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PubMed2003

Predictors for return to work in patients with median and ulnar nerve injuries.

PURPOSE: One of the consequences of median and ulnar nerve trauma is delayed return to work. The aim of this study was to determine return to work (RTW) and risk factors for delayed RTW in addition to time off work (TOW). Differences among median, ulnar, and combined median-ulnar nerve injuries were examined. METHOD: In this study 96 patients who were employed at the time of injury and who had undergone surgery for median, ulnar, or combined nerve injuries between 1990 and 1998 were evaluated. The response rate was 84% (n = 81). RESULTS: Within 1 year after injury, 59% (n = 48) returned to work. Mean TOW was 31.3 weeks. Return to work after combined nerve injuries was 24% versus after isolated median (80%) and ulnar (59%) nerve injuries. Level of education, type of job, and compliance to hand therapy were predictors for RTW. Furthermore, grip strength loss, tip pinch strength loss, and sensory recovery differed strongly between the RTW and no-RTW population. CONCLUSIONS: The predictors found in this study increase our understanding of delayed RTW after median and ulnar nerve injury and may be used to optimize postinjury rehabilitation.

Accidents, Occupational↗
PubMed2002

[Occupational physician's role regarding return to work of workers with acquired disability].

Occupational physicians are expected to play important roles in helping workers with an acquired disability return to work. However, the key elements to develop a successful program to help these workers return to work are still unclear. In this study, we searched the literature referring to occupational physicians' role in the return-to-work process of the workers with acquired disability. Many of these studies mentioned the following; occupational physicians should start co-operating with the treating physician right after the appearance of the disability and exchange medical and occupational health information with each other. When a disabled worker wishes to return to work, the occupational physician in charge should carefully evaluate his/her work ability, and fitness for the work. We also performed a hearing survey at 15 diverse institutions and organizations that are generally aimed at promoting employment, social welfare and medical service for disabled persons located in at least a 5 million population prefecture in Japan. Among them, the Local Occupational Center for the Disabled functions as the practical gateway for employment, and the Health and Welfare Center is the principal window for the social welfare of the disabled. However, their services are sometimes limited to only those who have become jobless and not for those returning to their original work. We considered that occupational physicians should also communicate positively with the organizations to promote successful returning of the workers with acquired disability to their former work.

Data Collection↗
PubMed1997

Case management at work for SSA disability beneficiaries: process results of the Project NetWork return-to-work demonstration.

This article presents the results of the process analysis of the evaluation of the Project NetWork demonstration, a Federal demonstration undertaken by the Social Security Administration (SSA) in 1991 to test alternative methods of providing rehabilitation and employment services to SSA's Disability Insurance beneficiaries and Supplemental Security Income disabled and blind applicants and recipients. The major findings are: (1) from an operational standpoint, it is feasible to expand access to vocational rehabilitation (VR) services to a broad spectrum of SSA beneficiaries, and (2) roughly similar results are achieved, in terms of client intake and provision of services, when case management services are provided by SSA staff, contracted out to State VR agencies, or contracted with private VR providers. Later evaluation reports will trace demonstration impacts on earnings and disability benefits and report the overall benefits and costs of return-to-work services for this population.

Adolescent↗
PubMed1996

Prognostic factors for return to work after a first compensated episode of back pain.

OBJECTIVES: To determine which factors measured at baseline and during the course of treatment influence time to return to work after a first compensated episode of back pain. METHODS: The design is a treatment inception cohort including 305 compensated workers out of 402 eligible ones presenting at two rehabilitation centres for conventional treatment. Crude and adjusted rate ratios (RRs) along with 95% confidence intervals (95% CIs) were estimated with the Cox's proportional hazards regression. RESULTS: 50% of workers had not returned to work after 112 days of follow up, and 11.3% still had not after 270 days. At the end of the study period (maximum follow up time was 1228 days), 230 workers (75.4%) had returned to work, 6.5% had not, and a similar percentage had retired, gone into vocational training, or returned to school. In the final model stratified for radiating pain during treatment, which was an important prognostic variable, workers between 21 to 30 years of age had a greater chance of returning to work (RR (95% CI) 1.43 (1.04 to 1.98) than those > or = 30. The other factors associated with a greater chance of returning to work were: a diagnosis of sprain or pain upsilon a diagnosis of intervertebral disc disorder (2.20 (1.23-3.91)), < 30 days of waiting between the accident and the beginning of treatment (1.30 (0.96 to 1.77)), a good flexion at baseline (1.52 (1.04 to 2.23)), absence of neurological symptoms during treatment (1.40 (0.98-2.00)), > 24 months of employment in the industry (1.49 (1.10 to 2.03)), working for a public industry upsilon a private one (1.63 (1.21 to 2.19)), and the ability to take unscheduled breaks (1.45 (1.06 to 1.97)). CONCLUSIONS: Even with a first episode of back pain, time to return to work is long and the proportion not returning is high. Return to work as expected is influenced by disease and host characteristics but also by social and work factors. Reinstatement programmes should account for all these factors.

