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PubMed2004

The prognostic value of functional capacity evaluation in patients with chronic low back pain: part 2: sustained recovery.

STUDY DESIGN: Historical cohort study. OBJECTIVES: We investigated the ability of the Isernhagen Work Systems' Functional Capacity Evaluation to predict sustained recovery. SUMMARY OF BACKGROUND DATA: Functional Capacity Evaluation is commonly used to determine readiness or ability for safe return to work following musculoskeletal injury, implying a low risk of future recurrence or "reinjury." However, this theoretical construct has not yet been tested. METHODS: Workers' compensation claimants who underwent Functional Capacity Evaluation following low back injury and subsequently demonstrated recovery in the form of suspension of total temporary disability benefits or claim closure were studied. The number of failed tasks and performance on the floor-to-waist lift task in the protocol were used as indicators of Functional Capacity Evaluation performance. Indicators of sustained recovery included whether or not total temporary disability benefits restarted, the claim was reopened, or a new back claim was filed. Logistic regression was used to determine the prognostic effect of Functional Capacity Evaluation alone and after controlling for suspected confounding variables. RESULTS: Overall, 46 of 226 patients (20%) experienced a recurrent back-related event within the year following Functional Capacity Evaluation. Opposite to the initial hypothesis, a lower number of failed Functional Capacity Evaluation tasks was consistently associated with higher risk of recurrence after controlling for potential confounding variables. Performance on the floor-to-waist lift task was not related to future recurrence. CONCLUSIONS: Contrary to Functional Capacity Evaluation theory, better Functional Capacity Evaluation performance as indicated by a lower number of failed tasks was associated with higher risk of recurrence. The validity of Functional Capacity Evaluation's purported ability to identify claimants who are "safe" to return to work is suspect.

Adult↗
PubMed2005

The effects of a graded activity intervention for low back pain in occupational health on sick leave, functional status and pain: 12-month results of a randomized controlled trial.

INTRODUCTION: Behaviorally oriented graded activity interventions have been suggested for sick-listed workers with low back pain on return to work, but have not been extensively evaluated. METHODS: One hundred and thirty-four workers were randomly assigned to either a graded activity intervention (n = 67) or usual care (n = 67) and followed-up for 12 months. RESULTS: The graded activity group returned back to work faster with a median of 54 days compared to 67 days in the usual care group. The graded activity intervention was more effective after approximately 50 days post-randomization (HRR = 1.9, CI = 1.2-3.1, p = 0.01). Differences between the groups in number of recurrent episodes, total number of days of sick leave due to low back pain, and total number of days of sick leave due to all diagnoses, were in favor of the graded activity group, although not statistically significant. No effects of the graded activity intervention were found for functional status or pain. CONCLUSION: Graded activity intervention is a valuable strategy to enhance short-term return to work outcomes.

Activities of Daily Living↗
PubMed1991

A comparison of single-level fusions with and without hardware.

During a 47-month period, 68 patients were studied prospectively to compare single-level lumbar fusion with and without adjunctive pedicular fixation. Fusion indications were disabling back pain for a minimum of 6 months, inability to work, and failed conservative care. Twenty-nine patients fused without hardware and 39 fused with VSP fixation in identical procedures. All patients were evaluated according to fusion success, perceived pain, and return to work. Pseudarthrosis was demonstrated in 58.6% of the noninstrumented group. No pseudarthroses were noted in instrumented patients. Pain improvement in the nonhardware group was 41.4%, and in the hardware group, 76.9%. Return to work was 31% and 72% in each group, respectively. The fusion rate for patients exhibiting single-level disc disease improves with spinal fixation.

Adult↗
PubMed1997

Surgical outcome and cost-minimisation-analyses of laparoscopic and open hernia repair: a randomised prospective trial with one year follow up.

