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1.
Crit Care ; 25(1): 382, 2021 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749756

RESUMO

BACKGROUND: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. METHODS: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. RESULTS: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty. CONCLUSIONS: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.


Assuntos
COVID-19/epidemiologia , Estado Terminal/epidemiologia , Pessoas com Deficiência , Recuperação de Função Fisiológica/fisiologia , Retorno ao Trabalho/tendências , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , COVID-19/diagnóstico , COVID-19/terapia , Estudos de Coortes , Estado Terminal/terapia , Feminino , Seguimentos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
2.
J Occup Health ; 63(1): e12284, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34811863

RESUMO

OBJECTIVES: Motivation for return to work (RTW) reflects the degree of willingness to resume work activities and has been shown to be a crucial factor in long-term work disability. The satisfaction of basic psychological needs and motivation as described by the Self-Determination Theory (SDT) yield associations with outcomes such as quality of life and job satisfaction. The current study is the first study to examine whether motivation and basic psychological needs are predictive for RTW outcomes at 1-year follow-up. METHODS: About 349 people with a work disability (mean = 131.32 days off work) participated in this observational longitudinal research. Quality of motivation (MAWS) and basic psychological need satisfaction and frustration (BPNSFS) were measured at baseline. At 12-month follow-up, differences in RTW were assessed in terms of (1) time until RTW, (2) partial RTW, (3) relapse within 12 months, (4) work disability longer than 12 months. Binary logistic and cox regression analyses were used. RESULTS: Controlled motivation regarding the former job was related to shorter time until RTW. Autonomous motivation and amotivation did not seem predictive for RTW variables. The frustration of the basic needs was related to a longer work disability, need satisfaction was not related to the RTW variables. No significant predictors for relapse and partial RTW were found. CONCLUSIONS: The frustration of basic psychological needs was predictive for a longer work disability. Controlled motivation on the other hand predicted faster RTW, which was an unexpected direction. SDT seems to have predictive value, yet underlying mechanisms remain unclear.


Assuntos
Motivação , Retorno ao Trabalho/psicologia , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-34770019

RESUMO

Musculoskeletal injuries occur frequently after road traffic crashes (RTCs), and the effect on work participation is not fully understood. The primary aim of this review was to determine the impact of sustaining a musculoskeletal injury during an RTC on the rate of return to work (RTW), sick leave, and other work outcomes. The secondary aim was to determine factors associated with these work-related outcomes. An electronic search of relevant databases to identify observational studies related to work and employment, RTC, and musculoskeletal injuries was conducted. Where possible, outcome data were pooled by follow-up period to answer the primary aim. Fifty-three studies were included in this review, of which 28 were included in meta-analyses. The pooled rate of RTW was 70% at 1 month, 67% at 3 months, 76% at 6 months, 83% at 12 months, and 70% at 24 months. Twenty-seven percent of participants took some sick leave by one month follow-up, 13% by 3 months, 23% by 6 months, 36% by 12 months, and 22% by 24 months. Most of the factors identified as associated with work outcomes were health-related, with some evidence also for sociodemographic factors. While 70% of people with RTC-related musculoskeletal injury RTW shortly after accident, many still have not RTW two years later.


Assuntos
Acidentes de Trânsito , Doenças Musculoesqueléticas , Emprego , Humanos , Doenças Musculoesqueléticas/epidemiologia , Retorno ao Trabalho , Licença Médica
4.
Front Public Health ; 9: 722604, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34604160

RESUMO

Objective: The objective of this study was to investigate how knowledge and practice of coronavirus disease 2019 (COVID-19) prevention measures affected concerns about returning to work among supermarket staff. Attitudes about the ability of traditional Chinese medicine (TCM) to prevent COVID-19 were also assessed. Methods: A cross-sectional study was conducted in Huanggang, Hubei Province, China from April 23 to 25, 2020. Participants were invited to fill out an electronic questionnaire on their cell phones. Results: The results showed that from 2,309 valid questionnaires, 61.5% of participants were concerned about resuming work. Major concerns included asymptomatic infection (85.01%) and employees gathering in the workplace (78.96%). Multivariate logistic regression indicated that the female gender, having school-aged children and pregnancy were risk factors for being concerned about resuming work, while good knowledge and practice of preventive measures were protective factors. Knowledge and practice of preventive measures were positively correlated. Among preventive measures, the highest percentage of participants knew about wearing masks and washing hands. Meanwhile, 65.8% of participants expressed confidence in the ability of TCM to prevent COVID-19, where 74 and 51.3% thought there was a need and a strong need, respectively, for preventive TCM-based products. Among them, 71.5% preferred oral granules. Regarding TCM as a COVID-19 preventative, most were interested in information about safety and efficacy. Conclusion: These findings suggested that promoting knowledge and practices regarding COVID-19 prevention can help alleviate concerns about returning to work. Meanwhile, TCM can feasibly be accepted to diversify COVID-19 prevention methods. Clinical Trial Registration:http://www.chictr.org.cn/, identifier: ChiCTR2000031955.