Adult↗
PubMed2007

Return to work and health-related quality of life after burn injury.

OBJECTIVE: Although severe burn injury is associated with long-term rehabilitation and disability, research on returning to work in burn patients is limited. The aims of this study were: (i) to explore injury- and personality-related predictors of returning to work, and (ii) to compare health-related quality of life and health outcome in working versus non-working individuals. DESIGN: Cross-sectional study. SUBJECTS: Forty-eight former patients with pre-burn employment were evaluated on average 3.8 years after the burn. METHODS: Data were collected from medical records and by a questionnaire in which the patients were asked about their main activity status described in the terms: work, studies, pension, disability pension, sick leave or unemployment. It also contained the Swedish universities Scales of Personality, SF-36, Burn Specific Health Scale-Brief, items assessing fear-avoidance, Impact of Event Scale-Revised and Hospital Anxiety and Depression Scale. RESULTS: Thirty-one percent had not returned to work. In logistic regression, returning to work was associated with time since injury, the extent of full-thickness injuries, and the personality trait embitterment. Those who did not work had lower health-related quality of life, poorer burn-specific health, more fear-avoidance and more symptoms of posttraumatic stress disorder, but they did not differ from those who were working regarding general mood. CONCLUSION: Returning to work was explained by both injury severity and personality characteristics. Those who did not work were characterized by low health-related quality of life and poorer trauma-related physical and psychological health.

Adult↗
PubMed1988

Return to work after rehabilitation in coronary bypass patients. Role of the occupational medicine specialist during rehabilitation.

The aim of the study was to assess the role of the occupational medicine specialist in improving return to work (RTW) after coronary bypass graft (CABG) surgery, with an early intervention in the rehabilitation programme of the patients. There were 57 patients (56 male, 1 female, mean age was 50.7 years), sent for rehabilitation 22 days after surgery (49% of them had a prior myocardial infarction, and the ejection fraction (EF) was greater than or equal to 0.55 in 67%, 0.30 less than EF less than 0.55 in 25%, or less than or equal to 0.30 in 8%; myocardial revascularization was complete in 47% of the patients). Jobs required a high level of physical activity in 52.5% of the patients, a medium or low level in 44% and 3.5% of the patients were unemployed. At 7 months follow-up, 73.2% out of the 56 alive patients had returned to work with a mean delay of 109.9 +/- 84 days after surgery. The causes of non-return to work were social and economical factors (46.6%), psychological factors (40%) and medical reasons (13.4%). No clinical data were correlated with return to work (age, EF, extent of revascularization, or results of the stress tests), but return to work varied with the energy requirement in jobs with 97.3% return to work in case of low physical level, and 46.7% in case of high physical level (P less than 0.001). The comparison with a previous study performed in 1984 in 45 rehabilitation patients (with non-systematic vocational counselling), showed an increase in return to work in cardiac patients from 51% to 78% (P less than 0.05) after intervention of the occupational physician. So, the different ways of improving return to work in post-CABG patients are complementary: exercise training and secondary prevention are important, but must be completed with individual vocational counselling that should be included in every rehabilitation programme.

Adult↗
PubMed2000

Return to work after spinal cord injury.

OBJECTIVE: To describe predictors of return to work after spinal cord injury (SCI), in particular the physical intensity of the pre-injury job. STUDY DESIGN: Survey. SETTING: Patients' home. METHODS: We interviewed 234 persons with a spinal cord injury (SCI) between 18 and 65 years of age and who were gainfully employed at the time of the injury. Possible predictors were tested with logistic regression analyses. RESULTS: After the SCI, only 37% of the persons were gainfully employed. People with heavy and strenuous physical work pre-injury regained work in only 25%, respectively 21%. Being male (Odds Ratio (OR) 3.70), light to moderate physical job pre-injury (OR 3.16), high Barthel Index (OR 2.76), high educational level (OR 2.12) and education post-injury (OR 2.14) were significant predictors for returning to gainful work after injury. Many unemployed persons thought they were capable of working. CONCLUSIONS: Only a minority returned to gainful employment after SCI even to a physically less demanding job. In addition to intensive inpatient re-education, long-term support in job seeking is very important, including switching to a less demanding job.