OBJECTIVE: To compare outcome and costs between laparoscopic and open hernia repair. DESIGN: Prospective randomised study. SETTING: One university and two district hospitals in Sweden. SUBJECTS: 200 men aged 25-75 years. MAIN OUTCOME MEASURES: Operating time, hospital stay, complications, and time to recovery. A cost-minimisation-analysis was used in which the total costs were calculated for a defined period of time for each option. RESULT: The one year follow-up rate was 98%. Mean (SD) operation times in the laparoscopic and open groups were 72 (30) and 62 (25) minutes, respectively (p = 0.009). Hospital stay and complication rates did not differ between the groups. Among employees the mean (SD) periods off work in the laparoscopic and open groups were 10 (8) and 23 (21) days, respectively (p = 0.0001). The mean direct costs of the laparoscopic operation were increased by SEK 4037 (US$ 483) but the savings in indirect costs resulting from earlier return to work were SEK 11392 (US$ 1364). CONCLUSIONS: Laparoscopic hernia repair gave the employed patients faster recovery and return to work, and was the most cost-effective strategy provided that both direct and indirect costs were included.

Adult↗
PubMed1992

[An analysis of the work activities and survival of patients operated on for stomach cancer].

The paper deals with the analysis of dynamics of working activity of 146 radically treated gastric cancer patients examined by the Oncological Commission for Ability Expertise of Novosibirsk in 1984-1988 and then followed for 2-5 years. The percentage of patients returning to work was the highest during the first and third years posttreatment. This was attributed to extension of temporary invalidity period and rehabilitation of group 2 invalids, respectively. Lethality among patients returning to work was 8.2 +/- 2.3% as compared to 62.6 +/- 2.5% in a group of 385 patients who did not work. Labor activity did not adversely influence the clinical course of disease. The unfavorable course was attributed to biological properties of tumor such as low degree of differentiation and infiltrative pattern of growth.

Adult↗
PubMed2003

Employer satisfaction with workers' compensation health care: results of the Washington State Workers' Compensation Managed Care Pilot.

Developing more effective approaches to disability prevention has been a longstanding challenge for the workers' compensation system. A major obstacle to this goal has been the lack of communication and interaction between employers and physicians who care for injured workers. From 1995 through 1997, the Washington State Department of Labor and Industries sponsored a major demonstration program, known as the managed care pilot (MCP), to assess the effects of managed care on medical and disability costs, patient satisfaction and employer satisfaction. We developed a telephone survey and administered it to 243 employers as part of the MCP evaluation. Topics covered in this survey include satisfaction with treatment rendered, duration of lost work time, work modifications, and satisfaction with communication received during the employee's recovery period. Employers in the intervention (managed care) condition were more satisfied with the managed care/occupational medicine system than the employers in the comparison group were with the fee-for-service system. MCP employers were satisfied particularly with the frequency and quality of communication received from the health care provider regarding return to work and work modification issues. Improved employer-provider communication may foster early return to work and thereby have a beneficial effect on health and employment outcomes for injured workers.

Fee-for-Service Plans↗
PubMed2003

Does early intervention with a light mobilization program reduce long-term sick leave for low back pain: a 3-year follow-up study.