Assuntos
COVID-19 , Medicina Tradicional Chinesa , Atitude , Criança , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Retorno ao Trabalho , SARS-CoV-2 , Supermercados , Inquéritos e Questionários
5.
Int Marit Health ; 72(3): 223-227, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34604993

RESUMO

Since the global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent of a coronavirus disease 2019 (COVID-19) infection started, millions of people globally have become infected. It must not be forgotten that thousands of those affected are commercial or recreational divers. A severe COVID-19 seriously affects the respiratory system and the pulmonary parenchyma but it may also involve the cardiovascular and the blood coagulation system. For this reason, many divers and hyperbaric medicine specialists are becoming increasingly concerned about a diver's ability to safely return to diving after a SARS-CoV-2 infection. The article presents current guidelines for diving fitness health assessment after a COVID-19 both for active and prospective divers, with particular emphasis on the types of diagnostic procedures and tests to be performed in cases of asymptomatic infection with SARS-CoV-2 as well as in patients who have recovered from a symptomatic COVID-19.


Assuntos
COVID-19/complicações , Mergulho/normas , Retorno ao Trabalho , Guias como Assunto , Humanos , SARS-CoV-2
6.
Medicina (B Aires) ; 81(5): 742-748, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34633946

RESUMO

Degenerative spinal disease is the leading cause of low back pain and sciatica in the general population. It is an important cause of absenteeism and increased expenses. Its incidence increases in people subjected to tasks that overload the spine, such as construction workers. Instrumented arthrodesis is a frequent practice with satisfactory results for its resolution. To date, in our country, we haven't found statistical data on this group of work-related patients. Our objective was to evaluate laboral impact generated by instrumented lumbosacral arthrodesis in construction workers. We did a retrospective, descriptive, comparative and monocentric study. Construction workers' patients with degenerative low back pain and instrumented lumbar or lumbosacral arthrodesis who were operated between January 2005 to August 2018 were included. Clinical and imaging evaluation and follow-up for a period of 18 to 24 months. Assessed with the Oswestry Disability Index (IDO) and the Visual Analog Pain Scale (VAS). The sample was analyzed in groups according to the functions at the time of returning to work, retirement or dismissal. We evaluated 139 patients. Mean age 42 years, degenerative spinal disease of the lumbosacral segment, 66.9% of the sample without postoperative complications resumed the same pre-surgical activity. Post-surgical IDO and VAS scores were worse in patients discharged, retired, and/or requalified. Patients under 42 years of age, without postoperative complications who improved more than 1 Oswestry category, returned to their usual tasks with satisfactory results in the medium and long term.


Assuntos
Retorno ao Trabalho , Fusão Vertebral , Adulto , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Retrospectivos
7.
J Orthop Sports Phys Ther ; 51(10): 529, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34592829

RESUMO

This JOSPT Infographic on return to work after injury is based on clinical practice guidelines by Daley et al titled "Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists" (J Orthop Sports Phys Ther 2021;51(8):CPG1-CPG102. doi:10.2519/jospt.2021.0303), which reviewed the scientific literature between January 1999 and August 2020. J Orthop Sports Phys Ther 2021:51(10):529. doi:10.2519/jospt.2021.9002.


