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PubMed1991

Work hardening: a mandate for hand therapy.

Conditioning for return to work has become an integral part of the comprehensive hand rehabilitation program. Through experience and the development of guidelines, the practice of work hardening has matured. Skillful evaluation of the injured worker has enhanced the efficacy of work hardening programs. An understanding of program planning, implementation, and influential economic factors assist the work hardening team in creating and maintaining program excellence.

Adult↗
PubMed2000

Paget-Schroetter syndrome: what is the best management?

BACKGROUND: The evaluation of 312 extremities in 294 patients with Paget-Schroetter syndrome (effort thrombosis of the axillary-subclavian vein) over 30 years provides the basis for optimal management determination. METHODS AND RESULTS: Group I (35 extremities) was initially treated with anticoagulants only. Twenty-one developed recurrent symptoms after returning to work, requiring transaxillary resection of the first rib. Thrombectomy was necessary in eight. Group II (36 extremities) was treated with thrombolytic agents initially, with 20 requiring subsequent rib resection after returning to work. Thrombectomy was necessary only in four. Of the most recent 241 extremities (group III), excellent results accrued using thrombolysis plus prompt first rib resection for those evaluated during the first month after occlusion (199). The results were only fair for those if seen later than 1 month (42). CONCLUSIONS: An early diagnosis (less than 1 month), expeditious thrombolytic therapy, and prompt first rib resection are critical for the best results.

Adolescent↗
PubMed1999

[The effect of myocardial infarct on the employment situation of patients].

INTRODUCTION AND OBJECTIVES: The impact of acute myocardial infarction in labour activity changes from one country to another as well as patients' characteristics. Our purpose was aimed to learn the main demographic, professional, clinical and therapeutic variables which might affect the return to work after suffering a myocardial infarction in our environment. METHODS: 584 patients treated consecutively in our Coronary Unit for 4 years, aged under 65, were studied. The following aspects were analyzed: age, sex, previous ischaemic heart disease, previous working condition, professional level, economical area of labour activity, main therapeutic procedures and complications, number of days of sick leave, posterior labour status and date of invalidity or death, should it occur. The minimum follow up period was two years. RESULTS: 65.3% of patients were regularly working before suffering the myocardial infarction. Mean length of sick leave after myocardial infarction was 243.9 days although it changed according to age and economical areas. 56.6% of the patients returned to work according to age (odds ratio = 0.92), high professional status (odds ratio = 2.14), economical area of services (odds ratio = 2.03), and the presence of previous anginal attacks (odds ratio = 1.73). CONCLUSIONS: In our environment, patients less likely to resume their work after suffering a myocardial infarction are older, working in agricultural and industrial areas, with a lower professional level and without known ischemic heart disease antecedents.

Age Factors↗
PubMed1999

A quality of life study in 20 adult long-term survivors of unrelated donor bone marrow transplantation.

There are few specific data available concerning quality of life (QOL) of survivors of unrelated donor bone marrow transplantation (UD-BMT). The procedure is expensive, difficult and is being employed increasingly yet we have little information concerning the QOL of survivors to justify this intervention. In this study, 20 long-term (>1 year post-BMT) survivors were studied with four self report questionnaires designed to assess quality of life, satisfaction with life, social support and employment status. Overall, satisfaction with life measures was above average but there was dissatisfaction with physical strength and appearance. The post-transplant employment data indicates that 60% of long-term survivors returned to full-time work and 15% to part-time work. Failure to return to work was not correlated with graft-versus-host disease (GVHD), relapse, age at or time since transplant. In general, there was a good correlation between the clinician's and patient's view of their health but the clinician's assessment of the patients mental health and energy was higher than the patients reported. Further research is required in the area of QOL post-UD-BMT. This will enable transplant physicians to counsel patients better pre-BMT and to evaluate fully the results achieved by different centres performing the procedure.

Adolescent↗
PubMedDate not supplied

Structured exercise circuit program for burn patients.

A 10-station structured exercise circuit was developed for burn patients. This conditioning program was designed to accelerate overall functional mobility. The effectiveness of this structured exercise program (SEP) was examined with respect to length of hospitalization, number of outpatient occupational/physical therapy visits required over a three-month period following discharge, and number of days required to return to work post-discharge. Results showed no change in hospitalization. There was, however, a significant decrease in the number of outpatient therapy visits required post-discharge and an earlier return to work date for those patients enrolled in the SEP.