STUDY DESIGN: A randomized clinical trial. OBJECTIVES: To evaluate long-term clinical and economical effects of a light mobilization program on the duration of sick leave for patients with subacute low back pain. SUMMARY OF BACKGROUND DATA: Twelve-month follow-up results from a previous study showed that early intervention with examination at a spine clinic, giving the patients information, reassurance, and encouragement to engage in physical activity as normal as possible had significant effect in reducing sick leave. At 12-month follow-up, 68.4% in the intervention group were off sick leave, as compared with 56.4% in the control group. Patients in this study were followed-up for a period of 3 years to investigate possible long-term effects. MATERIALS AND METHODS: Four hundred fifty-seven patients placed on a sick list for 8 to 12 weeks for low back pain were randomized into two groups: an intervention group (n = 237) and a control group (n = 220). The intervention group was examined at a spine clinic and given information and advice to stay active. The control group was not examined at the clinic but was treated within the primary health care. RESULTS: Over the 3 years of observation, the intervention group had significantly fewer days of sickness compensation (average 125.7 d/person) than the control group (169.6 d/person). This difference is mainly caused by a more rapid return to work during the first year. There was no significant difference for the second or third year. In particular, there is no increased risk for reoccurrence of illness from early return to work. At 6-month follow-up, patients in the intervention group were less likely to use bed rest and more likely to use stretching and walking to cope with their back pain compared with the control group. This effect diminished. At 12-month follow-up, the only significant difference between the groups was in the use of stretching. Economic returns of the intervention were calculated in terms of increases in the net present value of production for the society because of the reduction in number of days on sick leave. Net benefits accumulated over 3 years of treating the 237 patients in the intervention group amount to approximately 2,822 dollars per person. CONCLUSIONS: For patients with subacute low back pain, a brief and simple early intervention with examination, information, reassurance, and encouragement to engage in physical activity as normal as possible had economic gains for the society. The effect occurred during the first year after intervention. There were no significant long-term effects of the intervention. The initial gain obtained during the first year does not lead to any increased costs or increased risks for reoccurrence of illness over the next 2 years.

Adolescent↗
PubMed1992

Endoscopic release of the carpal tunnel: a randomized prospective multicenter study.

A 10-center randomized prospective multicenter study of endoscopic release of the carpal tunnel was carried out. Surgery was performed with a new device for transecting the transverse carpal ligament while control hands were treated with conventional open surgery. There were 122 patients in the study; 25 had carpal tunnel surgery on both hands and 97 had surgery on one hand. Of the surgical procedures, 65 were in the control group and 82 were in the device group. The endoscopic device was coupled to a fiberoptic light and a video camera. A trigger-activated blade was used to incise the transverse carpal ligament. After surgery, the best predictors of return to work and to activities of daily living were strength and tenderness variables. For patients in the device group with one affected hand, the median time for return to work was 21 1/2 days less than that for the control group. Two patients treated with the endoscopic device required reoperation by open surgical decompression; only one of these had incomplete release with the device. Two patients in the device group experienced transient ulnar neurapraxia.

Activities of Daily Living↗
PubMed1999

Evaluation of two new heart valve surgery techniques: partial sternotomy and port-access approaches.

OBJECTIVES: This review attempts to compare the port-access and partial sternotomy approaches of minimally invasive valve surgery. METHODS: Our brief experiences of the two techniques are summarized with an attempt to compare safety, cost-effectiveness of the procedure and post discharge follow-up. One hundred and two patients undergoing the procedures between May 1996 and October 1998 were analyzed. There were 65 patients in the partial sternotomy (MIV) group and 37 patients in the port-access (PAV) group. With the exception of a higher incidence of COPD in the MIV patients, there was no significant difference in pre-operative variables between these two groups. RESULTS: Total operating room time, surgery time and cross-clamp time were significantly increased in the PAV group. The operative mortality of patients with MIV was 3% (n = 2) while the PAV group was 8% (n = 3) (P = ns). More new atrial fibrillation was found in the MIV (26% versus 5%, P = 0.009). Otherwise, there was no significant complications observed in either group. During the 4-6 week follow-up, of those who were employed, 76% of MIV and 69% of PAV patients had returned to work. Of the retired patients more than 95% of the patients in both groups had resumed their daily routine activity. Importantly, the study showed PAV patients returned to work about 4 weeks sooner than MIV patients. CONCLUSIONS: MIV approach is more 'surgeon friendly' and can be carried out without increased intra-operative resource utilization. The PAV approach requires formal training and capital outlay for unique equipment, disposable and ancillary procedures. From a financial perspective, if the PAV technique is to become widely accepted intra-operative efficiencies must be maximized, post-operative fast-tract protocol must be utilized, financial expenditures for disposable equipment must decrease and requirement of ancillary procedures must be reduced.

