Non-working Patients Research Articles

Unemployment as a risk factor for AIDS and death for HIV-infected patients in the era of highly active antiretroviral therapy

Objectives:To assess the association between social situation and disease progression among patients diagnosed with HIV infection since the advent of highly active antiretroviral therapy (HAART), taking late testing into account.Methods:Prospective...

Patient factors associated with attrition from a self‐management education programme

To examine utilization patterns of diabetes self-management training (DSME) and identify patient factors associated with attrition from these services at an ambulatory diabetes education centre (DEC). A retrospective medical chart review of first time visits (536) to the centre between 1 August 2000 and 31 July 2001 was conducted for patients with type 2 diabetes. Descriptive analyses were conducted to examine utilization patterns over a 1-year period. Multivariable logistic regression was used to identify patient factors associated with attrition from DSME and non-use of group education among new patients. Almost 50% of new patients withdrew prematurely from recommended DSME services over the 1-year period, and only 24.8% attended group education. Patient variables such as being older than 65 years of age, primarily speaking English, or working full or part-time were associated with attrition from DSME and non-use of group education when compared with middle aged, non-English-speaking, and non-working patients. High DSME attrition rates indicate that retention needs to become a focus of programme policy, planning and evaluation to improve programme effectiveness. DSME tailored to the cultural and linguistic characteristics of the community, and convenient and accessible to working and older patients will potentially increase retention in and accessibility to these services.

Quality of life of cancer survivors after physical and psychosocial rehabilitation

As the number of newly diagnosed cancer patients and the survival rates of cancer increase, more and more cancer patients are facing distressing physical and psychosocial problems as a result of their cancer and its treatment. To address these problems, a 12-week rehabilitation group program for cancer patients (all cancer types), combining physical exercise and psycho-education, was tested in a longitudinal cohort study (n=658). At baseline, participants reported a low quality of life, measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) (range 0-100). Halfway through the intervention significant improvements were found in all domains, except cognitive functioning. At the end of rehabilitation, participants had reached significant improvements on all outcome variables: in global quality of life (from 63.0 to 71.9), emotional functioning (from 66.2 to 74.4), cognitive functioning (from 70.5 to 74.4) and fatigue level (reduction from 49.8 to 41.8) while, moreover, non-breast cancer patients showed clinically relevant improvement in physical functioning (from 67.3 to 80.4) and social functioning (from 63.4 to 79.4) and non-working patients showed a clinically relevant improvement in role functioning (from 57.0 to 69.6).

Employment and disability for work in patients with COPD: a cross-sectional study among Dutch patients

The aim was to gain insight into work experiences and problems of subjects with chronic obstructive pulmonary disease (COPD) to develop more effective guidelines for preventing work disability and work loss. A total of 617 patients aged 45-60, recruited from pulmonary outpatient clinics and general practices, completed a questionnaire on (respiratory) health and work history. Of the patients 43% were female, 52% were employed and more than half were less educated. Comorbidity was present in 52% of the study group. Of those who stopped working (N=260), 36% stopped before the onset of COPD, 39% stopped because of COPD and 25%, although having COPD, had other reasons to stop. Of the patients with a work history 39% had an invalidity benefit: 21% of the working and 60% of the non-working patients. For one-third of these patients COPD was not the reason for having an invalidity benefit. For 56% of those who had a benefit because of COPD, comorbidity contributed to work disability. No difference in current smoking habit was seen between working patients and non-working patients. Yet, non-working patients were more often smokers at the moment they stopped working. Furthermore, former smokers who still worked stopped smoking at a younger age than former smokers who stopped working. Compared with workers and independent of smoking habit, former workers were more exposed to dust/irritants, had their work(place) less frequently modified and had more unfavourable (social) work experiences. For employees with COPD, work loss is often multi-factorial. Comorbidity is often present and an important cause for work loss. Therefore occupational health guidance has to take other interfering (health) factors than COPD into consideration as well. In preventing work disability, work(place) adjustment merits more attention.