Assuntos
Saúde do Trabalhador , Traumatismos Ocupacionais/reabilitação , Retorno ao Trabalho , Terapia por Exercício , Humanos
8.
Curr Oncol ; 28(5): 3866-3875, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34677248

RESUMO

Return to work (RTW) after breast cancer is associated with improved quality of life. The link between household characteristics and RTW remains largely unknown. The aim of this study was to examine the effect of the family situation on women's RTW two years after breast cancer. We used data of a French prospective cohort of women diagnosed with stage I-III, primary breast cancer (CANTO, NCT01993498). Among women employed at diagnosis and under 57 years old, we assessed the association between household characteristics (living with a partner, marital status, number and age of economically dependent children, support by the partner) and RTW. Logistic regression models were adjusted for age, household income, stage, comorbidities, treatments and their side effects. Analyzes stratified by age and household income were performed to assess the association between household characteristics and RTW in specific subgroups. Among the 3004 patients included, women living with a partner returned less to work (OR = 0.63 [0.47-0.86]) and decreased their working time after RTW. Among the 2305 women living with a partner, being married was associated with decreased RTW among women aged over 50 (OR = 0.57 [0.34-0.95]). Having three or more children (vs. none) was associated with lower RTW among women with low household income (OR = 0.28 [0.10-0.80]). Household characteristics should be considered in addition to clinical information to identify vulnerable women, reduce the social consequence of cancer and improve their quality of life.


Assuntos
Neoplasias da Mama , Retorno ao Trabalho , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida
9.
Rev Esp Salud Publica ; 952021 Oct 25.
Artigo em Espanhol | MEDLINE | ID: mdl-34697284

RESUMO

OBJECTIVE: The COVID-19 pandemic caused by the SARS-CoV-2 virus has generated a great burden on health systems, and healthcare workers have been the most affected. In Spain, the Health Ministry issued common protocols regarding the return-to-work of healthcare workers presenting a negative PCR (Polymerase Chain Reaction) test result and complete resolution of symptoms. Some autonomous communities decided to include a CT (Cycle Threshold) value criterion as well. The aim of this paper was to compare the time intervals required to obtain a negative PCR result by means of both criteria. METHODS: A multicenter, cross-sectional study was performed from March to September of 2020, in the health areas of Navarra, La Rioja and Vigo (Galicia), managed by their own Occupational Risk Prevention Units. The PCR negativization time intervals were analyzed according to gender, age, professional category and the PCR repetition criteria used (clinical or defined by CT). Mean difference calculation by Student's t-test and Kaplan-Meier survival analyzes were conducted. RESULTS: The sample amounted to a total of 1,052 workers: 673 from Navarra, 335 from La Rioja and 44 from Vigo, with an average age of 46 years, and of which 81% were women, 35.48% nursing personnel and 23.65% physicians. No statistically significant differences were found between the PCR negativization time periods with any of the variables, except with the CT criterion, which presented a mean of 6.49 days (95% CI, 4.96-8.02), longer and displaying positively displaced survival curves. CONCLUSIONS: The CT criterion for carrying out the control PCR test lengthened the reincorporation of essential personnel in the fight against the pandemic.


Assuntos
COVID-19 , Retorno ao Trabalho , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Espanha/epidemiologia
10.
Sante Ment Que ; 46(1): 175-202, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34597494

RESUMO

Introduction Common mental disorders (CMDs) account for 30% to 50% of all illness absences. The success of RTW is not only due to the individual but rather to the result of the interaction between the stakeholders involved in the RTW process. Numerous mental health applications have been developed to improve patient management and optimize communication between professionals, but have not been validated. Moreover, no technological solution has been developed to date to facilitate both consultation among the RTW stakeholders (e.g., managers, health professionals) and systematic support for the employee in his or her RTW. Objective To address these shortcomings, the purpose of this article is twofold: 1) to describe the development of the PRATICAdr application (Return-to-Work Platform focused on Stakeholder Interaction and Communication: a Sustainable Recovery Program) and 2) to document PRATICAdr application user testing. Method The development of PRATICAdr has been operationalized in three phases: 1) needs assessment, 2) conceptualization of the internal mechanisms of the application and programming techniques and 3) testing of the application in real situation. The application is evaluated through questionnaires and interviews to measure user satisfaction. Results PRATICAdr allows to follow in real time the path of RTW stakeholders involved in the personalized support of the employee in his RTW. The operationalization of the RTW process and the inclusion of validated assessment tools help systematize the stakeholders' consultation and shared decision-making, as well as the monitoring and actions taken to undertake a recovery-promoting RTW. The PRATICAdr interface was developed to simplify the user experience for the employee on sick leave and all RTW stakeholders. Regarding user satisfaction, results show that the first 16 users of PRATICAdr, employees in a large healthcare organization returning to work following a CMD, were very satisfied (average>9/10) with the Web application, as well as the participation of RTW stakeholders and the questionnaires included in PRATICAdr. Improvements were also suggested. Conclusion PRATICAdr is implemented in two large organizations (>15,000 employees) in order to evaluate its effectiveness with employees on sick leave due to CMD registered in a RTW process. The aim of this article was to present not only the development of PRATICAdr, but also to measure user satisfaction. Preliminary results indicate a high level of satisfaction among employees on sick leave who used PRATICAdr. In terms of future avenues, the integration of e-learning will be addressed with the objective of customizing the RTW program according to the predictions of duration of sick leave and sustainable RTW.


