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PubMed1991

Percutaneous laparoscopic cholecystectomy: the first fifty.

A series of 50 percutaneous laparoscopic cholecystectomies was performed by one surgeon between 7 June and 25 October 1990 using a modified technique as described by Dubois. There were 42 females and 8 males, the average age being 44 years with a range of 14-76 years. The average operating time was 80 min, ranging from 35 to 210 min. Postoperative stay averaged 2.9 days and there was an average of 11 days to return to work. Complications consisted of a subhepatic bile collection requiring open drainage, one minor wound infection and one minor abdominal wall haematoma. Laparoscopic cholecystectomy is a safe technique for removing the gall-bladder resulting in a rapid convalescence and early return to work. The initial learning curve is long and careful case selection should be carried out in this phase.

Adolescent↗
PubMed1986

Psychosocial problems among survivors of Hodgkin's disease.

The psychosocial problems that develop in long-term survivors of Hodgkin's disease were examined in a cross-sectional survey of 403 patients. The average age at treatment was 27 years and at interview was 36 years. The median time since treatment was 9 years. Sixty percent of the patients were treated for stage I or II disease and 40% for stage III or IV. Eighty-two percent of the patients had never relapsed, and 98% were free of disease at the time of interview. The study investigated the type and frequency of problems by means of a self-administered questionnaire using standard survey items to assess disruption in three areas of life: sense of well-being, family relationships, and employment. Results indicate that energy had not returned to patients' satisfaction in 37% of the cases. This was influenced by age, time since therapy, stage of disease, and type of treatment. Patients with self-reported energy loss were more likely to be depressed. Moderately high divorce rates (32%), problems with infertility (18%), and less interest in sexual activity (20%) were reported. Employment patterns favored men returning to work, and number of hours worked was highly correlated with less depression, younger age, and return of energy. Difficulties at work were reported by 42% of the cases. The interaction of treatment, biologic, psychosocial, and functional variables is described.

Adolescent↗
PubMed1988

Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment.

Twenty-seven shoulders (in 26 patients) that had surgical repair of a rupture of the long head of the biceps tendon between 1962 and 1981 were evaluated at three to 22 years after injury (mean, 13 years). Thirty similar patients had been treated nonsurgically and were evaluated two to 15 years (mean, 4.6 years) after tendon rupture. Biomechanical testing was performed on ten patients in the surgical group and 13 in the nonsurgical group. Residual arm pain was infrequent in both surgically and nonsurgically treated groups. Residual subjective weakness at the elbow was reported in four of the surgical group and in 20 of the nonsurgical group. Surgically treated patients returned to work later than nonsurgical patients; however, 11 in the nonsurgical group were not able to return to full work capacity, versus only two in the surgical group. On biomechanical testing, the nonsurgical group had lost a mean of 21% of supination strength and 8% of elbow flexion strength but had no weakness in grip, pronation, or elbow extension. The surgical group had lost no strength in any of these testing modes.

Adult↗
PubMedDate not supplied

Molten metal burns to the lower extremity.

In this study of ten consecutive patients sustaining molten metal injuries to the lower extremity who were treated with excision and grafting, treatment with compression Unna paste boot was compared with that with conventional dressing. Hospital stay was decreased from 12.2 days in the conventional dressing group (five patients) to 6.4 days in the Unna group (five patients). Ambulation was initiated on postoperative day (POD) 2.2 in the Unna group, compared with POD 8.0 in the conventional dressing group. Return to work was on POD 44.8 in the Unna group versus POD 86.3 in the conventional dressing group. Treatment of molten metal injuries to the lower extremity with Unna paste compression dressing resulted in shorter hospital stay, earlier ambulation, and more rapid return to work.

Accidents, Occupational↗
PubMed1995

Nonphysical factors that affect work hardening success: a retrospective study.

The high cost of health care and limited information regarding the effects of work hardening have prompted a need to further study work hardening programs. The purpose of this study was to determine the success of a work hardening program that included physical, occupational, and psychological therapies, and to determine if there are nonphysical factors associated with successful work hardening. One hundred medical records of injured workers with low back pain and other musculoskeletal disorders were retrospectively reviewed. Factors examined included months of injury, education level, sex, race, presence of an attorney, prior surgery, pain behaviors, smoking, medication use, and diagnosis severity. Seventy-six percent of the subjects successfully completed the program, and 50% of the subjects were returned to work at discharge. Nonphysical factors that limited successful work hardening were presence of pain behaviors (p < .01), attorney representation (p < .01), McAndrews score above 70 (p < .05), and education less than high school (p < .05). The author concludes that the return to work rate for injured workers in this study is comparable to rates of previous studies and that there are nonphysical factors associated with the success of work hardening.