Work status and chronic low back pain: exploring the international classification of functioning, disability and health

Purpose. Exploring which variables are related to work status in patients with chronic low back pain (CLBP), classified according to the International Classification of Functioning, Disability and Health (ICF).Method. Ninety-two patients with CLBP filled out questionnaires inquiring after health status, impairments in body functions/structures, limitations in activities of daily living (ADL), participation in work, environmental and personal factors. Additionally, patients performed tests to measure physical fitness and performance of work-related activities. Univariate analyses were performed to investigate whether differences exist between working and non-working patients. Logistic linear regression analysis was performed to explain work status from the variables of functioning.Results. Non-working patients had a lower self-reported physical and mental health, lower physical fitness, more self-reported limitations in ADL, lower education, more depressive symptoms and higher psycho neuroticism than working patients. Self-reported physical and mental health and educational level correctly classified 84.5% of the patients as working or non-working. Performance of work-related activities was not significantly related with work-status.Conclusions. The relation between work status and CLBP is multidimensional, as was illustrated by using the bio-psychosocial model of the ICF. Patients with a low educational level, a low self-reported physical or mental health were more likely to be non-working. Self-reported limitations and physical and mental health are more important in explaining work status than objective measurements of performance.

Endoscopic Carpal Tunnel Release: A Review of 753 Cases in 486 Patients

Endoscopic carpal tunnel release is gaining increasing acceptance relative to the standard open carpal tunnel release for the treatment of carpal tunnel syndrome. Concerns about endoscopic carpal tunnel release include effectiveness of therapy and complication rates. This study attempted to evaluate outcomes of endoscopic carpal tunnel release in a large patient cohort. Four hundred eighty-six patients (753 hands) with carpal tunnel syndrome who underwent endoscopic carpal tunnel release by a single surgeon were reviewed retrospectively. Data included demographics, subjective complaints, prior interventions, preoperative examination findings, and postoperative follow-up. All follow-up data were obtained from a single, independent, occupational therapy clinic. Median patient age was 48 years. Three hundred seventy-seven patients were gainfully employed at presentation, and 206 filed a worker's compensation claim. Median symptom duration was 2 years. Nonoperative therapy was ineffective in 151 patients. Preoperative nerve conduction studies were consistent with carpal tunnel syndrome in 472 patients (97 percent); all patients had either physical examination findings or nerve conduction studies consistent with carpal tunnel syndrome. Four hundred eighty-six patients (100 percent) obtained symptom relief. Complications included one transient median nerve neurapraxia, six complaints of residual pain, and one complaint of hypersensitivity. Worker's compensation patients and non-worker's compensation patients returned to work full-duty at similar times postoperatively. Ninety percent of employed patients returned to their original occupation. The authors' data indicate that an endoscopic approach for the treatment of carpal tunnel syndrome is safe and effective. Patients demonstrated a high return-to-work rate and an extremely low complication rate. The data challenge the belief that endoscopic carpal tunnel release results in higher complication rates.

Who Returns to Work After Heart Transplantation?

Detailed information regarding the work history of heart transplant patients is limited. Therefore, the work history and factors associated with return to work at 1 year after heart transplantation were examined in 237 heart transplant patients as part of a longitudinal quality-of-life study at two university medical centers. Patient characteristics were as follows: 81% male; 89% white; mean age 54 years (range 24 to 71); mean level of education 13 years; and 84% were married. Data were collected using the following instruments: Work History tool; Rating Question Form; Heart Transplant Stressor Scale; Quality of Life Index; Sickness Impact Profile; Jalowiec Coping Scale; Social Support Index; Heart Transplant Symptom Checklist; and Chart Review Form. Frequency distributions, chi-square, t-tests and stepwise regression were used to examine the work history of patients. Pre-transplant, only 17% of patients were working as compared with 26% (61 of 237) working by 1 year after transplant (p = 0.003). Pre-transplant non-working patients (n = 197) were hospitalized more frequently, were more physically disabled, had more symptom distress, and rated their health as poorer. After heart transplant non-working patients (n = 176) had more rejection, infection and medical complications and more hospital days. Patients who were working either pre- or post-transplant were more likely to hold jobs that were less physically demanding. Factors significantly associated with return to work by 1 year after heart transplant were better functional ability, higher education, fewer endocrine problems, fewer acute rejection episodes and shorter heart transplant waiting time. Clinical and demographic variables influence return to work after heart transplantation. Knowledge of these variables provides the health-care team with information to assist patients in securing gainful employment.