Assuntos
Transtornos Mentais , Retorno ao Trabalho , Comunicação , Feminino , Humanos , Masculino , Licença Médica , Inquéritos e Questionários
11.
BMC Musculoskelet Disord ; 22(1): 889, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666734

RESUMO

BACKGROUND: Arthroscopic subacromial decompression is one of the most commonly performed shoulder surgeries in the world. It is performed to treat patients with suspected shoulder impingement syndrome, i.e., subacromial pain syndrome. Only few studies have specifically assessed return-to-work rates after subacromial decompression surgery. All existing evidence comes from open, unblinded study designs and this lack of blinding introduces the potential for bias. We assessed return to work and its predictors in patients with shoulder impingement syndrome in a secondary analysis of a placebo-surgery controlled trial. METHODS: One hundred eighty-four patients in a randomised trial had undergone arthroscopic subacromial decompression (n = 57), diagnostic arthroscopy, a placebo surgical intervention, (n = 59), or exercise therapy (n = 68). We assessed return to work, defined as having returned to work for at least two follow-up visits by the primary 24-month time point, work status at 24 and 60 months, and trajectories of return to work per follow-up time point. Patients and outcome assessors were blinded to the assignment regarding the arthroscopic subacromial decompression vs. diagnostic arthroscopy comparison. We assessed the treatment effect on the full analysis set as the difference between the groups in return-to-work rates and work status at 24 months and at 60 months using Chi-square test and the predictors of return to work with logistic regression analysis. RESULTS: There was no difference in the trajectories of return to work between the study groups. By 24 months, 50 of 57 patients (88%) had returned to work in the arthroscopic subacromial decompression group, while the respective figures were 52 of 59 (88%) in the diagnostic arthroscopy group and 61 of 68 (90%) in the exercise therapy group. No clinically relevant predictors of return to work were found. The proportion of patients at work was 80% (147/184) at 24 months and 73% (124/184) at 60 months, with no difference between the treatment groups (p-values 0.842 and 0.943, respectively). CONCLUSIONS: Arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy or exercise therapy on return to work in patients with shoulder impingement syndrome. We did not find clinically relevant predictors of return to work either. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00428870 .


Assuntos
Síndrome de Colisão do Ombro , Artroscopia , Descompressão Cirúrgica , Terapia por Exercício , Seguimentos , Humanos , Retorno ao Trabalho , Síndrome de Colisão do Ombro/diagnóstico , Síndrome de Colisão do Ombro/cirurgia , Dor de Ombro/diagnóstico , Dor de Ombro/cirurgia , Resultado do Tratamento
12.
Artigo em Inglês | MEDLINE | ID: mdl-34682449

RESUMO

The aim of the current cohort study was to explore the relationship between return to work (RTW) after cervical cancer treatment and different medical and occupational covariates. We also investigated the effect of RTW on all-cause mortality and survival outcomes of cervical cancer survivors. Data were collected between 2004 and 2015 from the database of the Taiwan Cancer Registry, Labor Insurance Database, and National Health Insurance Research Database. The associations between independent variables and RTW were analyzed by Cox proportional hazard models. A total of 4945 workers (82.3%) who returned to work within 5 years after being diagnosed with cervical cancer. Patients who underwent surgical treatment were more likely to RTW by the 5th year compared to other groups, with a hazard ratio (HR) of 1.21 (95% CI: 1.01~1.44). Small company size and a monthly income greater than NT 38,200 were inversely associated with RTW (HR = 0.91, 95% CI: 0.84~0.98 and HR = 0.48, 95% CI: 0.44~0.53). Furthermore, RTW showed a statistically significant decrease in the risk of all-cause mortality in the fully adjusted HR, (HR = 0.42, p < 0.001). Some medical and occupational factors are associated with RTW in cervical cancer survivors. Returning to work may have a beneficial effect on the survival of patients with cervical cancer.


