个案管理技术在工伤职工重返工作中的应用

目的:通过研究个案管理技术在推动工伤职工重返工作过程中的作用,分析工伤职工再就业问题,探讨协助工伤职工再就业的有效方法。方法:选择5位伤残情况不同的工伤职工作为研究对象,将个案管理的介入工作分为4个时期,在工伤职工的住院康复和重返工作过程中采用了评估、康复辅导、干预和管理、就业支援与随访等个案管理技术方法,协助工伤职工实现再就业,并对再就业问题进行比较分析。结果:经过出院后6个月的就业随访,1位返回了原公司不同工作岗位,1位在新公司实现再就业,2位实现自雇创业,1位多次尝试创业未成功。结论:工伤职工在再就业过程中存在多种影响因素;个案管理技术对工伤职工的重返工作有帮助,可以应用于工伤职业康复服务中。     

职业培训对工伤人员重返工作岗位的作用

随着我国城市化、工业化进程的快速发展,各种工业意外和职业病不断增加。工伤不仅严重影响受伤职工个人及家庭生活,也造成大量社会劳动力的丧失,影响社会的进步和经济的可持续性发展。因而以恢复劳动者身体功能和职业劳动能力为主要目标的工伤康复由此应运而生,各国相继实施工伤保险制度以分散风险,同时高度重视工伤康复的作用,降低工伤所造成的损失和保障工伤职工的基本权益。     

急性心肌梗死患者急诊PCI术后重返工作岗位的影响因素分析

目的重返工作岗位是急性心肌梗死患者身心恢复正常的一个重要的标志。本研究对急性心肌梗死患者PCI术后重返工作岗位的影响因素进行分析。方法人选病例为因急性心肌梗死患者人院行急诊PCI术的203患者，在术后1个月电话咨询是否恢复工作。结果术后1月时，有38％的患者恢复正常工作（78／203），其中42％男性患者恢复工作（60/142），29％的女性患者恢复正常工作（18／61）。恢复工作的患者中50％有吸烟史（39／78），未恢复工作中有63％有吸烟史（79／125）（P〈0．05）；恢复工作的患者中36％（28／78）有多支血管病变，未恢复工作中有59％（74／125）有多支血管病变（P〈0．05）。多因素回归分析显示多支血管病变为影响患者重返工作岗位的危险因素（P=0．001，OR=0．327）。结论多支血管病变为影响患者重返工作岗位的危险因素。     

心肌梗死患者重返工作岗位的研究进展

重返工作岗位是衡量心肌梗死患者是否完全康复并成功融入社会的重要指标.本研究介绍了国内外心肌梗死患者重返工作岗位的现状,从社会人口学、疾病、职业、自评健康、焦虑和抑郁、社会支持6个方面综述重返工作岗位影响因素的研究进展,并介绍了运动康复、心理干预、健康教育、职业康复等干预措施,旨在为医护人员构建心肌梗死患者职业康复方案,...     

冠心病患者重返工作岗位情况及影响因素的Meta分析

目的 ：分析冠心病患者重返工作岗位的情况及影响因素,为临床制订冠心病患者重返工作岗位的干预措施提供参考依据。方法：计算机检索中英文数据库中有关冠心病患者重返工作岗位的情况及影响因素的研究,检索时间从建库至2023年2月。采用RevMan 5.3和StataMP 17.0软件进行Meta分析。结果 ：共纳入10篇文献,涉及研究对象11 394例。Meta分析结果显示,冠心病患者重返工作岗位率为58%[95%CI(0.47～0.69)]。性别[OR=2.37,95%CI(1.65～3.40)]、年龄[OR=1.26,95%CI(1.07～1.47)]、工作性质[OR=5.91,95%CI(3.65～9.57)]、病变血管数量[OR=0.16,95%CI(0.05～0.46)]、恐惧疾病进展[OR=0.87,95%CI(0.82～0.91)]、社会支持[OR=1.13,95%CI(1.07～1.18)]为冠心病患者重返工作岗位的影响因素。结论 ：冠心病患者重返工作岗位率较低,且受多种因素的影响,医务人员应全面、重点关注以上高危人群,及时给予干预与支持。     

经皮冠状动脉介入治疗患者重返工作岗位影响因素及干预的研究进展

经皮冠状动脉介入治疗已成为心血管疾病的主要治疗手段.重返工作岗位标志着患者从疾病状态到回归社会常态的转变,是疾病恢复的重要指标.该文对经皮冠状动脉介入治疗患者重返工作岗位的概念、现状、影响因素及干预措施进行综述,以期为重返工作岗位的概念界定、综合干预措施的制订和护理实践研究提供参考.     