Adult↗
PubMed1992

Early ambulation and discharge in 100 patients with burns of the foot treated by grafts.

Traditional treatment after grafting of foot, ankle, and lower leg burns is bedrest, limb elevation, and gradual ambulation only after 5 to 10 days. In 1982 we suggested that aggressive surgical treatment and early ambulation could shorten hospital stay and decrease morbidity. Our treatment of these burns is excision and grafting, application of an Unna (dome paste) boot immediately in the operating room or the next morning, with normal ambulation 4 hours later and discharge of the patient if there are no other reasons for continued hospitalization. This paper reports the continuation of this plan in 100 patients treated since 1982 with a mean age of 28.8 +/- 16.9 (SD) years and burn size of 3.7% +/- 4.4%. Sheet grafts were applied to 64% with a 96% take and narrowly meshed grafts to 36% with a 97% take. Results were excellent in 85 patients, satisfactory in ten, and poor in three who required another graft. Return to work was in 4.7 +/- 3 weeks. Unna boot application permits immediate ambulation, avoids frequent dressing changes, permits a brief or no hospital stay, and provides excellent graft take with prompt return to work.

Administration, Topical↗
PubMed1996

Calcaneal fractures: operative versus nonoperative treatment.

BACKGROUND: The purpose of this report is to compare the late results after operative and nonoperative treatment of intra-articular calcaneal fractures. METHODS: From 1982 to 1992 we treated 250 calcaneal fractures of which 193 were intra-articular. Because of a change in operative indication, most fractures were treated nonoperatively before 1989 and operatively thereafter. Follow-up was possible at an average of 5.1 years for 124 intra-articular calcaneal fractures. Out of these, two groups of 33 nonoperatively and 30 operatively treated cases were formed matching each other with regard to prognostic parameters. Results were assessed by a clinical score considering pain, gait, footwear, and return to work. Pre- and postoperative tuber joint angle measurements were evaluated for their prognostic significance. RESULTS: In this series of patients, the only statistically significant advantage of operative therapy was concerning return to work. There was no correlation between tuber joint angle and end results. Only when the extremes of the spectrum (nonoperative and operative cases with tuber joint angle < 0 degrees vs. > 25 degrees) were tested against each other was a significant advantage in the group with near normal joint angles found. Thus, open reduction and internal fixation of intra-articular calcaneal fractures can only be expected to benefit those patients with near anatomic reconstruction.

Activities of Daily Living↗
PubMed1988

The role of anterior lumbar fusion for internal disc disruption.

Internal disc disruption is a syndrome of traumatically induced low-back pain arising from the intervertebral disc. The diagnosis is confirmed by abnormal discography with concordant pain reproduction at the affected level or levels. Thirty-four patients with internal disc disruption at one level were followed for an average of 29 months. Eighteen (53%) underwent anterior lumbar fusion at the L4-5 disc, 11 (32%) at the L5-S1 disc and the remainder at the L3-4 or L2-3 disc. Bank bone was used in all but seven patients for interbody fusion. Treatment was judged a success by the patient returning to work or normal activities and requiring either no medications or an antiinflammatory drug only. By the above criteria 25 patients (74%) had successful outcome of treatment. The average time to return to work or normal activities was 6.1 months. The overall union rate was 73% with an average time to union of approximately 12 months. Complications consisted of graft extrusion requiring revision and retrograde ejaculation. These occurred in one patient and were the only complications in the series. We concluded that disc excision and anterior interbody fusion is an effective treatment for internal disc disruption.

Adolescent↗
PubMed2002

Association of comorbidity and outcome in episodes of nonspecific low back pain in occupational populations.

We examined the relationship between comorbidity and first return to work after episodes of work-disabling, nonspecific low back pain (NSLBP). An inception cohort of workers with new episodes of NSLBP was identified from administratively maintained occupational health records. We compared 6-month return-to-work rates between workers with one or more comorbid conditions with those without documented comorbidity. Workers with comorbidity were 1.31 times more likely to remain work disabled than those with uncomplicated NSLBP, after adjusting for age, gender, lifting demands, and company membership (adjusted hazards ratio [HR] = 1.31; 95% confidence interval [CI] 1.12 to 1.52). Concurrent injury (i.e., sprains or strains of the neck, upper extremity, and lower extremity; contusions; and lacerations) had the strongest association (adjusted HR = 1.49; 95% CI, 1.21 to 1.83), followed by musculoskeletal disorders (adjusted HR = 1.13; 95% CI, 0.77 to 1.66). Comorbidities should be routinely evaluated at first visit by occupational health professionals to better manage disability associated with LBP.