Adult↗
PubMed1992

[Changes in occupational status following cancer. An empirical study on occupational rehabilitation].

The importance of vocational integration has increased during the last years, whereas an analysis of the literature shows, that research in this field has been neglected especially in german speaking countries. This study investigates the situation and the problems of vocational integration after cancer. 380 former patients with different diagnoses treated in a university medical center have been asked by a self developed questionnaire for their experiences in treatment and medical rehabilitation, their actual impairment in physical and vocational functioning, their estimation of rehabilitation success, their actual employment problems and the changes of job conditions due to cancer. As the results show, more than one third of the sample returned to work often reducing working time or changing their job. Especially older patients with worse prognoses have been retired early. Special programs of vocational rehabilitation are not used by patients we examined, whereas programs of medical rehabilitation are used showing great differences between diagnostic groups. The return to work is influenced by age, tumor localisation, prognosis and the former status in job. The results are discussed with regard to the problems of psychosocial rehabilitation of cancer patients.

Adaptation, Psychological↗
PubMed2005

Employer, insurance, and health system response to long-term sick leave in the public sector: policy implications.

This study has been conducted to describe the situation of long-term sick-listed persons employed in the public sector regarding the medical reasons of their sick leave, the duration of their problems, the duration of the actual sick leave, rehabilitation support, rehabilitation measures, and the persons expectations of the future. Response rate of a postal questionnaire, where 484 women and 51 men on long-term sick leave answered, was 69%. The study-group consisted of 90% women with a median age of 50 years. The most common reasons for sick listing were long-lasting musculoskeletal problems, especially neck/shoulder pain, low back pain and osteoarthritis or other joint problems and mental problems, especially depression and burn-out syndromes. Forty-seven procent of the men and 57% of the women had been on the sick list for more than a year. Only half of them had been subjected to the legally required rehabilitation investigation of the employer This half got access to rehabilitation programs and/or vocational rehabilitation to a greater extent than those who not had been subjected to rehabilitation investigation. Less than half had been in contact with the workplace-connected rehabilitation actors, the Occupational Health Service or the Trade Union. In spite of this the sick-listed persons had a positive view of their future return to work. For long-term sick-listed persons in the public sector, there is a great potential for improvements of the rehabilitation at the workplace arena, in the involvement and cooperation between the already existing rehabilitation actors, in order to promote return to work.

Absenteeism↗
PubMed2005

Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review within the Cochrane Collaboration Back Review Group. OBJECTIVES: To assess the effectiveness of back schools for patients with nonspecific low back pain (LBP). SUMMARY OF BACKGROUND DATA: Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating patients with LBP. However, the content of back schools has changed and appears to vary widely today. METHODS: We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials to November 2004 for relevant trials reported in English, Dutch, French, or German. We also screened references from relevant reviews and included trials. Randomized controlled trials that reported on any type of back school for nonspecific LBP were included. Four reviewers, blinded to authors, institution, and journal, independently extracted the data and assessed the quality of the trials. We set the high-quality level, a priori, at a trial meeting six or more of 11 internal validity criteria. Because data were clinically and statistically too heterogeneous to perform a meta-analysis, we used a qualitative review (best evidence synthesis) to summarize the results. The evidence was classified into four levels (strong, moderate, limited, or no evidence), taking into account the methodologic quality of the studies. We also evaluated the clinical relevance of the studies. RESULTS: Nineteen randomized controlled trials (3,584 patients) were included in this updated review. Overall, the methodologic quality was low, with only six trials considered to be high-quality. It was not possible to perform relevant subgroup analyses for LBP with radiation versus LBP without radiation. The results indicate that there is moderate evidence suggesting that back schools have better short- and intermediate-term effects on pain and functional status than other treatments for patients with recurrent and chronic LBP. There is moderate evidence suggesting that back schools for chronic LBP in an occupational setting are more effective than other treatments and placebo or waiting list controls on pain, functional status, and return to work during short- and intermediate-term follow-up. In general, the clinical relevance of the studies was rated as insufficient. CONCLUSION: There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain and improve function and return-to-work status, in the short- and intermediate-term, compared with exercises, manipulation, myofascial therapy, advice, placebo, or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodologic quality and clinical relevance and evaluate the cost-effectiveness of back schools.