工作模拟评估用于工伤职业司机重返工作岗位风险评估的研究

目的:研究使用工作模拟评估预测工伤职业司机重返工作岗位风险情况,并检测其有效性。方法:依据162例工伤职业司机参加工作模拟评估情况给予重返工作岗位建议。3个月后,通过电话随访确定其就业情况,对比分析工作模拟评估的预测有效性,同时分析影响工作模拟评估预测效力的因素。结果:工作模拟评估结果与职业司机实际安全就业情况一致性K系数为0.489。单因素二元Logistics回归分析显示患者出院时就业意愿(OR=1.821,CI:1.238-2.678)、雇佣关系(OR=0.583,CI:0.379-0.896)及企业性质(OR=0.710,CI:0.527-0.956)可影响工作模拟评估的预测效力,多因素二元Logistics回归分析显示患者出院时就业意愿(OR=1.718,CI:1.151-2.564)和单位性质(OR=0.724,CI:0.530-0.988)为影响工作模拟评估预测能力的重要因素。结论:工作模拟评估是一种有效的受伤职业司机复工风险的评估方法,但需考虑患者就业愿意和单位性质等。     

重返工作岗位对肝肾移植患者生活质量的影响

目的 对重返工作岗位的肝肾移植患者的生活质量进行研究分析,旨在了解重返工作岗位对其生活质量的影响。方法 采用一般情况问卷和生活质量综合评定量表（GQOH-74）,调查重返工作岗位肝肾移植术后患者30例（观察组）生活质量情况,并将其与未重返工作组30例（对照组）进行比较,分析重返工作岗位对肝肾移植术后患者生活质量的影响。结果 观察组生活质量总分、各维度、各因子分高于对照组,差异显著。结论 重返工作岗位有助于提高肝肾移植患者术后的生活质量。     

重返工作岗位对肝肾移植患者生活质量的影响

目的 对重返工作岗位的肝肾移植患者的生活质量进行研究分析,旨在了解重返工作岗位对其生活质量的影响.方法 采用一般情况问卷和生活质量综合评定量表(GQOLI-74),调查重返工作岗位肝肾移植术后患者30例(观察组)生活质量情况,并将其与未重返工作组30例(对照组)进行比较,分析重返工作岗位对肝肾移植术后患者生活质量的影响.结果 观察组生活质量总分、各维度、各因子分高于对照组,差异显著.结论 重返工作岗位有助于提高肝肾移植患者术后的生活质量.     

乳腺癌生存者重返工作岗位干预现状研究进展

乳腺癌是女性中最常见的癌症[1],也是导致女性死亡的主要原因。据统计,全球乳腺癌新发病例数约2100万[2],约占女性癌症新发病例的1/4,预计到2021年中国乳腺癌新发病例数可达到2500万。由于早期筛查早期诊断以及治疗手段的不断发展,乳腺癌患者5年生存率不断提高。有研究显示,美国乳腺癌患者5年生存率为90%,中国乳腺癌患者5年生存率为73.0%[3]。多数乳腺癌生存者(BCS)确诊时处于工龄阶段,因治疗需要、对疾病复发的恐惧[4]、担心致畸致残、情感障碍[5]、功能改变[6]等,BCS在长时间甚至终身不再重返工作岗位。而对于BCS,特别是年轻生存者而言,生活和情感层次的需要使得重返工作岗位的问题尤为重要。目前,国内BCS重返工作岗位的相关研究仍较少见。     

Biographical disruption of injured workers in chronic pain

Purpose.?This research explored how injured workers living with work-related chronic pain rethink and reconstruct their biographical experience.

Method.?This qualitative study used a grounded theory approach to data collection and analysis. Semi-structured focus groups were conducted to gather data and analysis was performed by the coding of emergent themes.

Results.?Analysis of the focus groups revealed the impact that chronic pain has on the social components of an injured worker's life; particularly their sense of self, their relationship to others and how they perceive themselves in social situations.

Conclusions.?Injured workers experienced changes (physical, psychological and social transformations) that led to biographical disruption; a change in self-identity, which in turn contributed to changes in important relationship dynamics. Injured workers spoke of repeated losses – loss of self, relationships and of the life imagined. Understanding the meaning of these losses could improve the conditions surrounding the injured worker's biographical reconstruction and facilitate the rehabilitation process.     