Adolescent↗
PubMed2004

[The prognostic value of the Hand Injury Severity Score in industrial hand injuries].

BACKGROUND: We evaluated the value of the "Hand Injury Severity Score" (HISS) in determining the prognosis of industrial hand injuries. METHODS: Hand injury severity scores of 112 patients (17 females, 95 males; mean age 31 years; range 15 to 54 years) were calculated following surgery for industrial hand injuries. During the course of rehabilitation program, the patients were followed-up regularly. Pearson correlation coefficients were used to determine the relationship between the HISS scores and the time intervals from injury to healing and return to work. RESULTS: The mean HISS score was 37.1+/-27 (range 6 to 116). The time to healing ranged from 12 to 210 days (mean 73.7+/-40.7 days). All the patients returned to work after a mean of 80.4+/-52.9 days (range 7 to 300 days), mainly to previous working places with (12%) or without (79%) changing job activities. Nine per cent of the workers had to change their jobs. The HISS scores were found to be correlated with the healing period and the time to work (p<0.05 and p<0.000, respectively). CONCLUSION: The results of this study indicated that HISS was a useful system in predicting the prognosis in the early stages of industrial hand injuries.

Accidents, Occupational↗
PubMed1991

Long-term outcome of massive small bowel resection.

The long-term outcome for seven patients 4-17 yr (mean 7.1 yr) after massive small bowel resection, leaving 5-160 cm (mean 86.4) of small bowel, was reviewed. Their mean age at the final enterectomy was 40 yr. Adaptation to foodstuffs and the effects of physiologic alterations and complicating diseases on their return to work were emphasized. More than 3.5 yr after surgery, the patients had adapted to many kinds of foodstuffs, but dietary fat could not be tolerated by three patients. Six patients returned to work an average of 2.7 yr after surgery, but four were obliged to discontinue their work because of rehospitalization for long-term complications. In addition, their working hours were limited, and they could not engage in heavy physical work, owing to physiologic alterations, such as a reduced metabolic state, after massive enterectomy.

Adult↗
PubMed1993

Effects of changing the pattern of sickness absence referrals in a local authority.

The high costs of sickness absence in North Tyneside Metropolitan Borough Council prompted a review of the system of referral of cases of long-term sickness absence to their occupational health service for opinion about fitness to work. Earlier and more consistent referral of these employees produced reductions in average lengths of sickness absence. Time off before medical retirement was reduced from 72 weeks to 53 weeks, and time off before returning to work was reduced from 40 weeks to 25 weeks. Exact figures of the financial savings could not be calculated, but the estimated saving was 760,000 pounds in the first year. Although the occupational health service was not responsible for the whole of this saving, it played an important role in the exercise. It was concluded that earlier referral of employees with long-term sickness absence enabled decisions about returning to work to be made sooner, thus saving large amounts of money.

Absenteeism↗
PubMed1997

[Multidisciplinary treatment program on chronic low back pain, part 4. Prognosis of treatment outcome and final conclusions].

