Monigue Hw Hw Frings-Dresen

How many people return to work after acquired brain injury?: A systematic review

Primary objective: To investigate how many people return to work (RTW) after acquiring brain injury (ABI) due to traumatic or non-traumatic causes. Secondary objectives were to investigate the differences in outcome between traumatic and non-traumatic causes, the development of RTW over time and whether or not people return to their former job. Methods: A systematic literature search (1992–2008) was performed using terms of ABI and RTW. The methodological quality of the studies was determined. An overall estimation of percentage RTW 1 and 2 years post-injury was calculated by data pooling. Main outcomes and results: Finally, 49 studies were included. Within 2 years post-injury, 39.3% of the subjects with non-traumatic ABI returned to work. Among people with traumatic ABI, 40.7% returned to work after 1 year and 40.8% after 2 years. No effect of cause or time since injury was found. Some people with traumatic ABI who returned to work were not able to sustain their job over time. Changes of occupation and job demands are common among people with ABI. Conclusions: About 40% of the people with traumatic or non-traumatic ABI are able to return to work after 1 or 2 years. Among those with acquired traumatic brain injury a substantial proportion of the subjects were either not able to return to their former work or unable to return permanently.

Prognostic factors of return to work after acquired brain injury: A systematic review

Primary objective: To provide insight into the prognostic and non-prognostic factors of return to work (RTW) in people with traumatic and non-traumatic acquired brain injury (ABI) who were working before injury. Methods: A systematic literature search (1992–2008) was performed, including terms for ABI, RTW and prognostic factors. The methodological quality of the studies was determined. Evidence was classified as strong (positive, negative or no), weak or inconsistent. Main outcomes and results: Following classification of the studies, 22 studies were included. Strong evidence was found that ‘gender’ and ‘anatomic location’ were not associated with RTW after non-traumatic ABI and that both ‘injury severity’ (classified by the Glascow Coma Scale) and ‘suffering from depression’ or ‘anxiety’ were not associated with RTW after traumatic ABI. In addition strong evidence was found for the negative prognostic value on RTW of the ‘inpatient length of stay’, after traumatic ABI. Weak evidence was found for the three trainable/treatable factors ‘ability to perform activities of daily living’, ‘residual physical deficits/higher disability level’ and ‘number of associated injuries’. Conclusion: Strong evidence was found that six variables either had no association or a negative association with RTW. It is recommended to focus in rehabilitation on the factors for which weak evidence was found but that are trainable/treatable with the goal of improving the process of vocational rehabilitation.

What Promotes Sustained Return to Work of Employees on long-term Sick Leave? Perspectives of Vocational Rehabilitation Professionals

OBJECTIVES The aim of this study was to (i) explore promoting factors for sustained return to work (RTW), according to vocational rehabilitation professionals (VRP) that are amenable to change for employees who have been on sick leave >18 months and (ii) gain insight into crucial aspects of interventions. METHODS Semi-structured interviews were carried out with 23 VRP. All interviews were transcribed fully verbatim. An inductive analysis of the transcripts was performed, using a process of identifying, coding, and categorizing the primary patterns in the data. RESULTS Key influenceable promoting factors for sustained RTW by long-term sick-listed employees include: employee-based vocational guidance; integral, effective communication between the sick-listed employee and all RTW stakeholders; personal factors; a supportive work environment; and a stimulating social environment. Crucial aspects of interventions include: gathering information and setting priorities; improving qualifications; influencing cognitions; monitoring the sick-listed employee through the rehabilitation process; offering tailor-made interventions at different stages within a personal time-bound action plan; and preparing the employee and the work environment for RTW. CONCLUSIONS Sustained RTW for long-term sick-listed employees can be achieved by focusing on the influenceable promoting factors for RTW. The use of combined interventions in a holistic approach involving the worker and his environment is considered the best way to address the multicausality of work disability and could help maximize RTW outcomes.

Association between Work and Chronic Obstructive Pulmonary Disease (COPD)

To support occupational physicians in their assessment and notification of occupational diseases, diagnostic registration guidelines are developed with information about associations between work-related risk factors and diseases. The objective of this review of systematic reviews is to examine whether work-related risk factors are associated with chronic pulmonary obstructive disease (COPD). We searched the electronic database of Medline for systematic reviews published between 1 January 2009 and 20 June 2017. Reviews were included when COPD was assessed by data on lung function and when work-related exposures to vapors, dusts, gases, or fumes (VDGF) were described. One author selected studies and extracted data; two authors assessed study quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR). In all eight systematic reviews included, various exposures to vapors, dusts, gases, and fumes (VGDF) at work are associated with COPD. Two-thirds of the included studies are cross-sectional and show a high heterogeneity in population, setting, and mostly self-reported-exposures. Two high-quality reviews (AMSTAR score ≥ 9) including meta-analyses show associations and excess risk of COPD for work-related general exposure to VDGF with a summary odds ratio of 1.4 (95% confidence interval (CI) 1.19–1.73) and to inorganic dust with a mean difference in predicted forced expiratory volume in one second (FEV1) of −5.7% (95% CI: −8.62% to −2.71%). Exposure to VGDF at work is associated with a small but increased risk of COPD. More detailed workplace measurements of specific VGDF are warranted to gain an insight into dose–response relationships.