Predictive Validity of the Work, Osteoarthritis, or Joint Replacement Questionnaire (WORQ) for Return to Work after Total Knee Arthroplasty: A 12-Month Multicenter Prospective Cohort Study.

BACKGROUND: After total knee arthroplasty (TKA), a minority of working patients are dissatisfied and experience a late or no return to work (RTW). This study aimed to identify whether a pre-defined grouping based on self-reported ability to perform work-related activities at three months post-TKA was associated with the ability to perform work-related activities at six and 12 months and RTW at three, six, and 12 months post-TKA. METHODS: A 12-month multicenter prospective cohort study was performed among working TKA patients intending to RTW. The work, osteoarthritis, or joint replacement questionnaire (WORQ) score (range 0 to 100) was used to assess patients' ability to perform work-related activities. Patients were grouped into early-, intermediate-, and late-recovery groups at three months post-TKA. The median age of the cohort (n = 182) was 59 years [IQR [interquartile range] 55 to 62], and 52% were women. Analyses included Spearman's correlation tests, and Kaplan-Meier survival analyses. RESULTS: The early- (n = 54) and intermediate-recovery groups (n = 68) clinically improved their ability to perform work-related activities at three and 12 months, respectively, while the late-recovery group (n = 60) did not do so until 12 months (rs = 0.6, 0.27, and 0.25, respectively). The early-recovery group returned to work earlier (median 62 [IQR 41 to 90] days) compared to the intermediate- (75 [46 to 115] days) and late-recovery groups (84 [58 to 116] days) and resumed 100 percent of their working hours at six months versus 12 months in the intermediate- and late-recovery groups (rs = 0.37, 0.33, 0.1 at three, six, and 12 months, respectively). CONCLUSION: At three months post-TKA, the WORQ can be used to distinguish early-, intermediate-, and late-recovery groups, which are associated with the ability to perform work-related activities at six and 12 months post-TKA and RTW at three and six months.

Does Consulting an Occupational Medicine Specialist Decrease Time to Return to Work Among Total Knee Arthroplasty Patients? A 12-Month Prospective Multicenter Cohort Study.

PURPOSE: The aim of this study is to investigate whether total knee arthroplasty (TKA) patients who consulted an occupational medicine specialist (OMS) within 3 months after surgery, return to work (RTW) earlier than patients who did not consult an OMS. METHODS: A multi-center prospective cohort study was performed among working TKA patients, aged 18 to 65 years and intending to RTW. Time to RTW was analyzed using Kaplan Meier and Mann Whitney U (MWU), and multiple linear regression analysis was used to adjust for effect modification and confounding. RESULTS: One hundred and eighty-two (182) patients were included with a median age of 59 years [IQR 54-62], including 95 women (52%). Patients who consulted an OMS were less often self-employed but did not differ on other patient and work-related characteristics. TKA patients who consulted an OMS returned to work later than those who did not (median 78 versus 62 days, MWU p < 0.01). The effect of consulting an OMS on time to RTW was modified by patients' expectations in linear regression analysis (p = 0.05). A median decrease in time of 24 days was found in TKA patients with preoperative high expectations not consulting an OMS (p = 0.03), not in patients with low expectations. CONCLUSIONS: Consulting an OMS within 3 months after surgery did not result in a decrease in time to RTW in TKA patients. TKA patients with high expectations did RTW earlier without consulting an OMS. Intervention studies on how OMSs can positively influence a timely RTW, incorporating patients' preoperative expectations, are needed.

The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients.

Purpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation "to advise", low to very low in a recommendation "to consider", unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines "lifting" and "whole body vibration". The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.