Pre-injury job characteristics and return to work among injured workers in South Korea: differences by socio-demographic and injury-related characteristics

Purpose: This study examined the effect of pre-injury job characteristics on the odds of RTW outcomes for specific socio-demographic and injury-related characteristics among injured workers in South Korea.

Methods: This study employed first-wave data for 1993 participants from the Panel Study of Workers’ Compensation Insurance. A two-step cluster analysis was conducted to profile pre-injury job characteristics, including monthly wages, length of service, company size, contract type, and working hours. For each subsample selected by the characteristics of the independent variables, multinomial logistic regression analyses were performed to predict the odds ratio for being unemployed or working in a new firm versus returning to the pre-injury job, depending on cluster membership.

Results: Two clusters were identified with pre-injury job characteristics. Workers in the unstable employment cluster were more likely than were workers in the stable employment cluster to be unemployed or work in a new firm rather than return to the pre-injury job; this held for all socio-demographic and injury-related characteristics.

Conclusions: Our results showed a need to develop differential RTW strategies for injured workers in insecure jobs at the time of injury.

• Implications for rehabilitation

• Policymakers and rehabilitation practitioners need to take into account not only socio-demographic or injury-related characteristics but also working conditions at the time of injury when designing return-to-work programs for injured workers in South Korea.

• Injured employees in poor working conditions are relatively more vulnerable in the return-to-work process and deserve special attention and supports from the Korean government.

• The Korean government needs to review return-to-work policies for injured workers in unstable employment environment in the context of employment relationships rather than individual characteristics.

     

急性职业性手外伤患者回归工作的影响因素分析

目的：探讨影响急性职业性手外伤患者回归工作（RTW）的因素,以期为工伤职工回归工作提供参考。方法：对福州地区60例急性职业性手外伤患者通过电话采访进行问卷调查,调查内容包括受伤的类型、职业、工作性质、教育程度、损伤部位、住院时间、受伤归因、单位的性质、雇佣类型、伤前对工作的满意度、伤前与同事间关系、是否为家庭主要劳动力、工伤保险状况以及是否接受正规康复治疗等。采用单因素相关分析和Logistic回归分析方法获得影响返回工作岗位的潜在因素。结果：在被调查的内容中得到4个有意义的影响因素,包括工作类型（白领）（OR=19.195,95%可信区间为1.001~368.014）、受伤归因（内因）（OR=6.256,95%可信区间为1.024~38.215）、伤前与同事有良好关系（OR=11.016,95%可信区间为1.715~70.755）及是家庭主要劳动力（OR=10.568,95%可信区间为1.528~73.086）。结论：RTW是一个受多因素影响的过程。     

Perspectives of unemployed workers with mental health problems: barriers to and solutions for return to work

Purpose: To evaluate the barriers to and solutions for return to work (RTW) from the perspective of unemployed workers who were sick-listed due to mental health problems.

Methods: We conducted semi-structured interviews with 25 sick-listed unemployed workers with mental health problems. Qualitative data analysis was performed, using a process of identifying, coding, and categorising the patterns in data.

Results: All workers experienced multiple problems in different domains of life related to their disease, personal circumstances (e.g., divorced, debts) and their environment (e.g., labour market problems, issues with the Social Security Agency). Workers differed in the way they perceived their RTW process and in the extent to which they were able to envision and implement the solutions for RTW, thus resulting in three types of workers’ attitudes towards their own RTW process: (1) “frozen”; (2) “insightful though passive”; and (3) “action mode”.

Conclusions: We conclude that the sick-listed unemployed workers with mental health problems have to deal with multiple problems, of which medical problems are only a part. These workers need help aimed at their coping methods according to one of the three types of workers’ characteristics. Moreover, they need specific help organising and structuring their problems, getting their life back on track, and finding employment.

• Implications for Rehabilitation

• Unemployed workers with mental health problems face considerable challenges which impede their return to work. Evaluating the workers’ attitude may provide useful information on their own return-to-work process.

• In many cases, workers indicate a need for coaching to help them with problem-solving, planning, gaining structure, getting their life back on track, and finding employment.

• Rehabilitation professionals should tailor RTW interventions to the needs of these workers, aimed at their specific problems and taking into account the workers’ coping methods according to one of three types of workers’ attitudes towards their own RTW process.