Humans↗
PubMed1988

Profile of half-day arthroscopic surgery in a district general hospital.

The first 50 patients who underwent arthroscopic surgery as a half-day procedure in Doncaster Royal Infirmary were studied: 22 patients underwent an arthroscopic meniscectomy and 6 patients had other procedures. The mean return-to-work time for meniscectomy patients was 23.9 days. The cost improvement per patient, when compared with a two-night stay in hospital, was pounds 432.84 per patient. Not only is this a comparatively comfortable operation for the patient, but a rapid return to work is possible. The saving to the Department of Health and Social Security, when assessed on a national scale, could be very considerable.

Adolescent↗
PubMed1996

[The duration of breast feeding and work activity].

The objective of this work was to study the influence of working conditions and socio-demographic, personal and social support factors on the duration of breast-feeding. The study population consisted of primiparous or secundiparous women who have had a child in a Valencian public hospital and who have carried out a professional activity during their pregnancy. Information was collected by means of a face-to-face interview in the maternity ward two days after childbirth, a telephone interview five months later and a postal questionnaire one hear after childbirth. A total of 545 surveys were obtained. A simple analysis of the data was carried out. A total of 64% of the mothers reported after one year that they had breast-fed. Seventeen percent breast-fed for one month or less, 13.3% for two months, 24.8% for three months, 12.7% for four months and 32.3% for 5 or more months. The duration of breast-feeding was longer among women over 25 years of age, among secundiparous women and among those who did not return to work after childbirth. It was shorter among those whose maternity leave was shorter and among those whose husbands work without a contract. Therefore, among women who carry-out paid work, the main factor which limits the duration of breast-feeding is the return to work after childbirth. The application of certain measures which favour maintaining breast-feeding (reduction of working day, flexibility in work hours, etc.) should be done so with caution and always with the mother's consent and without this implying a risk for the continuity in work and professional promotion.

Adult↗
PubMed1978

Availability of retired persons for work: findings from the retirement history study.

The increase in the proportion of retirees in the population has given rise to concern that the financial burden on workers could become onerous. Consequently, considerable interest has developed in encouraging workers to delay retirement until age 65 and beyond. The effectiveness of programs to accomplish this objective would be enahnced by knowledge of the reasons for early retirement and the characteristics of those who have retired. On the basis of three waves of longitudinal data from the Retirement History Study, an availability measure has been constructed to provide estimates of how many recent retirees would be likely, given the opportunity, to return to work. Incorporating information on perceived income adequacy and work attitudes, the measure is applied in this article to men and women aged 62 to 67 in 1973 who had retired since 1969. An initial screening to determine those with work limitations removed half the retirees from consideration, and the measure indicates that relatively few of those remaining would have been readily available to return to work.

Age Factors↗
PubMed1990

Fetal homotransplants (ventral mesencephalon and adrenal tissue) to the striatum of parkinsonian subjects.

Fetal ventral mesencephalon and fetal adrenal tissue grafted to the caudate nucleus of four and three parkinsonian patients, respectively, have been shown to be an alternative treatment for the amelioration of the signs of the disease. The ventral mesencephalon patients had a significant amelioration of rigidity, bradykinesia, postural imbalance, gait disturbance, and facial expression. Three of these four patients have returned to work. The fatal adrenal group only showed amelioration of rigidity and bradykinesia. Though these patients are now able to perform their basic daily living activities, and one of them has renewed her household tasks, the other two have not yet been able to return to work. The differences observed between the ventral mesencephalon- and the fetal adrenal-transplanted patients may be related to the heterogeneity of their disease and/or the type of graft implanted. However encouraging our results may be, this experimental procedure obviously requires further studies, and should not be practiced outside of highly qualified clinical research centers.

Adrenal Glands↗
PubMed2004

Back schools for non-specific low-back pain.