Adolescent↗
PubMed2004

Treating physicians' perceptions of barriers to return to work of their patients in Southern Ontario.

AIMS: The aim of this paper is to understand the treating physician's perspective with respect to the barriers that their patients face returning to work from injury and illness. METHODS: The methodology used was focus groups conducted in Southern Ontario with treating physicians. RESULTS: The main barrier identified by the treating physicians in the return to work process was the lack of accommodated work. The main areas identified for the use of additional resources was facilitated investigations, assessments and treatments for their patients and education and training for treating physicians. With respect to communication, physicians indicated that they wanted to know more about the work to which their patients were returning. CONCLUSIONS: Treating physicians believe that the most significant barriers for the timely return to work for their patients exist in the workplace, specifically related to lack of knowledge about appropriate modified work. The treating physicians' role in the return to work process is demanding due to insufficient time to deal with return to work issues, lack of training, not enough of the appropriate information and the treating physicians' role ambiguity.

Communication Barriers↗
PubMed2006

Stroke patients' experiences of return to work.

Purpose. The aim of this study was to describe the experience of return to work (RTW) after stroke from the patient's perspective.Method. Six patients who had their first ever stroke in 2001, were <65 years of age and were working at the time of their stroke were included. Information was obtained via an open-ended interview. The material was transcribed verbatim and analysed using Giorgi's empirical phenomenology.Results. Rehabilitation was perceived as primarily aimed at restoring bodily functions and a return to everyday activities, rather than at promoting a return to work. It was not experienced as adapted to the participants' needs or their age. The workplace was experienced as very important in the rehabilitation process. When the informants experienced that the rehabilitation professionals were not taking action, they took control of the situation themselves. The informants expressed pride in their own capacity to take the initiative and in their ability to take action. Both self-employed and employed informants said they had possibilities and opportunities to take action since their work situation was flexible. The informants' adaptation to a new role at work was perceived as facilitated by the understanding and positive attitude of co-workers.Conclusion. Among this group of stroke patients, the individual patient's capacity and ability to return to work was enhanced by motivation or "will" and self-efficacy in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. There are similarities between the RTW process and processes of health promotion.

Adaptation, Psychological↗
PubMed2003

Return to work of cancer survivors: a prospective cohort study into the quality of rehabilitation by occupational physicians.

AIMS: To describe and assess the quality of rehabilitation of cancer survivors by occupational physicians and to relate the quality of the process of occupational rehabilitation to the outcome of return to work. METHODS: One hundred occupational physicians of a cohort of cancer survivors were interviewed about return to work management. Quality of rehabilitation was assessed by means of four indicators that related to performance in knowledge of cancer and treatment, continuity of care, patients complaints, and relations at work. The cohort of patients was prospectively followed for 12 months to assess time to return to work and rate of return to work. Patients' and physicians' satisfaction with care was also assessed. The relation between performance and these outcome measures was studied in a multivariate analysis, taking into account the influence of other work and disease related factors that could potentially predict return to work. RESULTS: For knowledge of cancer and treatment, only 3% had optimal performance because occupational physicians did not communicate with treating physicians. For continuity of care, patient complaints, and relations at work, performance was optimal for 55%, 78%, and 60% of the physicians respectively. After adjustment for other prognostic factors, overall physician's performance (hazard ratio (HR) 0.5, 95% CI 0.3 to 0.8) and continuity of care (HR 0.5, 95% CI 0.3 to 0.9) were related to the return to work of patients. Overall optimal performance was also related to a small but significant higher level of satisfaction with care, both for patients and physicians. CONCLUSION: Quality of occupational rehabilitation of cancer survivors can be improved substantially, especially with regard to communication between physicians and continuity of care. There is a need for the development of more effective rehabilitation procedures which should be evaluated in a randomised controlled trial.

Adult↗
PubMed2005

Concerns and expectations about returning to work with low back pain: identifying themes from focus groups and semi-structured interviews.