Analysis of Cognitive Dysfunction in Patients with Low-Grade Glioma

All living adults with histopatologically proven diagnosis of low-grade glioma in a Swedish county were identified with help of the Regional Cancer Register, half of them (n = 24) participated in a neuropsychological evaluation. A considerable variation was found in cognitive function within this group of patients, ranging from good ability to severe disturbance. Different patterns of cognitive dysfunction emerged resulting in three subgroups; patients with severe, mild, and minimal selective dysfunction. The patients with severe disturbance had a global dysfunction covering most assessed cognitive domains. Slow information-processing speed was obvious in the subgroups with both severe and mild dysfunction. Cognitive problems present in the best performing group seemed related to tumor localization. Cognitive function in the whole sample was related to histopathological diagnosis of the tumor, as well as to educational level of the patients. The nonworking patients had significantly poorer performance than the working patients.

Waiting for orthopaedic surgery: factors associated with waiting times and patients' opinion

To assess waiting times for three groups of orthopaedic patients in Sweden and to identify factors explaining variations in waiting time. Also examined were factors associated with patients' perceptions that waiting times were too long. Retrospective study. Patients from orthopaedic units at 10 Swedish hospitals participated in the study. A questionnaire was sent to 1336 surgical patients (517 hip replacement, 321 back surgery, and 498 arthroscopic knee surgery) 3 months after surgery. Information extracted from the hospitals' patient administrative systems was also used. Outcome measures. Length of waiting time, socio-economic variables, hospital type, health-related quality of life, and opinion about waiting time. The data were analysed mainly using regression analyses. The overall response rate was 79%. In all pre-operative stages, waiting times were longest in the hip replacement group. Socio-economic variables were not consistent determinants of variation in waiting times except for working status in the back surgery group where working patients had shorter waiting times than non-working patients irrespective of phase of waiting time. Admission to a county/district county hospital, compared with a university/regional hospital, was associated with shorter time on the waiting list. Patients with better health-related quality of life had significantly longer waiting times for arthroscopic knee surgery by all waiting time measures. The length of wait was a significant predictor of the patients' acceptance of waiting time. Patients' influence over the date of surgery also appeared to affect their opinion about the waiting time. Hospital-related factors are more important than patient characteristics as explanations of variations in waiting times for orthopaedic surgery. Patients value short waiting times and the possibility of influencing the date of surgery.

Prospective assessment of outcomes improvement following fusion for low back pain.

This prospective study was performed to improve the quality of outcomes data in patients undergoing spinal fusion for low back pain. There is an accepted deficiency of this form of outcomes assessment in the literature. The aim was to determine the effectiveness of the surgical procedure in terms of patient satisfaction, outcome scores, and third-party measures. The measures of outcomes assessment included patient satisfaction, pain scores, low back outcome and Prolo scores, medication use, and employment status. Data collection was prospective prior to and at final follow-up. Eighty percent of 35 patients were followed for a mean of 31 months. Patient satisfaction was 71%; however, only 28.6% of patients followed achieved good or excellent low back outcome scores. Yet significant improvement occurred: 46.4% achieved a good or excellent outcome using the Prolo score. There was a 75% reduction in medication usage, and 75% of nonworking compensation patients returned to gainful employment. Patient satisfaction was markedly higher than improvement measured by the outcome scores. Dramatic improvements in medication usage and return to work were achieved, despite less than spectacular outcome scores. These findings support cautious use of posterior spinal fusion. Patients must appreciate improvement rather than normality as a realistic aim.

Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion.