Aged↗
PubMed2004

A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow.

We conducted a prospective, randomised, controlled trial of 45 patients (47 elbows), with tennis elbow, who underwent either a formal open release or a percutaneous tenotomy. All patients had pre- and post-operative assessment using the Disability of Arm, Shoulder and Hand (DASH) scoring system. Both groups were followed up for a minimum of 12 months. Statistical analyses using the Mann-Whitney U test and repeated measured ANOVA showed significant improvements for patient satisfaction (p = 0.012), time to return to work (p = 0.0001), improvements in DASH score (p = 0.001) and improvement in sporting activities (p = 0.046) in the percutaneous group. Those patients undergoing a percutaneous release returned to work on average three weeks earlier and improved significantly more quickly than those undergoing an open procedure. The percutaneous procedure is a quicker and simpler procedure to undertake and produces significantly better results.

Adult↗
PubMedDate not supplied

Laparoscopic cholecystectomy in Jordan.

This study was conducted on 100 patients with symptomatic gallbladder stones, aged 22-81 years with a mean of 51.5 years, who underwent cholecystectomy in Zarqa city, Jordan between July 1998 and July 1999. The success rate was 87% and the procedure was completed using the conventional method in 13 patients. The mean operative time was 60 minutes, complication rate was 5% and there were no deaths. The mean hospital stay was 1 day and mean time to return to work was 10 days. This study showed that laparoscopic cholecystectomy is a safe procedure with reasonable operative time, less postoperative pain, a short hospital stay, early return to work, and a low morbidity and mortality rate.

Absenteeism↗
PubMed1993

Residual impairments and work status 15 years after penetrating head injury: report from the Vietnam Head Injury Study.

We investigated the relationship of neurologic, neuropsychological, and social interaction impairments to the work status of a large sample of penetrating head-injured patients wounded some 15 years earlier during combat in Vietnam. Extensive standardized testing of neurologic, neuropsychological, and social functioning was done at follow-up on each head-injured patient (N = 520), as well as on a sample of uninjured controls (N = 85). Fifty-six percent of the head-injured patients were working at follow-up compared with 82% of the uninjured controls. Seven systematically defined impairments proved to be most correlated with work status. These were post-traumatic epilepsy, paresis, visual field loss, verbal memory loss, visual memory loss, psychological problems, and violent behavior. These disabilities had a cumulative and nearly equipotent effect upon the likelihood of work. We suggest that a simple summed score of the number of these seven disabilities can yield a residual "disability score" which may prove to be a practical tool for assessing the likelihood of return to work for patients in this population and perhaps in other brain-injured populations. These findings may also help to focus rehabilitation efforts on those disabilities most likely to affect return to work.

Adult↗
PubMed1992

Identification of patients with coronary disease at high risk for loss of employment. A prospective validation study.