PURPOSE: Studies of occupational low back pain (OLBP) have shown that return to work after injury is influenced by workers' concerns and expectations; however, these theoretical constructs have not been explored. The specific aim of this study was to identify themes related to self-efficacy and outcome expectancy for returning to work using qualitative research methods. METHOD: Twenty-eight individuals who recently returned to work (< 6 months) after an onset of OLBP responded to a newspaper advertisement and participated in focus groups. In a second phase of the study, patients with OLBP and an impending return to work (n = 23) were referred by their physiotherapists and interviewed to provide more immediate accounts of their concerns and experiences. Notes and recordings from both sources were searched for utterances describing beliefs about self-efficacy or outcome expectancy for returning to work. RESULTS: Two primary self-efficacy constructs emerged: self-efficacy for resuming physical activity and self-efficacy for resuming work. Self-efficacy for resuming physical activity included 8 sub-domains: lift, carry, sit, stand, push/pull, bend, climb, and reach. Self-efficacy for resuming work included 3 sub-domains: pain control, obtaining help, and meeting job demands. Outcome expectancy included four sub-domains: financial/job security, re-injury, workplace support, and self-image. CONCLUSIONS: Hesitation to return to work after OLBP involves not only concerns about pain and re-injury, but also the perceived ability to perform physical tasks, meet role expectations, obtain workplace support, and maintain job security.

Adolescent↗
PubMed1999

Has increased focus on vocational rehabilitation led to an increase in young employees' return to work after work-related disorders?

The aim of this study was to determine whether the large investments in vocational rehabilitation made in Sweden during the 1990s had improved the level of return to work for young employees and to study the factors predicting return to work. The study population comprised all employees under 30 years of age whose reports on work-related disorders were under consideration at regional social insurance offices in Västerbotten county in 1990 and 1994 (n = 266). Between these years, increased efforts were made by the Swedish government to improve vocational rehabilitation. Data was collected from the register and by means of questionnaires. It was found that employees with musculoskeletal disorders were more likely to return to work during periods of intensive vocational rehabilitation. No increase in the level of return to work was apparent if all disorders were considered. Men showed a higher level of return to work than women, although women were better educated.

Adolescent↗
PubMed2002

Return to work outcomes following accident compensation corporation work capacity assessment.

AIMS: To determine the proportion of Accident Compensation Corporation (ACC) claimants who have returned to fulltime work after ceasing to receive ACC weekly compensation following Work Capacity Assessment (WCAP). To assess what factors impact on return to work. To assess whether ACC's research findings into return to work outcomes WCAP are valid. METHODS: A structured questionnaire telephone follow-up survey was conducted with ACC claimants seen for WCAP. RESULTS: 43% of those exited from ACC weekly compensation after WCAP were currently working fulltime. Claimants who had exited ACC after WCAP were significantly more likely to be working than those remaining on ACC. Claimants over 40 years of age were significantly less likely to be working. Gender, race, length of time since injury, and retraining made no difference to return to work. 80% of claimants felt that the WCAP process was unfair. CONCLUSION: Nearly half of those claimants certified as being unfit for work but now exited from ACC via WCAP were working fulltime. This may indicate that ACC's rehabilitation is successful, or that claimants tend to remain on ACC for economic rather than injury reasons, or that WCAP results in claimants returning to physically unsuitable work putting them at risk of further injury. ACC's research finding, that 79% of claimants were working after WCAP does not appear to be valid.

Adult↗
PubMed1992

[Return to work of professional drivers after cardiac rehabilitation].

This study analysed the possibilities of returning to work of professional drivers after a cardiac event and rehabilitation. The population comprised 94 consecutive patients, all men, average age 48.8 years (range 30 to 63 years) referred after coronary bypass surgery (N = 39), myocardial infarction (N = 38), angina (N = 4) or valve replacement surgery (N = 13). Advice on professional reinsertion was given after the rehabilitation program, authorization to drive being given in the absence of cardiac symptoms, residual myocardial ischaemia, severe left ventricular dysfunction and serious ventricular arrhythmias. After 35 months, 4 patients were lost to follow-up; of the 90 remaining patients, the frequency of return to work (maximal at the 9th month) was 65.6% with 84.7% obtaining a renewal of their driving licence. In this series, 81% of patients were asymptomatic, 2 died, 16.7% had further cardiovascular complications. The morbidity and mortality were significantly greater in the group who had to stop driving (N = 40) (32.5% vs 8%, p < 0.001). Non complications occurred during work in those who resumed driving. This study confirms the safety of allowing low risk professional drivers, identified during cardiac rehabilitation by simple, reliable clinical and paraclinical criteria, to return to work.