     

职业模拟训练对工伤职工再就业的影响

目的 观察职业模拟训练的疗效,探讨有效的职业训练方法.方法 应用BTE PRIMUS职业模拟系统对65名工伤职工进行平均2.8个月的职业模拟训练,出院后对再就业情况跟踪调查6个月.结果 出院后6个月内重返原工作岗位29人（44.62%）,改变工种原单位工作24人（36.92%）,新单位工作6人（9.22%）,未能回到工作岗位6人（9.22%）.结论 应用BTE PRIMUS进行职业模拟训练有利于提高工伤职工的劳动能力,促进工伤职工重新就业.     

Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury

Purpose: To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI). Method: A systematic literature search was conducted in PubMed (2008–2014), applying terms for ABI and RTW. In addition, studies published after 2003 of a previous review on the same topic were added. The methodological quality of the included studies was assessed and evidence was classified. Results: Twenty-seven studies were included. There is strong evidence that a high education level is positively associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are negatively associated, and a clear tendency has been deduced from the studies that conscious state in the Emergency Department is not associated with RTW. After non-traumatic ABI, there is strong evidence that independence in activities of daily living is positively associated with RTW and aetiology of stroke is not. Conclusions: This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are not associated with RTW. In addition, it provides further evidence that personal factors after traumatic ABI and activity-related factors after non-traumatic ABI are strongly associated with RTW.

• Implications for Rehabilitation

• We found strong evidence for a significant association between RTW and personal factors (education level, unemployment) after traumatic ABI, and activities of daily living (ADL) after non-traumatic ABI.

• We advise to focus on work-related activities during the RTW process besides ADL-training and pay attention to and support patients at risk for not returning to work.

     

Determinants of return to work among Nigerian stroke survivors

Purpose: Employment, an important aspect of life, could be adversely affected by a disabling condition like stroke. This study explores the frequency and determinants of return to work (RTW) among Nigerian stroke survivors. Method: One-hundred and one stroke patients attending Physiotherapy clinics at seven teaching and specialist hospital centers in north-eastern Nigeria participated in the study. Socio-demographic, clinical and RTW data were obtained from participants while the modified Rankin Scale was used to assess functional ability. Chi-square statistics and multivariable logistic regression analysis was used to identify the determinants of RTW among the participants. Results: About half of the participants (55%) had returned to work. Absence of disability [Odds Ratio (OR) = 57.7; 95% CI = 12.0–276.8) and mild disability (OR = 15.1; 95% CI = 3.9–58.3) were the significant determinants of RTW, while post-stroke duration of a year or less was associated with lower chance of returning to work (OR = 0.2; 95% CI = 0.0–0.8). Conclusions: The prominence of functional independence among the determinants of RTW implies that rehabilitation efforts and support programmes to optimize functional ability, especially within the first year after stroke, will greatly enhance RTW among Nigerian stroke survivors.

Implications for Rehabilitation

• Functional outcome influenced vocational outcome, hence the need for rehabilitation efforts at improving functional status of stroke survivors to encourage return to work (RTW).

• The low rate of RTW within the first year after stroke may be addressed by the establishment of specilized sub-acute and long-term rehabilitation centers in Nigeria instead of depending only on existing inadequate outpatient rehabilitation practices

     

Work-related determinants of return to work of employees on long-term sickness absence

Purpose.?The aim of the study is to identify work-related determinants of return to work (RTW) of employees who are on long-term sickness absence.

Method.?The study was based on a sample of 926 employees on sickness absence (maximum duration of 12 weeks). The employees filled out a baseline questionnaire and were subsequently followed until the 10th month after listing sick. Cox proportional hazards regression analyses were used to identify determinants of RTW.

Results.?Working in one of the vocational sectors public administration, construction, financial and commercial services, transport, or education (P?=?0.00) and having low co-worker support (P?=?0.01) were related to longer duration to RTW in the mulitvariate model. Having low supervisor support (P?=?0.01) was associated with a higher RTW rate.

Conclusions.?Vocational sector is a strong predictor of RTW. Especially employees from the sector education are slow as to RTW. The observed association between low supervisor support and RTW was unexpected. However, the study confirms earlier research on the association between low co-worker support and RTW.     

The importance,measurement and practical implications of worker's expectations for return to work

Abstract

Purpose: Workers' own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct. Method: A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts. Results: A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings. Conclusions: Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker's movement through the RTW process and the outcomes achieved.

• Implications for Rehabilitation

• Return to work is an integral part of workplace injury management.

• The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes.

• A mismatch between an injured worker's expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker's concerns.

• Once underling issues are identified, work can be put into resolving these so that the worker's return to the workplace is not impeded.