Assuntos
Sobreviventes de Câncer , Neoplasias do Colo do Útero , Estudos de Coortes , Feminino , Seguimentos , Humanos , Retorno ao Trabalho , Taxa de Sobrevida
13.
BMC Public Health ; 21(1): 1846, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641825

RESUMO

BACKGROUND: Primary liver cancer is the fifth most common malignancy and limits patients' quality of life and working ability. Return to work after cancer treatment is an important step in social recovery. In addition, return to work represents the recovery of financial ability and improvements in self-confidence. The purpose of this article is to discuss the relationship between return to work and various covariables in workers with liver cancer. METHODS: The national registry cohort study collected adult workers newly diagnosed with liver cancer from 2004 to 2010 in Taiwan. There were 2451 workers included in our study. Primary liver cancer was diagnosed by using the International Classification of Diseases for Oncology code. Return to work after liver cancer survival was determined as returning to the same work or reemployment within five years after cancer diagnosis. The associations between independent variables and return to work were analyzed by Cox proportional hazard models. RESULTS: Workers who underwent surgery were more likely to return to work not only in the 2nd year but also in the 5th year. A lower survival rate was noted in the non-return-to-work group (p < 0.001) among all patients with liver cancer. The completely adjusted model identified that the rate of return to work was related to all-cause mortality with a hazard ratio of 0.244 (95% Confidence Intervals: 0.235-0.253). CONCLUSIONS: Our study indicated the impacts of treatment on the return to work of liver cancer survivors. In addition, in patient with liver cancer, return to work had positive effect on the survival rate.


Assuntos
Sobreviventes de Câncer , Neoplasias Hepáticas , Adulto , Estudos de Coortes , Seguimentos , Humanos , Qualidade de Vida , Retorno ao Trabalho , Taiwan/epidemiologia
14.
BMC Public Health ; 21(1): 1844, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641839

RESUMO

BACKGROUND: Many cancer survivors experience physical and/or psychosocial problems affecting return to work (RTW) and work retention. Current interventions on RTW lack evidence regarding effectiveness, while interventions for work retention are missing. Partners of cancer survivors may also experience work- and health-related outcomes; yet, these consequences are not well understood. Here, the protocol of the STEPS study is described. The study aims are to: 1) evaluate the (cost-)effectiveness of a rehabilitation program for RTW and work retention in cancer survivors, and 2) assess health- and work-related outcomes among cancer survivors' partners. METHODS: In a multicentre Randomized Controlled Trial (RCT), 236 working-age cancer survivors with an employment contract will be randomly allocated to a usual care group or an intervention group receiving a multidisciplinary rehabilitation program, combining occupational therapy facilitating work retention (e.g., energy management and self-efficacy training) and reintegration consultation addressing work-related issues (e.g., RTW planning and discussing workplace or task modifications with the supervisor). Alongside the RCT, a prospective cohort study will be conducted among cancer survivors' partners (n = 267). Participants in the RCT and cohort study will be asked to complete questionnaires at baseline, and after six and 12 months, assessing work- and health-related outcomes. Generalized estimating equations will be used to assess intervention's effectiveness, compared to usual care, regarding primary (i.e., working hours per week) and secondary outcomes. Also economic and process evaluations will be performed. For the cohort study, logistic or linear regression modelling will be applied assessing work- and health-related outcomes (primary outcome: working hours) of cancer survivors' partners, and what factors predict these outcomes. RESULTS: The study is planned to start in September 2021; results are expected in 2023. CONCLUSION: Compared to usual care, the STEPS intervention is hypothesized to be (cost-)effective and the intervention could be a valuable addition to standard care helping cancer survivors to sustain employment. Further, it is expected that living with a cancer survivor has a substantial impact on work and health of partners, while specific groups of partners that are at particular risk for this impact are likely to be identified. TRIAL REGISTRATION: Dutch Trial Register ( NTR;NL9094 ; 15-12-2020).


