Browsing by Subject "return to work"

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  • Russo, Fabrizio; De Salvatore, Sergio; Ambrosio, Luca; Vadalà, Gianluca; Fontana, Luca; Papalia, Rocco; Rantanen, Jorma; Iavicoli, Sergio; Denaro, Vincenzo (2021)
    Low back pain (LBP) is currently the leading cause of disability worldwide and the mostcommon reason for workers’ compensation (WC) claims. Studies have demonstrated that receivingWC is associated with a negative prognosis following treatment for a vast range of health conditions.However, the impact of WC on outcomes after spine surgery is still controversial. The aim of thismeta-analysis was to systematically review the literature and analyze the impact of compensationstatus on outcomes after lumbar spine surgery. A systematic search was performed on Medline,Scopus, CINAHL, EMBASE and CENTRAL databases. The review included studies of patientsundergoing lumbar spine surgery in which compensation status was reported. Methodologicalquality was assessed through ROBINS-I and quality of evidence was estimated using the GRADErating. A total of 26 studies with a total of 2668 patients were included in the analysis. WC patientshad higher post-operative pain and disability, as well as lower satisfaction after surgery whencompared to those without WC. Furthermore, WC patients demonstrated to have a delayed return towork. According to our results, compensation status is associated with poor outcomes after lumbarspine surgery. Contextualizing post-operative outcomes in clinical and work-related domains helpsunderstand the multifactorial nature of the phenomenon.
  • Paavola, Mika; Malmivaara, Antti; Taimela, Simo; Kanto, Kari; Järvinen, Teppo L. N. (2017)
    Introduction: Arthroscopic subacromial decompression (ASD) is the most commonly performed surgical intervention for shoulder pain, yet evidence on its efficacy is limited. The rationale for the surgery rests on the tenet that symptom relief is achieved through decompression of the rotator cuff tendon passage. The primary objective of this superiority trial is to compare the efficacy of ASD versus diagnostic arthroscopy (DA) in patients with shoulder impingement syndrome (SIS), where DA differs only by the lack of subacromial decompression. A third group of supervised progressive exercise therapy (ET) will allow for pragmatic assessment of the relative benefits of surgical versus non-operative treatment strategies. Methods and Analysis: Finnish Subacromial Impingement Arthroscopy Controlled Trial is an ongoing multicentre, three-group randomised controlled study. We performed two-fold concealed allocation, first by randomising patients to surgical (ASD or DA) or conservative (ET) treatment in 2:1 ratio and then those allocated to surgery further to ASD or DA in 1:1 ratio. Our two primary outcomes are pain at rest and at arm activity, assessed using visual analogue scale (VAS). We will quantify the treatment effect as the difference between the groups in the change in the VAS scales with the associated 95% CI at 24 months. Our secondary outcomes are functional assessment (Constant score and Simple shoulder test), quality of life (15D and SF-36), patient satisfaction, proportions of responders and non-responders, reoperations/treatment conversions, all at 2 years post-randomisation, as well as adverse effects and complications. We recruited a total of 210 patients from three tertiary referral centres. We will conduct the primary analysis on the intention-to-treat basis. Ethics and Dissemination: The study was approved by the Institutional Review Board of the Pirkanmaa Hospital District and duly registered at ClinicalTrials.gov. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations. © 2017 Article author(s).
  • Marinkovic, Ivan; Isokuortti, Harri; Huovinen, Antti; Trpeska Marinkovic, Daniela; Mäki, Kaisa; Nybo, Taina Tuulikki; Korvenoja, Antti; Raj, Rahul; Vataja, Risto; Melkas, Susanna (2020)
    Abstract: Background: We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW). Methods: We recruited 103 MTBI patients (mean age 40.8 years, SD 3.1) prospectively from University Hospital. The patients were followed up for one year. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) and Extended Glasgow Outcome Scale (GOSE) were administered one month after MTBI. Three months after MTBI, any psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Results: Psychiatric disorders were diagnosed in 26 patients (25.2%). The most common disorders were previous/current depression. At three months, there was no dierence between patients with psychiatric disorders versus those without them in RTW (95.7% vs. 87.3%, p = 0.260) or at least in part-time work (100% vs. 94.4%, p = 0.245). In Kaplan–Meier analysis, the median time to RTW was 10 days for both groups. The median RPQ score was 13.0 (Interquartile range (IQR) 6.5–19.0) in patients with a psychiatric disorder compared to 8.5 (IQR 2.3–14.0) in those without one (p = 0.021); respectively, the median GOSE was 7.0 (IQR 7.0–8.0) compared to 8.0 (IQR 7.0–8.0, p = 0.003). Conclusions: Approximately every fourth patient with MTBI had a psychiatric disorder. These patients reported more symptoms, and their functional outcome measured with GOSE at one month after MTBI was worse. However, presence of any psychiatric disorder did not aect RTW. Early contact and adequate follow-up are important when supporting the patient’s return to work.
