. All of them were permitted to return to work the following day. One complication (0.6%) occurred: a retro-esophageal abscess that responded to incision and drainage. CONCLUSION: PLDD of cervical disc herniations is effective and relatively non-invasive, and has a low complication rate. Because of the complexity of vital adjacent anatomic structures, it should only be performed after intensive training by a qualified interventionist with appropriate experience.

Cervical Vertebrae↗
PubMed1994

A comparison of laparoscopic and open inguinal hernia repair in servicemen.

In a prospective comparison of 70 servicemen undergoing inguinal hernia repair by either the Shouldice method or by laparoscopy, it was found that the laparoscopic operation took longer (mean 52.6 minutes compared to 28.4) and required a postoperative hospital stay as long as that following open operation. However the postoperative analgesia requirement was significantly less, and the patients undergoing laparoscopic herniorraphy were able to regain full fitness and to return to work earlier than those having a Shouldice repair. Despite the higher costs of the laparoscopic operation we believe that the earlier return to work makes this technique cost-effective.

Adolescent↗
PubMed2000

First lifetime back pain and psychiatry treatment: psychological factors and recovery in compensated workers.

The role of psychological factors in recovery from first lifetime low back pain (LBP) was explored in this study. Consecutive clients from one physiatry clinic in Montreal who had LBP of less than 3 months' duration, were on sick leave and receiving workers' compensation benefits, and reported the current event as first lifetime LBP were enrolled. Psychological factors that fluctuate with current events (Psychiatric Symptom Index) and remain stable over time (General Well Being Scale) were assessed. Outcomes were late return to work (> 31 days) and 1 year incidence of compensated recurrence. Results from two multivariate models indicated lower psychological distress predicted late return to work, and higher well being, higher aggressiveness, and lower anxiety predicted compensated recurrence. Researchers concluded psychological factors do not impact clients with all types of LBP in the same way. For individuals lacking prior LBP experience, better psychological functioning increased lengthy work absence. Thus, awareness of the clients' psychological profiles and previous LBP experiences may benefit recovery.

Adult↗
PubMed2005

[System of dynamic neutralization in the lumbar spine: experience on 94 cases].

OBJECTIVE: To assess the results obtained using the Dynesys system (Dynamic Neutralisation System for the spine), in a group of 94 patients. This new system for treating lumbar degenerative pathologies is based on lumbar stabilisation and preservation of articular function, as opposed to traditional arthrodesis restrictions. MATERIAL AND METHODS: We analyze series of 94 patients in whom this system was used. 62 were males and 32 females with an average age of 46.4 years. The pathologies treated were disc herniation in 27 cases, degenerative discopathy in 54 cases and lumbar channel stenosis in 13 cases. Follow-up was carried out between 14 and 24 months, assessing the clinical picture according to the Oswestry scale and the return to work. RESULTS: The final results on the Oswestry scale were 21.4% with respect to 56.8% prior to the treatment and the return to work was 82%. There was a remission of the sciatica symptoms in almost all the cases, as well as of the lumbar pain, and there was a 60% improvement in the claudication cases. With regard to complications, we would like to point out two cases due to the technique, one because of the wrong positioning of the screws and the other due to the rupture of the pedicle. There were two cases of subcutaneous seroma and two late subclinical infections. CONCLUSIONS: The dynamic neutralisation obtained using this system, should not be considered as an arthrodesis. Treatment using Dynesys enlarges the population of patients candidates for surgery to who initially do not apparently need a standard fixation, but who raise doubt regarding the application of techniques without instrumental support, incorporating the functionality concept as opposed to restricting movement. This system can be defined as a disc prosthesis fitted externally to the disc. We have obtained good results in the majority of our patients, although we believe that the follow-up should be increased.

Adult↗
PubMed1989

Determinants of vocational disability in patients with low back pain.

Eighty-seven unemployed subjects with low back pain were recruited from an orthopedic back pain clinic and were given a battery of physical and psychologic tests. Subjects were contacted six months later to determine their current compensation status and whether they had returned to work. Age, length of time out of work, how much they had lifted in their previous job, the number of weeks they had been compensated, current activity levels, leg pain, and various psychologic factors significantly differentiated those who worked from those who did not. Physical examination findings and testing of the ability to lift were not significantly related to return to work. It is suggested that demographic, job-related, and psychologic factors should be emphasized, rather than only physical capacity, in the evaluation of vocational potential and the assessment of disability in patients with low back pain.

Adult↗
PubMed1993

[Danish experience with physical and occupational rehabilitation after heart transplantation. The heart transplantation group at Rigshospitalet].

Heart transplantations have been carried out for one year (1.9.1990-1.9.1991) in Denmark. Twenty-three out of 27 patients survived at the end of this period. Prior to transplantation, all of the patients were in NYHA groups III or IV. On discharge, all of the patients could manage a 45-60 minutes training programme followed by a stair test (two to six floors up). Prior to transplantation, 17 patients received financial aid in one form or another and one child received special schooling. On an average 165 days (1.9.1991) after transplantation, nine patients were in full or part-time employment, two were students, seven received financial aid and five were still in hospital. A correlation between the duration of financial aid before transplantation and return to work after transplantation was found. In addition, age was found to be of significance. It is concluded that physical status and return to work are satisfactory.

Adolescent↗
PubMed2006

Agreement of a work-capacity assessment with the World Health Organisation International Classification of Functioning, Disability and Health pain sets and back-to-work predictors.

The degree of agreement between a clinical multi-professional work-capacity assessment and the Comprehensive World Health Organisation International Classification of Functioning, Disability and Health (ICF) Core Sets for chronic pain and risk factors for no return to work was investigated. A review of data records and interviews with team members included measures of body function/structure, activities/participation and environmental factors. Predictors for return to work were reviewed. The team used eight different methods for data collection. Of the 29 categories concerning environmental factors, two were excluded; the methods used were more unstructured, e.g. interviews. The agreement with the 41 predictors of work resumption was high. The clinical work-capacity assessment agreed largely with the Comprehensive ICF Core Sets for the components body function, body structure, activities and participation. Nine categories out of 69 were not included. The clinical work-capacity assessment agreed largely with the Comprehensive ICF Core Sets for chronic pain conditions and with 40 predictors of work resumption. Clinically speaking, however, the current work-capacity assessment lacks on-the-job site evaluations and this most certainly affects reliability. The same is true for ICF, although the structure lacks proper coding for relevant factors found at work.

Humans↗
PubMed1994

A prospective comparison of transabdominal preperitoneal laparoscopic hernia repair versus traditional open hernia repair in a university setting.

In this study, laparoscopic transabdominal preperitoneal inguinal hernia repair and traditional open inguinal hernia repair were compared in relation to operative time, hospital stay, pain medication use, recovery time, complications, and costs. Elective hernia repairs, 126 in 106 patients, were prospectively followed from January 1991 through September 1993. Seventy-five procedures were performed by laparoscopy and 51 by traditional open approach. Time off work, pain medication use, surgical complications, and hospital stay were all significantly less (p < 0.001) with the laparoscopic approach. Patients in the laparoscopic group returned to work on average 5.5 weeks earlier than patients who underwent traditional herniorrhaphy. The difference in operative times was not statistically significant; however, the difference in the cost of the operations was. In conclusion, laparoscopic inguinal hernia repair offers significantly decreased postoperative pain, shorter hospital stays, faster return to work, fewer complications, and comparable operative times, but at an increased expense for the cost of laparoscopic instrumentation and technology.

Adolescent↗