Assuntos
Sobreviventes de Câncer , Neoplasias , Estudos de Coortes , Análise Custo-Benefício , Humanos , Estudos Multicêntricos como Assunto , Países Baixos , Ensaios Clínicos Controlados Aleatórios como Assunto , Retorno ao Trabalho
15.
Int J Surg ; 95: 106100, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34600123

RESUMO

BACKGROUND: We aimed to identify preoperative psychosocial factors associated with return-to-work (RTW) and the associated cost of productivity loss due to work absenteeism following surgery. Research demonstrates a high economic burden from productivity loss after surgery, but the comparative cost of productivity loss relative to income across different operations has not been examined. MATERIALS AND METHODS: A mixed surgical cohort recruited for a randomized controlled trial were prospectively followed for up to two years following surgery with daily phone assessments to three months, weekly assessments thereafter to six months, then monthly assessments thereafter to determine RTW status, opioid use and pain. RESULTS: 183 of 207 (88.3%) patients in paid employment prior to surgery, who provided at least one day of follow-up, were included in this analysis. The average cost of productivity loss due to work absenteeism was $13 761 (median $9064). Patients who underwent total knee replacement incurred the highest income loss. Medical claims filed before surgery were significantly associated with relative income loss (AOR 5.09; 95% CI 1.73-14.96; p < 0.01) and delayed postoperative RTW. Elevated preoperative PTSD symptoms were associated with delayed RTW (HR 0.78; 95%CI 0.63-0.96; p-value = 0.02) while male gender (HR 1.63; 95%CI 1.11-2.38; p-value = 0.01) was associated with faster postoperative RTW. CONCLUSION: Surgery places a high economic burden on individuals due to postoperative productivity loss. Multidisciplinary approaches, such as pathways, that facilitate the operation and recovery may mitigate the economic consequences for patients, employers, and the healthcare system.


Assuntos
Artroplastia do Joelho , Retorno ao Trabalho , Análise Custo-Benefício , Emprego , Humanos , Masculino , Período Pós-Operatório
16.
Artigo em Inglês | MEDLINE | ID: mdl-34639580

RESUMO

Coordinators may play a key role during the return-to-work (RTW) process for people on sickness absence. There are still few studies on the newly implemented rehabilitation coordinators (RECO) within Swedish healthcare, and none focus on their competence. The aim of this study was to explore how persons with multimorbidity and psychosocial difficulties describe the professional competence of the RECO they encountered during their RTW process. The study takes a relational and practical approach in defining professional competence, including both what professionals do and what they possess. Interviews with 12 people with multimorbidity and psychosocial difficulties who had encountered a RECO during their RTW process were analysed using thematic analysis. Six different themes were found: communicative and coordinating skills; advisory and guidance skills; engagement and advocacy skills; being persistent and flexible; being empathic and therapeutic; being professional and trustworthy. Most of these are found in research on RTW coordinators, but being persistent, and having advisory, guidance, advocacy and therapeutic skills have not been recognised as important competences previously. This study adds patients' views on important professional competence that support the RTW process, which should be regarded in further developments of RECOs' functions and their competence descriptions.


Assuntos
Multimorbidade , Retorno ao Trabalho , Comunicação , Humanos , Competência Profissional , Suécia/epidemiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-34639624

RESUMO

The objective of this study was to conduct a fidelity evaluation of a motivational interviewing (MI) intervention delivered by social insurance caseworkers, in a three-arm randomized controlled trial (RCT) for improving return to work for people on sick leave with musculoskeletal disorders. The caseworkers received six days of MI training, including an intervention manual prior to the trial onset, as well as supervision throughout the trial. The caseworkers recorded 21 MI sessions at regular intervals during the trial. An independent MI analysis center scored the recordings using the MI treatment integrity code (MITI 4). In addition, three experienced MI trainers assessed the adherence to the MI intervention manual on a 1-4 Likert scale and MI competence. Total MITI 4 mean scores were at beginning proficiency levels for two components (global technical, mean 3.0; SD 0.6 and the reflections/questions ratio, mean 1.1; SD 0.2) and under beginning proficiency for two components (global relational, mean 3.2; SD 0.7 and complex question, mean 34.0; SD 21.2). The MI trainers' assessment showed similar results. The mean adherence score for the MI sessions was 2.96 (SD 0.9). Despite delivering a thorough course and supervision package, most of the caseworkers did not reach proficiency levels of good MI competence during the study. The fidelity evaluation showed that a large amount of training, supervision and practice is needed for caseworkers to become competent MI providers. When planning to implement MI, it is important that thorough consideration is given regarding the resources and the time needed to train caseworkers to provide MI in a social insurance setting.