The goal of the current study was to analyze the prospective clinical outcome of patients who failed closed or open treatment of a displaced intra-articular calcaneal fracture. This cohort of patients required a secondary subtalar fusion by distraction bone-block arthrodesis. Review of prospective, randomized trial database. Four level I trauma centers. Between April 1, 1991 and December 31, 1997, 424 patients with 471 displaced intra-articular calcaneal fractures were involved in a large, multicenter, randomized trial. Forty-four patients who required subtalar fusion following initial treatment of a displaced intra-articular calcaneal fracture were compared to the population of patients who did not require subtalar fusion. The variables compared between the two groups included Böhler angles, two computed tomography classification systems, and clinical scores including SF-36, visual analogue score, and oral analogue score. Subtalar distraction bone-block arthrodesis with tricortical bone graft was used in all 45 feet. The following were examined: x-ray fracture classification, specifically Böhler angles and Essex-Lopresti classification; computed tomography classification, specifically Sanders and Crosby; clinical scores, specifically validated visual analogue score, general health survey scores, oral analogue score, and other factors (i.e., patient demographics including age, sex, profession, smoking history, and Worker's Compensation Board involvement. Initial treatment of the 44 patients in our study was nonoperative in 37 (84%) patients and operative (open reduction and internal fixation) in 7 (16%) (1 patient had bilateral heel fractures). Patients requiring fusion differed demographically from those patients not requiring fusion. Mean age was 39 years in both the fusion and nonfusion group. The fusion group had 97% males, whereas the nonfusion group had 89% males. Sixty-four percent of the fusion patients were Worker's Compensation Board claims, whereas 35% of the nonfusion group were Worker's Compensation Board claims. Of those that required fusion, 77% were heavy laborers. On average, the fusion group had a Böhler angle 15 degrees less than the nonfusion group. Forty-six percent of the fusion patients were Sanders-type IV initial fractures. Logistic regression analysis revealed that the primary predictors of requiring fusion were Worker's Compensation Board status (odds ratio = 3.03, 95% confidence interval = 1.41-6.57), Sanders-type IV (odds ratio = 5.48, 95% confidence interval = 1.57-19.18), Böhler angle <0 degrees (odds ratio = 10.64-95% confidence interval = 1.33-85.17), and nonoperative initial treatment (odds ratio = 5.86-95% confidence interval = 2.33-14.67). These data suggest that the amount of initial injury involved with the calcaneal fracture is the primary prognostic determinant of long-term patient outcome. Böhler angle on presentation of <0 degrees was 10 times more likely to require a secondary subtalar fusion than a Böhler angle on presentation of >15 degrees. Sanders-type IV calcaneal fractures were 5.5 times more likely to be fused than a simple Sanders type II fracture. Worker's Compensation Board patients were three times more likely to be fused than non-Worker's Compensation Board patients. Nonoperative care was six times more likely to lead to a late fusion as compared to open reduction and internal fixation treatment. Late fusion provided relief from pain and improved function as evidenced by an improvement in visual analogue score postsurgery. This study demonstrates that there is a distinct patient group with a displaced intra-articular calcaneal fracture who are at high risk of subtalar fusion. These include male Worker's Compensation Board patients who participate in heavy labor work with a fracture pattern with Böhler angle less than 0 degrees. If their initial treatment was nonoperative, the likelihood of requiring late subtalar fusion was significantly increased. Initial open reductional open reduction and internal fixation of patients with displaced intra-articular calcaneal fracture minimized the likelihood that subtalar fusion would be required.

Endoscopic carpal tunnel release: thirteen years' experience with the Chow technique.

The purpose of this single-center study was to evaluate the results of endoscopic carpal tunnel release (ECTR) by using the dual portal Chow technique in a large series of patients. A total of 2,675 procedures in 1,886 patients were performed during a 13-year period. Follow-up evaluation was performed in 2,402 (90%) cases or 1,698 (90%) patients. The success rate was 95% and the recurrence rate was 0.5%. A total of 106 cases (4.5%) were considered failures or had unsatisfactory results. The overall complication rate was 1.1% but no serious complications occurred in this series. The return-to-work status was followed-up in 1,156 patients; 90% of non-worker's compensation patients and 60% of worker's compensation patients returned to work within 4 weeks. This study suggests that ECTR for carpal tunnel syndrome (CTR) is a reliable procedure with a high success rate. Based on our 13 years of experience, we believe that the technique is safe and iatrogenic complications can be avoided with meticulous surgical technique.