Adult↗
PubMed2001

Return to work for persons with traumatic brain injury.

Individuals with traumatic brain injuries experience an array of physical, cognitive, and emotional changes that often make return to preinjury employment unlikely and locating new employment difficult. The authors review the literature related to the return to work for persons with traumatic brain injuries. This includes return to work outcomes, factors influencing return to work, and vocational programs that enhance employment, including a supported employment approach. Guidelines for professionals engaged in supported employment practices are also provided.

Brain Injuries↗
PubMedDate not supplied

The likelihood of returning to work after breast cancer.

OBJECTIVE: This is an examination of factors associated with returning to work after the diagnosis of breast cancer. METHODS: Three months after being diagnosed with breast cancer, 296 employed women from the Detroit metropolitan area (52 black and 244 white women) were interviewed. These women were part of a larger cohort of 1,011 breast cancer patients ages 40 to 84 interviewed for the study "Health and Functioning in Women with Breast Cancer". RESULTS: Although most employed women returned to work within three months of the diagnosis of breast cancer, black women were twice as likely as white women to be on medical leave three months after diagnosis (OR = 1.94; 95% CI 1.04 to 3.62). Being on leave was found to be associated with the need for assistance with transportation, limitations in upper-body strength, and employment in jobs requiring physical activity. After adjusting for these factors, the racial difference was reduced and no longer statistically significant (OR = 1.34; 95% CI 0.67, 2.70). CONCLUSION: Breast cancer rehabilitation programs should not only address the patient's physical capacity but also the daily demands she is likely to face once she leaves the hospital and returns to work.

Adult↗
PubMed2003

Factors influencing return to work at one year after coronary bypass graft surgery: results of the PERISCOP study.

PURPOSE: The aim of this study was to evaluate the predictive factors of return to work after coronary bypass graft surgery, for the subgroup of professionally active patients aged less than 60 years included in the PERISCOP study. METHODS: In the principal, prospective, multicentre study, 2065 patients were evaluated 20+/-10 days after surgery by exercise testing, echocardiogram and 24-h ambulatory ECG monitoring. A questionnaire was completed one year after surgery. We studied a subgroup of this population, consisting of 530 patients previously defined (94.5% men; mean age: 50.5+/-5.8 years). RESULTS: One year after surgery, five of these patients had died and 21 were lost to follow-up. Among the remaining patients, 340 patients (67.5%) had returned to work. Forty patients (7.9%) had retired, 45 (8.9%) were on sick leave, 22 (4.4%) were unemployed, 49 (9.7%) returned to work after the deadline of 12 months, eight (1.6%) had given insufficient information on return to work. In multivariate analysis, the independent predictors of a failure to return to work were age >51 years [OR: 0.39 (95% CI: 0.25-0.59)], being a manual worker [OR: 0.49 (95% CI: 0.31-0.79)], being from South East France [(OR: 0.42 (95% CI: 0.23-0.74)], presence of angina [OR: 0.40 (95% CI: 0.20-0.82)], dyspnoea [(OR: 0.46 (95% CI: 0.28-0.77)] and a duration of exercise <420 s [(OR: 0.50 (95% CI: 0.33-0.76)]. CONCLUSIONS: Return to work after coronary bypass graft surgery is observed in 67.5% of cases and depends essentially on socio-professional factors and residual symptoms. A regional effect was also observed, which requires further study.

Age Factors↗
PubMedDate not supplied

Factors relating to return to work after burn injury.

This study examined the influence of various factors on the probability that 225 persons with severe burns would return to work 12 months after being discharged from the acute care setting. By use of multivariate analysis, 4 out of 15 variables significantly increased the probability of being employed: (1) being white, (2) not blaming oneself, (3) receiving workmen's compensation, and (4) being employed before the injury. With controls for burn severity and other variables, premorbid employment accounted for a person being 171 times more likely to return to work than one who was not employed before injury. Our findings suggest that some traditionally held impressions regarding factors related to return to work after a severe burn should be revisited. Moreover, despite earlier reports concluding that burn severity was the primary predictor of return to work, we found no factors in the acute care environment or patient characteristics that were statistically significant. Instead, findings from this series underscore the importance of the preinjury environment--especially being employed at the time of injury--as the strongest predictor of return to work after a severe burn.

Absenteeism↗