Assuntos
Entrevista Motivacional , Doenças Musculoesqueléticas , Humanos , Casamento , Doenças Musculoesqueléticas/terapia , Retorno ao Trabalho , Licença Médica
18.
Work ; 70(2): 467-478, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34633348

RESUMO

BACKGROUND: The ReWork-Stroke program was developed to meet the need for a person-centered rehabilitation program addressing return to work after stroke and was provided by occupational therapists (OTs). OBJECTIVE: To gain knowledge on the implementation process of the ReWork-Stroke program, the mechanisms of impact, and the contextual factors that might have affected the process. METHODS: A case study design was used. Data were collected by interviews with two ReWork-Stroke providers and their logbooks of 13 clients. Content analysis was applied. RESULTS: The ReWork-Stroke program varied in duration (12-48 weeks) and was largely implemented according to plan regarding components and how they were provided. It was mostly delivered at the workplace. Mechanisms of impact were building alliances with clients, providing intervention at the workplace, informing about stroke, assigning co-workers as tutors for clients, and collaboration between stakeholders. CONCLUSIONS: The ReWork-Stroke program can be implemented according to plan and is a flexible person-centered program in which stakeholders, coordinated by an OT, plan and take actions, mostly at the workplace, for the client's return to work. A key factor was recognizing the current work ability after stroke. Further program development includes a more structured evaluation and technical solutions for supporting stakeholders.


Assuntos
Retorno ao Trabalho , Acidente Vascular Cerebral , Humanos , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa
19.
Rev. baiana saúde pública ; 45(Especial 2): 217-233, 20211010.
Artigo em Português | LILACS | ID: biblio-1342848

RESUMO

Trabalhadores da saúde são mais expostos à contaminação pelo SARS-Cov-2. Na Bahia, cerca de 10% dos casos notificados no e-SUS VE, em 2020, são de trabalhadores da saúde. A Secretaria da Saúde do Estado da Bahia (Sesab) criou o Centro de Testagem e Atendimento Covid-19 (CTA), para diagnóstico da infecção e avaliação do retorno ao trabalho de seus trabalhadores. Para tanto, verificou-se a necessidade de um instrumento padrão, que subsidiasse as decisões médicas para o retorno imediato ou prorrogação do afastamento. Este relato descreve a experiência de construção coletiva de instrumento de avaliação clínica de retorno ao trabalho de trabalhadores após infecção pelo SARS-CoV-2, utilizando análise documental, revisão bibliográfica e diálogo entre a equipe. No instrumento, foram incluídas as seguintes variáveis: identificação, vínculo empregatício, notificação nos sistemas previdenciários, comorbidades, sintomas no diagnóstico e retorno, medicações usadas, internamento, entre outras. Foram atendidos 754 trabalhadores no período: a maioria de mulheres (60,0%); com idade entre 31 e 60 anos (79,69%); 20,16% profissionais da enfermagem; 18,04% administrativos, e 7,82% policiais militares. Quanto ao vínculo de trabalho, 37,14% eram servidores públicos estatutários e 34,48% eram trabalhadores terceirizados. A utilização do instrumento agilizou o atendimento, identificando os não aptos ao retorno imediato ao trabalho e determinando a alta com segurança. O estudo demonstra a importância do conhecimento do perfil dos trabalhadores atendidos e da avaliação contínua do processo de trabalho em saúde, centrado na atenção ao usuário e na sistematização da coleta de informações nos serviços de saúde, para subsidiar a tomada de decisões e o uso responsável dos recursos.


Health workers are more exposed to SARS-Cov-2 contamination; in Bahia, about 10% of the cases notified in e-SUS VE in 2020 are of health workers. The Health Department of the State of Bahia created the Covid-19 Testing and Care Center (CTA), to diagnose infection and evaluate the return to work for its workers. For such purpose, there was a need for a standard instrument to support medical decisions for immediate return or its extension. This report describes the experience of collective construction of a clinical assessment instrument for workers affected by SARS-CoV-2; it was proceeded a documentary analysis, literature review on the theme Covid 19, and dialogue between the team. The following variables were included in the instrument: identification, employment relationship, notification to social security systems, comorbidities, symptoms in diagnosis and return, medications used, hospitalization, among others. In total, 754 workers were attended in the period: the most were women (60.0%); ages between 31-60 years (79.69%); 20.16% were nurses; 18.04% administrative workers and 7.82% military polices. According to employment relationship, 37.14% were public agents, and 34.48% were outsourced workers. The instrument used allowed speeding up the service, identifying those not able to return immediately to work, and determining discharge safely. The study shows the relevance of knowledge of workers profile and continuous evaluation of the health work process centered on user care, in the systematization of information collection in workers' health care services, to support decision-making and responsible use of resources.