PROBLEM: Studies using a multimodal approach in order to prognose therapeutic success in patients suffering from back pain were seen to have highly diverse results. However, in spite of various independent health care systems, a common interest prevails in identifying determinants of therapeutic success in order to improve therapy. METHODS: Ninety disabled patients with chronic low back pain were admitted to an 8-week out-patient program of functional restoration and behavioral support. The program consisted of a pre-program (education, stretching and calisthenic exercises 4 h a day, three times a week for 3 weeks) and an intensive treatment period (physical exercises, back school education, cognitive behavioral group therapy, relaxation training, occupational therapy, socioeconomic and vocational counseling) which took place for 5 weeks, 7 h a day as an outpatient program. The program's philosophy encourages active effort on the patients' part in order to improve their functional status within a therapeutic environment. This reinforces behavior conducive to getting well, enhances the patients' sense of self-control over their pain and the resulting disability. The main therapeutic target was to facilitate the patients' return to work. Apart from medical examination and personal interview, the patients' physical impairment, pain descriptions, and psychological distress were also measured. This included variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and following 6 and 12 month intervals. The reliability of prognostic factors in predicting treatment outcome (return to work, reduction of pain intensity, self-assessment of success by the patients) was tested by analyses of variance and discriminant function analyses. RESULTS: Patients' return to the workplace could be predicted in 85% of cases based on whether an application for pension had been made, on the length of duration of work disability, and on "fixed" assumptions on the part of the patient concerning his work situation. Pre-treatment somatic findings (for example, diagnosis, degree of physical impairment, and functional debilities), together with depressive and psychovegetative reactions, were shown to have no connection with the patient's ability to return to the workplace. Similar findings were demonstrated for the prediction of pain reduction and patient satisfaction with treatment. CONCLUSIONS: Predicting successful treatment is hardly possible without analyzing individual circumstances, focusing on sociodemographic variables, workplace-related conditions, and aspects of individual motivation. With regard to objective therapeutic success, subjective perceptions proved highly influential. Treatment proved successful only when the patient's perception of functional disability was minimized. Hence, individual perceptions and experiences were more important than physical capabilities.

English Abstract↗
PubMed2002

Vocational rehabilitation in patients with chronic rheumatic diseases: a systematic literature review.

OBJECTIVE: To describe the effectiveness of vocational rehabilitation programs for patients with chronic rheumatic diseases by means of a systematic review of the literature. METHODS: Data were obtained by a computer-aided and manual search of the literature from 1980 until May 2001. Vocational rehabilitation programs had to be clearly defined interventions specifically aimed at having patients with rheumatic diseases reenter or remain in the work force. The vocational rehabilitation programs had to be executed by one or more health professionals. Outcome of the intervention had to be described in terms of vocational status (work disability, sick leave, job modification, paid occupation, retraining). RESULTS: Six studies were identified. All were uncontrolled studies. Follow-up periods ranged 2-84 months. Five of six vocational rehabilitation programs consisted of multidisciplinary intervention and 15% to 69% of the patients successfully returned to work. CONCLUSIONS: Although 5 of 6 studies showed a marked positive effect of vocational rehabilitation on work status, proof of the benefit of these interventions is limited, mainly due to methodologic differences and shortcomings. RELEVANCE: Work disability is a major consequence of the disease in patients with rheumatic conditions. More and more attention is being paid to preventing disability and promoting return to work. Knowledge regarding the effectiveness of vocational rehabilitation programs is insufficient. Semin Arthritis Rheum 32:196-203.

Chronic Disease↗
PubMed2002

Different functional treatment strategies for acute lateral ankle ligament injuries in adults.

BACKGROUND: Acute lateral ankle ligament ruptures are common problems in present health care. Early mobilisation and functional treatment are advocated as a preferable treatment strategy. However, functional treatment comprises a broad spectrum of treatment strategies and as of yet no optimal strategy has been identified. OBJECTIVES: The objective of this review is to assess different functional treatment strategies for acute lateral ankle ligament ruptures in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (December 2001), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966 to May 2000), EMBASE (1980 to May 2000), CURRENT CONTENTS (1993 to 1999), BIOSIS (to 1999), reference lists of articles, and contacted organisations and researchers in the field. SELECTION CRITERIA: Randomised clinical trials describing skeletally mature individuals with an acute lateral ankle ligament rupture and comparing different functional treatment strategies were evaluated for inclusion. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the quality of included trials and extracted relevant data on treatment outcome. Where appropriate, results of comparable studies were pooled. Individual and pooled statistics are reported as relative risks (RR) for dichotomous outcome and (weighted) mean differences (WMD) for continuous outcome measures with 95 per cent confidence intervals (95%CI). Heterogeneity between trials was tested using a standard chi-squared test. MAIN RESULTS: Nine trials involving 892 participants were included. Lace-up ankle support had significantly better results for persistent swelling at short-term follow up when compared with semi-rigid ankle support (RR 4.19, 95% CI 1.26 to 13.98); elastic bandage (RR 5.48; 95% CI 1.69 to 17.76); and to tape (RR 4.07, 95% CI 1.21 to 13.68). Use of a semi-rigid ankle support resulted in a significantly shorter time to return to work when compared with an elastic bandage (WMD (days) 4.24; 95% CI 2.42 to 6.06); one trial found the use of a semi-rigid ankle support saw a significantly quicker return to sport compared with elastic bandage (RR 9.60; 95% CI 6.34 to 12.86) and another trial found fewer patients reported instability at short-term follow-up when treated with a semi-rigid support than with an elastic bandage (RR 8.00; 95% CI 1.03 to 62.07). Tape treatment resulted in significantly more complications, the majority being skin irritations, when compared with treatment with an elastic bandage (RR 0.11; 95% CI 0.01 to 0.86). No other results showed statistically significant differences. REVIEWER'S CONCLUSIONS: The use of an elastic bandage has fewer complications than taping but appears to be associated with a slower return to work and sport, and more reported instability than a semi-rigid ankle support. Lace-up ankle support appears to be effective in reducing swelling in the short-term compared with semi-rigid ankle support, elastic bandage and tape. However, definitive conclusions are hampered by the variety of treatments used, and the inconsistency of reported follow-up times. The most effective treatment, both clinically and in costs, is unclear from currently available randomised trials.