BACKGROUND: Work disability is common in patients with coronary artery disease and adversely affects both economic well-being and quality of life. The purpose of this study was to construct a model to predict premature departure from the work force of patients with coronary disease and to validate this model prospectively in an independent cohort of patients. METHODS AND RESULTS: We enrolled 1,252 coronary disease patients referred for diagnostic cardiac catheterization who were less than age 65, employed, and without prior coronary angioplasty or coronary bypass surgery. Medical, functional, psychological, economic, and job-related variables were measured at the time of baseline diagnostic cardiac catheterization, and all patients were followed for 1 year. Three hundred twelve patients underwent percutaneous transluminal coronary angioplasty (PTCA) within 60 days of catheterization, and 449 had coronary artery bypass graft surgery (CABG) within 60 days of catheterization. The remaining 491 patients were treated with initial medical therapy. Logistic regression was used to develop a multivariable model for predicting 1-year work status in the training sample patients (872 patients enrolled between March 1986 and February 1989). This model was then validated in the independent prospective test sample (380 patients enrolled between March 1989 and June 1990). Eight factors were independent predictors of departure from the work force: lower initial functional status (as assessed by the Duke Activity Status Index), followed by older age, black race, presence of congestive heart failure, lower education level, presence of extracardiac vascular disease, poorer psychological status, and lower job classification. Standard clinical variables provided only 20% of the total predictive information available from the model about follow-up work outcomes, whereas functional measures provided 27%, and demographic and socioeconomic measures provided 45%. In the test sample, the area under the receiver operating characteristic curve for the model predictions was 0.74, compared with 0.80 in the training sample, and model predictions agreed well with observed prevalences of return to work. After adjustment for baseline imbalances, there was no significant difference in 1-year return-to-work rates among the patients receiving initial PTCA or CABG therapy versus initial medical therapy. CONCLUSIONS: Patients with coronary disease who are at high risk for premature departure from the work force can be accurately identified from a combination of medical and nonmedical risk factors. The model developed in this study provides a tool to identify patients at high risk for premature loss from the work force. Such patients may benefit from special multidimensional intervention programs designed to preserve work status. Our data show that revascularization with either PTCA or CABG is not, by itself, sufficient to accomplish this goal.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Arthroscopic classification and treatment of lateral epicondylitis: two-year clinical results.

We assessed the clinical utility of 42 arthroscopic releases for lateral epicondylitis in 40 patients (average age, 43 years) with an average of 14 months of symptomatic history before surgery. At arthroscopy, we found 15 type I lesions (intact capsule), 15 type II lesions (linear capsular tear), and 12 type III lesions (complete capsular tear), and associated disorders were found in 69% of the patients. At an average follow-up of 2.8 years, patients were asked to report on elbow pain and function. Subjectively, the patients rated their pain at rest as an average of 0.9 (0 = no pain; 10 = severe pain). They rated their pain with activities of daily living as 1.4 and their pain with sports and work as 1.9. Functionally, they averaged 11.1 of 12 possible points. Of the 39 elbows in the 37 patients who were available for follow-up, 37 were rated "better" or "much better." Patients returned to work in an average of 2.2 weeks. Grip strength averaged 96% of the strength of the unaffected limb. Arthroscopic tennis elbow release is a reliable treatment that allows patients an expedited return to work and may result in greater postsurgical grip strength.

Activities of Daily Living↗
PubMed1992

Clinical outcome and emotional-behavioural status after isolated coronary surgery.

In order to evaluate clinical and psychosocial results of isolated coronary artery by-pass graft (CABG) we studied 626 consecutive patients, mean age 61 +/- 8 years (86% men), in a follow-up (median: 58 months) with a complete questionnaire about cardiosurgical problems (post-operative vital status, angina relapse, infarction, heart failure, PTCA, redo, PM) and psychosocial variables (mood, irritableness, job satisfaction, hobby satisfaction, family relations, sexual activity, general well-being and work status). Global evaluation improvement of psychosocial variables was found in 71% of patients without cardiac events (group A) and 11% of patients with cardiac events (group B); worsening was found in 2% of group A and 1% of group B; no referred variations in 13% and 2% respectively (p < or = 0.05. Interests (in work, hobbies and sexual activities) demonstrate an improvement in 20% (group A) and 2% (group B); worsening in 12% (group A) and 4% (group B); no variations in 51% (group A) and 11% (group B) (p < or = 0.005). Patients reported a well-being evaluation improvement about 66% in the group returning to work without restriction, 13% in those with limitation, 6% no further working; worse or unchanged well-being evaluation was found in 9% of patients returning to work without restriction, 3% with limitation, 3% no further working (p < or = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Breastfeeding works: the role of employers in supporting women who wish to breastfeed and work in four organizations in England.