Los trabajadores de la salud están más expuestos a la contaminación por SARS-Cov-2. En Bahía cerca del 10% de los casos notificados en el e-SUS VE en el año 2020 son de trabajadores de la salud. La Secretaría de Salud del Estado de Bahía (Sesab) creó el Centro de Atención y Pruebas Covid-19 (CTA) para diagnosticar la infección y evaluar el regreso al trabajo de los trabajadores de Sesab. Para eso, era necesario un instrumento estándar para respaldar las decisiones médicas para el regreso inmediato o la extensión de la licencia. Este informe describe la experiencia de construcción colectiva de un instrumento de evaluación clínica para el regreso de trabajadores al trabajo después de la infección por el SARS-CoV-2; en que se utilizó análisis documental, revisión de la literatura y diálogo entre el equipo. Se incluyeron en el instrumento las siguientes variables: identificación, relación laboral, notificación en los sistemas de seguridad social, comorbilidades, síntomas en diagnóstico y retorno, medicación utilizada, hospitalización, entre otras. 754 trabajadores fueron atendidos en el periodo: predominancia de mujeres (60,0%), con edades de entre 31-61 años (79,69%); el 20,16% de profesionales de enfermerías; el 18,04% administrativos y el 7,82% policías militares. En cuanto a la relación laboral, el 37,14% eran funcionarios y el 34,48% eran trabajadores subcontratados. El uso del instrumento agilizó el servicio, identificando a quienes no pudieron regresar de pronto al trabajo y determinando el dar de alta de manera segura. El estudio demuestra la importancia del conocimiento del perfil de los trabajadores atendidos y la evaluación continua del proceso de trabajo en salud centrado en la atención al usuario, así como en la sistematización de la recopilación de información en los servicios de salud para apoyar la toma de decisiones y el uso responsable de los recursos.


Assuntos
Saúde do Trabalhador , Pessoal de Saúde , Retorno ao Trabalho , COVID-19
20.
BMC Health Serv Res ; 21(1): 955, 2021 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-34511093

RESUMO

BACKGROUND: Internationally, elective spinal surgery rates in workers' compensation populations are high, as are reoperation rates, while return-to-work rates following spinal surgery are low. Little information is available from Australia. The aim of this study was to describe the rates, costs, return to work and reoperation following elective spinal surgery in the workers' compensation population in New South Wales (NSW), Australia. METHODS: This retrospective cohort study used administrative data from the State Insurance Regulatory Authority, the government organisation responsible for regulating and administering workers' compensation insurance in NSW. These data cover all workers' compensation-insured workers in New South Wales (over 3 million workers/year). We identified a cohort of insured workers who underwent elective spinal surgery (fusion or decompression) between January 1, 2010 and December 31, 2018. People who underwent surgery for spinal fracture or dislocation, or who had sustained a traumatic brain injury were excluded. The main outcome measures were annual spinal surgery rates, cost of the surgical episode, cumulative costs (surgical, hospital, medical and physical therapy) to 2 years post-surgery, and reoperation and return-to-work rates 2 years post-surgery. RESULTS: There were 9343 eligible claims (39.1 % fusion; 59.9 % decompression); claimants were predominantly male (75 %) with a mean age of 43 (range 18 to 75) years. Spinal surgery rates ranged from 15 to 29 surgeries per 100,000 workers per year, fell from 2011-12 to 2014-15 and rose thereafter. The average cost in Australian dollars for a surgical episode was $46,000 for a spinal fusion and $20,000 for a decompression. Two years post-fusion, only 19 % of people had returned to work at full capacity; 39 % after decompression. Nineteen percent of patients underwent additional spinal surgery within 2 years of the index surgery, to a maximum of 5 additional surgeries. CONCLUSION: Rates of workers' compensation-funded spinal surgery did not rise significantly during the study period, but reoperation rates are high and return-to-work rates are low in this population at 2 years post- surgery. In the context of the poor evidence base supporting lumbar fusion surgery, the high cost, increasing rates, and the increased likelihood of poor outcomes in the workers' compensation population, we question the value of this procedure in this setting.


Assuntos
Retorno ao Trabalho , Indenização aos Trabalhadores , Adolescente , Adulto , Idoso , Austrália , Estudos de Coortes , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Reoperação , Estudos Retrospectivos , Adulto Jovem
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