Adult↗
PubMed1996

A four-year experience with laparoscopy in the management of appendicitis.

BACKGROUND: The study was conducted to determine the influences of laparoscopy in the management and outcome of patients with appendicitis. METHODS: A retrospective analysis of 154 consecutive patients who were treated for suspected appendicitis. The pre-operative diagnosis included appendicitis, right lower quadrant pain of unknown etiology, and generalized peritonitis. RESULTS: Laparoscopy was used in 108 patients, including 70 laparoscopic appendectomies (LA) and 31 LAs converted to open appendectomy (OA). Forty-six patients had OA. The average operating time for LA was 74.3 minutes and 48.8 minutes with OA. Postoperative complications for LA (7%) included 1 trochar wound hemorrhage, 2 wound infections, and 2 intra-abdominal sepsis; and for OA (9%) were 1 post-operative intra-abdominal hemorrhage, 4 wound infections, 1 wound dehiscence, and 1 intra-abdominal sepsis. Post-operative stay for LA averaged 2.5 days and for OA averaged 4.5 days (P = .0049). LA patients had a considerably faster return to work and/or normal activity than OA patients (P = .00065). CONCLUSIONS: Laparoscopy influenced the management of 29% of patients presenting with suspected appendicitis. LA resulted in shorter hospitalization and a more rapid return to work and/or normal activity than OA.

Adolescent↗
PubMed2002

[Postoperative rehabilitation of patients with carpal tunnel syndrome].

The purpose of this study was to investigate the effect of mobilisation or splinting on symptoms after surgical Treatment of Carpal Tunnel Syndrome. Only original articles concerning the effect of mobilisation or splinting on symptoms after surgical Treatment of Carpal Tunnel Syndrome were included in this investigation. Concerning these topics only seven original articles were found. There was no significant influence of splinting for several weeks found on the symptom "pain" in the literature. Even there was a delay of returning to activities of daily living and the recovery of fist und keypinch strength through splinting. A program of physiotherapy and ergotherapy lead to a significant shorter recovery of dexterity in comparison to an home exercise program. Even the rehabilitated patients showed a shorter return-to-work interval. After carpal tunnel surgery neither physiotherapy nor splinting lead to a significant release of the symptom "pain". But physiotherapy leads to a shorter recovery of dexterity and shorter return-to-work interval. Due to the lack of knowledge about this topic further controlled clinical studies investigating the rehabilitation process after carpal tunnel surgery would be necessary.

Carpal Tunnel Syndrome↗
PubMed2002

Industrial medicine and acute musculoskeletal rehabilitation. 4. Evaluation and management of the injured worker with a lower-extremity injury.

UNLABELLED: This self-directed learning module highlights the importance of recognizing the relationships between multiple, concurrent joint injuries in the lower extremity of an injured worker. This chapter focuses on evaluating the lower extremity and devising a rehabilitation program that incorporates the entire kinetic chain. Further recommendations for return to work are discussed. OVERALL ARTICLE OBJECTIVES: (a) To accurately recognize and diagnose coexisting injuries in the lower extremity and (b) to devise an evaluation and treatment program enabling the worker to return to work.

Acute Disease↗