  • Lindholm, Frida (Helsingin yliopisto, 2021)
    Vid septoplasti rätas en deviation i nässkiljeväggen ut vilken orsakat obstruktiv andning. Det saknas omfattande forskning om sjukfrånvaron efter septoplasti. Sjukfrånvaro är en stor utgift för samhället och arbetsgivaren, därför är det skäl att dimensionera frånvaron rätt både enligt operationens art och patientens arbete. Målet med studien är att fastställa hur lång sjukledighet patienterna får utskrivet efter operationen samt vilka faktorer som påverkat längden. I denna studie undersökte vi ordinerad sjukfrånvaro i ett retrospektivt material på septoplastier gjorda åren 2015, 2016 och 2018 vid Helsingfors och Nylands sjukvårdsdistrikt. Faktorer som tagits i beaktande är: arbetets art, när operationen utförts, specialiseringsgraden på kirurgen, stängningsmetoden och förlängning av ordinarie sjukfrånvaron samt orsaker till det. Av 771 patienter fick 85% sjukfrånvaro. Sjukfrånvarons längd var i medeltal 11,6 dagar (1–25 dagar). Veckodagen hade en inverkan på längden: på måndag fick patienterna kortast och på torsdag längst sjukfrånvaro (10.92 vs. 12,1 p=0,006). Specialiserande läkare skrev nästan en dag längre sjukfrånvaro jämfört med specialläkare (0,825, p=0,028). Patienter med fysiskt arbete fick 1,42 dagar längre sjukfrånvaro jämfört med patienter med kontorsarbete, p=0,005. Förlängning av sjukfrånvaron fick 3,5%, postoperativ infektion var den vanligaste orsaken. Eftersom få fick förlängning kan man anta att 11 dagar är lämplig längd på sjukfrånvaron. Veckodagen, specialiseringsgraden och arbete är det främsta faktorer som påverkade längden. För att fastställa den optimala längden på sjukfrånvaro krävs vidare forskning.
  • Huovinen, Antti (Helsingin yliopisto, 2020)
    Tausta: Traumaattisen aksonaalisen vaurion (TAI) merkitystä prognostisena tekijänä lievässä traumaattisessa aivovammassa ei ole tutkittu tarpeeksi. Yksittäisiä tutkimuksia löytyy TAI:n merkityksestä oireisuuteen ja kokonaisvaltaiseen toipumiseen lievän aivovamman jälkeen, mutta kirjallisuudessa ei löydy viitteitä, jotka suoraan tutkisivat lievillä aivovammapotilailla TAI-leesioiden vaikutusta työhönpaluuseen Tavoitteet: Tavoitteena on tutkia, mikä on traumaattisen aksonaalisen vaurion prognostinen merkitys työhönpaluuseen, posttraumaattisiin persistoiviin oireisiin sekä kokonaisvaltaiseen toipumiseen lievän traumaattisen aivovamman jälkeen. Metodit: Tutkimus sisälsi 113 prospektiivisesti kerättyä lievän aivovamman saanutta työikäistä ja työssäkäyvää potilasta. Akuuttivaiheen jälkeen potilaat lähetettiin HUS Aivovammapoliklinikalle neurologin arvioon noin kuukauden kuluessa tapaturmasta. Tätä edeltävästi potilaat kävivät 3T MRI-tutkimuksessa 3-17 vuorokauden sisällä vammasta. HUS Aivovammapoliklinikalla arvioitiin myös oireisuus Rivermead Post-Concussion Symptom Questionnaire -kyselyllä (RPQ) ja kokonaisvaltainen toipuminen Glasgow Outcome Scale Extended -mittarin (GOS-E) avulla. Työhönpaluu arvioitiin retrospektiivisesti jatkuvana muuttujana ja onnistunut työhönpaluu varmistettiin strukturoidulla puhelinhaastattelulla. Tulokset: 98,2% aivovammapotilaista oli palannut työelämään vuoden kohdalla. Työhönpaluuajan mediaani oli 9 vuorokautta. TAI-potilaat (n=22) eivät tilastollisesti eronneet muista lievän aivovamman saaneista potilaista oireisuuden suhteen, ja heidän kokonaisvaltainen toipuminen oli yhtä hyvää. Työhönpaluuajoissa ei ollut tilastollisesti merkittävää eroa ryhmien välillä. Pohdinta ja johtopäätökset: Tutkimuksessa TAI-potilaat toipuivat yhtä hyvin kuin muut lievän aivovamman saaneet potilaat. Traumaattinen aksonaalinen vaurio ei välttämättä ole prognostinen tekijä työhönpaluulle lievässä aivovammassa. Sen sijaan, että tavoittelisimme yhä tarkempia kuvantamismenetelmiä, jatkossa syytä olisi keskittyä muihin riskitekijöihin sekä suojaaviin tekijöihin, jotka vaikuttavat lievästä aivovammasta toipumiseen.
  • Honkonen, N.; Liira, J.; Lamminpaa, A.; Liira, H. (2018)
    Background Work ability meetings (WAMs) are planned discussions between an employee, a manager and an occupational physician (OP) to support work ability and return to work (RTW). During the last decade, WAMs become a popular intervention in Finnish occupational healthcare, although research on their content is lacking. Aims To describe the practice of WAMs in Finland. Methods We sent an internet survey by e-mail to members of the Finnish Society of Occupational Health Physicians in August 2014. We asked them to describe the last WAM they had attended, the employee the meeting concerned, the reason why it was convened, the content of the meeting and the action plan developed. Results A total of 303 of 1304 OPs responded (24%) to the survey. The meetings were most often arranged for employees in manual or clerical work (71%). There were several overlapping reasons for convening a WAM, including a worker's reduced work ability (57%), functional ability (42%) or long-term sickness absence (38%). The meetings consisted of RTW planning, clarification of the situation and a dialogue between the three parties. In half of the cases, the action plans dealt with modifications of work tasks. A third of cases were forwarded to vocational rehabilitation, while permanent disability pension was considered in 6% of cases. Conclusions The focus of WAMs was on workplace adjustments to support workers to remain at work. The WAMs dealt mostly with early interventions for RTW: work modifications, adjustments and vocational rehabilitation.