Standardized treatment of intra-articular calcaneal fractures using an oblique lateral incision and no bone graft.

The purpose of this study was to evaluate our protocol with the modified skin incision without bone graft in the treatment of intra-articular calcaneal fractures in a consecutive series. Thirty-three displaced intra-articular calcaneal fractures operatively treated by a single surgeon were evaluated. Each fracture was managed according to a standardized protocol that included an oblique lateral incision and stable internal fixation, without supplemental bone graft. Fractures were classified according to two accepted criteria. Patients were evaluated with serial clinical and radiographic examinations. Final evaluation was made after at least a 2-year follow-up and was determined by the use of a functional outcome assessment questionnaire. Anatomic or near anatomic reductions were obtained in 97% of cases. All fractures healed without loss of initial reduction or collapse. Excellent or good results were achieved in 88% of non-worker's compensation patients and 27% of worker's compensation patients. Fractures with anatomic reductions were more likely to achieve a good or excellent result. Ninety-two percent of patients returned to the workforce. Complications included one superficial wound infection and five cases of peroneal tendinitis requiring hardware removal. One patient underwent subtalar fusion secondary to painful posttraumatic arthritis. The open reduction and internal fixation using our standardized protocol is an effective method of treatment for intra-articular calcaneal fractures.

Employment status, job characteristics, and work-related health experience of people with a lower limb amputation in The Netherlands

Schoppen T, Boonstra A, Groothoff JW, de Vries J, Göeken LNH, Eisma WH. Employment status, job characteristics, and work-related health experience of people with a lower limb amputation in The Netherlands. Arch Phys Med Rehabil 2001;82:239-45. Objectives: To describe the occupational situation of people with lower limb amputations in The Netherlands and to compare the health experience of working and nonworking amputee patients with a nonimpaired reference population. Design: Cross-sectional study in which patients completed a questionnaire about their job participation, type of job, workplace adjustments to their limb loss, their position in the company, and a general health questionnaire. Setting: Orthopedic workshops in The Netherlands with a population of lower limb amputees. Patients: Subjects were recruited from orthopedic workshops in the Netherlands. They ranged in age from 18 to 60 years (mean, 44.5yr) and had a lower limb amputated at least 2 years (mean, 19.6yr) before this study. Main Outcome Measures: A self-report questionnaire, with 1 part concerning patient characteristics and amputation-related factors, and the other concerning job characteristics, vocational handicaps, work adjustments, and working conditions; and a general health questionnaire (RAND-36) to measure health status. Results: Responses were received from 652 of the 687 patients (response rate, 95%) who were sent the questionnaire. Sixty-four percent of the respondents were working at the time of the study (comparable with the employment rate of the general Dutch population), 31% had work experience but were not presently working, and 5% had no work experience. After their amputations, people shifted to less physically demanding work. The mean delay between the amputation and the return to work was 2.3 years. Many people wished their work was better adjusted to the limitations presented by their disability and they mentioned having problems concerning possibilities for promotion. Seventy-eight percent of those who stopped working within 2 years after the amputation said that amputation-related factors played a role in their decision. Thirty-four percent said that they might have worked longer if certain adjustments had been made. The health experience of people who were no longer working was significantly worse than that of the working people with amputations. Conclusions: Although amputee patients had a relatively good rate of job participation, they reported problems concerning the long delay between amputation and return to work, problems in finding suitable jobs, fewer possibilities for promotion, and problems in obtaining needed workplace modifications. People who had to stop working because of the amputation showed a worse health experience than working people.