An important factor influencing duration of breastfeeding is mother's employment status. The main aim of this study was to determine the experience and views of employees (n = 46) in four large public sector organizations concerning breastfeeding support at work. Participants were recruited if they were employed by one of four public service employers and if they were planning to go on maternity leave in the next 6 months, on maternity leave or within 6 months of return from maternity leave. They completed a questionnaire anonymously. Almost 80% of women wanted to continue breastfeeding after returning to work. However, 90% of all respondents were not aware of any employer policy nor offered any information concerning support to enable breastfeeding after returning to work, despite two organizations having a range of maternity- and breastfeeding-related policies in development and some facilities in place. Almost 90% of respondents stated the employers should do more to support breastfeeding. This should include providing pregnant staff with information about breastfeeding support that they should expect and could therefore plan to use, including access to facilities to express and to store breast milk, to enable them to work flexible hours and to take rest breaks during working hours. Recommendations are made for employers.

Adult↗
PubMed2005

Prognostic factors for duration of sick leave due to low-back pain in dutch health care professionals.

BACKGROUND: Information on prognostic factors for duration of sick leave due to low-back pain (LBP) is growing. In this prospective cohort study prognostic factors for duration of sick leave and course of disability were identified in a very early stage of sick leave due to LBP in an occupational health care setting. METHODS: A total of 615 workers calling in sick from work due to LBP at an occupational health service (OHS) of one institution completed a questionnaire. Duration of follow-up was 26 weeks. Prognostic factors were identified by means of Cox regression analysis and multiple linear regression analysis, and explained variance was calculated. RESULTS: Median time to first return to work (RTW) was 5 days (Inter Quartile Range (IQR) = 2-12). Median time to lasting return to work (LRTW) was 6 days (IQR = 3-13). The final model for delayed RTW included self-reported expected duration of sick-leave, treatment by GP or specialist, care-seeking, diminished mobility, and the interaction between care-seeking and diminished mobility. The final model for LRTW included: self-reported expected duration of sick-leave, treatment by GP or specialist, care-seeking, the interaction between the self-reported expected duration of sick-leave and seeking care at OHS, complaints due to job stress, diminished mobility, and the interactions between expected duration of more then 10 days and seeking OP care and diminished mobility. Median total days on sick leave (TDSL) was 6 days (IQR = 3-13 days). The final model for TDSL included: age, expected duration of sick leave, treatment by GP or medical specialist, seeking OP care, complaints due to physical load, and diminished mobility. Explained variance (R2) of these models ranged from 30 to 35%. CONCLUSIONS: Poor prognosis for duration of sick leave can be identified by means of a simple questionnaire administered on the first day of sick leave. Workers at high risk for longer duration of sick leave (all outcomes) expected to stay off work longer, were already being treated by a MD, sought OP care, and had diminished mobility. In case of delayed LRTW workers reported job stress as a possible cause of sick leave. Interactions were found in both RTW and LRTW between care-seeking and diminished mobility and in LRTW between expected duration of sick leave and seeking OP care. Older age increased TDSL with borderline significance.

Adult↗
PubMed2005

Differences among outcome measures in occupational low back pain.

The rate of recurrence in low back pain patients has been reported as high as 70%; therefore, it is believed that researchers have a poor understanding of low back pain recovery. To enhance our understanding of recovery, a large cross-sectional study was conducted to compare outcome measures of return to work, impairment of activities of daily living, pain symptoms, and functional performance probability. A total of 208 workers were examined. The percentage of workers recovered based on return to work criteria was 99% compared to 25% for impairment of activities of daily living, 17% for symptoms, and 12.5% for functional performance probability. Single functional performance measures of range of motion, velocity, and acceleration had recovery rates of 59, 13, and 10%, respectively. It appears that all these criteria are measuring very different parameters of low back pain recovery. The residual loss in functional performance may indicate a decreased tolerance to physical demand providing potential insight for why recurrent low back pain rates are high.

Activities of Daily Living↗