BACKGROUND: Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating patients with low-back pain (LBP). However, the content of back schools has changed and appears to vary widely today. OBJECTIVES: To assess the effectiveness of back schools for patients with non-specific LBP. SEARCH STRATEGY: We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials to May 2003 for relevant trials reported in English, Dutch, French or German. We also screened references from relevant reviews and included trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) that reported on any type of back school for non-specific LBP were included. DATA COLLECTION AND ANALYSIS: Four reviewers, blinded to authors, institution and journal, independently extracted the data and assessed the quality of the trials. We set the high quality level, a priori, at a trial meeting six or more of 11 internal validity criteria. As data were clinically and statistically too heterogeneous to perform a meta-analysis, we used a qualitative review (best evidence synthesis) to summarize the results. The evidence was classified into four levels (strong, moderate, limited or no evidence), taking into account the methodological quality of the studies. We also evaluated the clinical relevance of the studies. MAIN RESULTS: Nineteen RCTs (3584 patients) were included in this updated review. Overall, the methodological quality was low, with only six trials considered to be high quality. It was not possible to perform relevant subgroup analyses for LBP with radiation versus LBP without radiation. The results indicate that there is moderate evidence suggesting that back schools have better short and intermediate-term effects on pain and functional status than other treatments for patients with recurrent and chronic LBP. There is moderate evidence suggesting that back schools for chronic LBP in an occupational setting, are more effective than other treatments and placebo or waiting list controls on pain, functional status and return to work during short and intermediate-term follow-up. In general, the clinical relevance of the studies was rated as insufficient. REVIEWERS' CONCLUSIONS: There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain, and improve function and return-to-work status, in the short and intermediate-term, compared to exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodological quality and clinical relevance and evaluate the cost-effectiveness of back schools.

Exercise↗
PubMed2002

A social psychology approach to measuring vocational rehabilitation intervention effectiveness.

It is rare for rehabilitation researchers to report substantial relationships between functional capacity and vocational rehabilitation achievements. The reason for this is that there are many other factors that also impact on the return-to-work outcomes people achieve. A solution to the problem of having to take into consideration the effects of multiple factors when evaluating intervention effectiveness is to focus more directly on cognitions and behaviors that have been theoretically and empirically linked with a satisfactory return to work. The aim of this paper is to explore and describe a measure of rehabilitation effectiveness based in cognitive-behavioral theory. Rather than the measurement of employment per se, the described measure is focused on the efforts individuals make in relation to achieving their desired outcome. To test the effectiveness, acceptability, and utility of the approach, the measure was trialed with 170 people with a spinal cord injury. This preliminary work has revealed that participants found the measure acceptable and gave detailed responses in regards to: their satisfaction with their vocational status; what it is they would prefer to be doing; and what it is that they are doing to achieve their aims. Study findings suggest that while the approach is likely to require further development, focusing on process variables holds promise as an evaluation approach when assessing the success of vocational rehabilitation intervention effectiveness.

Adult↗
PubMed1997

A prospective study of Waddell signs in patients with chronic low back pain. When they may not be predictive.

STUDY DESIGN: Analysis of the treatment-outcome predictive power of Waddell signs by evaluating them before and after functional restoration, with assessment of 1-year socioeconomic outcomes. OBJECTIVE: To evaluate the presence of Waddell nonorganic signs in a group of patients with chronic low back pain presenting for functional restoration, and to determine whether they were predictive of treatment success of failure. SUMMARY OF BACKGROUND DATA: Waddell has described "nonorganic" physical signs in patients with chronic low back pain indicative of somatization. Other researchers have correlated high Waddell scores with psychosocial barriers that required additional consultation, and have suggested that diminution of a Waddell score during physical rehabilitation is predictive of subsequent therapeutic success. METHODS: Total positive Waddell signs score and individual sign scores were assessed at initial presentation for functional restoration treatment and at discharge in a group of 50 patients with chronic low back pain (average length of disability = 17.9 months; average age = 38.5 years). Patients were then tracked and assessed with a 1-year follow-up structured interview to evaluate outcome variables such as return to work, work retention, re-injury rate, health utilization, and subsequent surgery. RESULTS: Statistical analyses of these data revealed no significant associations between Waddell total positive score or changes in score and therapeutic success as measured by any of the behavioral outcomes such as return to work. Also, no predictive value was found for the individual positive signs of their changes and therapeutic success. CONCLUSIONS: Although positive Waddell signs have been found to be predictive in patients with short-term chronic low back pain, the current results suggest that, in patients who have longer duration of pain and who undergo a comprehensive functional restoration program, these signs are not significantly prognostic. Because functional restoration is an interdiscipilinary approach that effectively manages somatization complaints in a consistent manner by all treatment personnel, such complaints do not create any major barriers to recovery. Therefore, although Waddell signs may be predictive of treatment outcome in less intensive rehabilitation programs, they do not provide any predictive power in a comprehensive functional restoration program, which has a basic goal of managing barriers to recovery in a clinically efficacious manner.

Adult↗
PubMed1997

Early physician notification of patient disability risk and clinical guidelines after low back injury: a randomized, controlled trial.

STUDY DESIGN: Back-injured workers with high disability risk scores on a predictive questionnaire participated in a randomized, controlled trial of physician notification, with outcomes follow-up 3 months after injury. OBJECTIVES: To test whether physician intervention improves return to work and self-assessment outcomes for people at relatively high risk for disability. SUMMARY OF BACKGROUND DATA: Only a small number of back-injured workers suffer significant disability. Quick identification of these people would facilitate more efficient targeting and trials of interventions. Controlling variations in practice through practice guidelines has been recommended as a promising strategy for improving care and reducing disability. METHODS: Workers filing back injury reports responded to a disability prediction questionnaire. Those with high risk scores were randomly assigned to control or intervention groups. Patient-designated physicians in the intervention group received two letters identifying the patient's risk and making recommendations for care, including the Agency for Health Care Policy and Research's algorithms for acute low back pain. Predictive accuracy of the questionnaire and efficacy of physician intervention were evaluated on the basis of work status and self-assessments 3 months after injury. RESULTS: Of the 268 workers completing the questionnaire portion of the study, 32 (12%) were out of work because of back pain 3 months after injury. The questionnaire's predictive accuracy included maximum kappa of 0.277 and a receiver operating curve area of 0.78. Fifty-three people completed the physician intervention trial. The intervention had no significant impact on return to work, self-assessed pain, or satisfaction with health care. CONCLUSIONS: Stratification of back-injured people according to disability risk can can increase intervention efficiency by identifying those who require treatment and sparing those who do not. The apparent failure of risk notification and practice guidelines to reduce disability in this study may be improved by different application methods in the future.

Adolescent↗
PubMed2001

Effectiveness of lumbar facet joint nerve blocks in chronic low back pain: a randomized clinical trial.

This randomized clinical trial was designed to determine the effectiveness of therapeutic lumbar facet joint nerve blocks. Two hundred patients were evaluated with controlled diagnostic blocks for the presence of facet joint mediated pain. Eighty four patients, or 42% were determined to have lumbar facet joint mediated pain. These patients were randomly allocated into two groups: Group I receiving therapeutic injections with local anesthetic and Sarapin, and Group II receiving therapeutic injections with a mixture of local anesthetic, Sarapin, and methyl prednisolone. A total of 73 patients were treated with medial branch blocks under fluoroscopy. Results showed that patients underwent multiple procedures over a period of 2(1/2) years. The mean number of procedures or interventions was 2.5 +/- 0.09 from 1 to 3 months, whereas it was 4 +/- 0.13 for 4 to 6 months, 6.1 +/- 0.21 for 7 to 12 months, and 8.4 +/- 0.31 for 13 to 32 months. Cumulative significant relief with one to three injections was 100% up to 1 to 3 months, 82% for 4 to 6 months, 21% for 7 to 12 months, and 10% after 12 months, with a mean relief of 6.5 +/- 0.76 months. There was significant improvement noted in overall health status with improvement not only in pain relief, but also with physical, functional, and psychological status, as well as return-to-work status. In conclusion, the results of this study demonstrate that medial branch blocks with local anesthetic and Sarapin, with or without steroids, are a cost effective modality of treatment, resulting in improvement in pain status, physical status, psychological status, functional status and return to work.

Journal Article↗
PubMed1990

Gallstone lithotripsy vs cholecystectomy. A preliminary cost-benefit analysis.

From July 1988 to January 1989, we compared the course of 48 patients undergoing elective cholecystectomy with that of 18 undergoing extracorporeal shock wave lithotripsy for symptomatic cholelithiasis with respect to treatment, hospitalization, recovery, and cost. For elective cholecystectomy, average length of surgery was 76 minutes (range, 31 to 186 minutes); average length of stay was 4 days; total cost was $6240; morbidity was 10%; and return to work averaged 5 weeks. Average extracorporeal shock wave lithotripsy treatment length was 136 minutes (80 to 158 minutes); average length of stay was 2 days; total cost was $5921; and hematuria and petechiae were seen in 33% and 28%, respectively. Re-treatment cost was $4880. All of these patients were active in 24 hours; return to work averaged 3 days. As results of the Food and Drug Administration study are still pending, recurrence and re-treatment rates are unknown. We conclude that extracorporeal shock wave lithotripsy is less costly, initially, with further reductions probable when performed on an outpatient basis. Though re-treatment may be required, return to normal activity is dramatically shortened.

Adult↗