Treatment of Patients with Chronic Somatic Symptoms by Means of Art Psychotherapy: A Process Description

Background: Inability to express emotions is common in patients with long-lasting somatic symptoms associated with incapacitation and impaired quality of life. One method for treating this inability is art psychotherapy. In this study the typical course in such treatments is described. Patients were followed longitudinally before therapy and every 4th to 6th month during the treatment. Methods: Patients with long-lasting psychosomatic conditions resulting in partial or total loss of working capacity for at least 1 year have been treated in the programme. All of them had chronic pain. The majority of the patients that were referred to us were offered treatment. Three-fourths of those who started treatment stayed in treatment as long as the therapist considered it optimal. Twenty-four patients (22 women and 2 men) in the present study had their treatment started on average 2 years (range 13–42 months) before the end of the treatment period. In addition these 24 patients were contacted 6–48 months after the end of the therapy (average 23 months) and a short post-evaluation was made by telephone. Results: The first year of treatment was characterized by emotional turmoil paralleled by increased energy level reflected in temporary elevation of serum uric acid. Significant improvement was observed with regard to anxiety-depression after one year of treatment. A tendency towards decreased levels of psychosomatic symptoms in general was observed after two years of treatment. One-fourth of the 20 non-working or parttime working patients increased their working activity. Conclusions: A slow partial recovery was observed. Art psychotherapy may have contributed to this.

II. Do chronic pain patients' perceptions about their preinjury jobs differ as a function of worker compensation and non-worker compensation status?

(1) To demonstrate a relationship between intent to return to preinjury job and preinjury job perceptions about that job; and (2) to demonstrate that worker compensation chronic pain patients (WC CPPs) would be more likely than non-worker compensation chronic pain patients (NWC CPPs) not to intend to return to a preinjury type of job because of preinjury job perceptions. The relationship between preinjury job perceptions and intent to return to the preinjury job was investigated and compared between worker compensation (WC) and nonworker compensation (NWC) chronic pain patients (CPPs). Within the WC and NWC groups CPPs not intending to return to their preinjury type of work were compared to those CPPs intending to return on preinjury job perception. Compensation status, being a WC CPPs or being a non-WC CPPs, has been claimed to be predictive or not predictive of return to work post pain treatment. These studies have, however, ignored the preinjury job stress perception variable as an area of research. WC CPPs were age- and sex-matched to NWC CPPs and statistically compared on their responses to rating scale and yes/no questionnaires for intent to return to work and perceived preinjury job stress. In a second analysis, both the WC and NWC groups were divided according to their intent to return to work and statistically compared on their responses to these questionnaires. Both male and female WC CPPs were less likely than their counterparts to intend to return to their preinjury job. Both WC and NWC were found to complain of preinjury job complaints, and these complaints were found to differ between WC and NWC CPPs. An association between intent not to return to work and the perceptions of preinjury job dissatisfaction and job dislike was found for male and female WC CPPs and for male and female NWC CPPs. There may be a relationship between some preinjury job perceptions and intent to return to the preinjury type of work in some groups of CPPs. However, a specific relationship between WC status, intent not to return to the preinjury type of work, and preinjury job perceptions in comparison to NWC CPPs could not be demonstrated.

An Analysis of Factors Affecting Employment of Chronic Dialysis Patients

Less than 30% of chronic dialysis patients are employed, but little is known about the factors affecting the employment status of these patients. Some conflicting reports about an improvement in vocational status with the use of erythropoietin and the lack of information about the contribution of dialysis adequacy (as assessed by KT/Vurea) to employment status prompted us to examine demographic and biochemical factors associated with employment status in chronic in-center hemodialysis (n = 46) and continuous peritoneal dialysis (n = 31) patients who were ≤55 years of age. Thirty-three of the 77 patients (43%) were either working or attending school full-time. The working patients were noted to be better educated (20 of 33 working v 12 of 44 nonworking patients had >12 years of education; P = 0.005) and on dialysis for a shorter mean time (44 ± 52 months for the working patients v 77 ± 78 months for the nonworking patients; P = 0.03). Sex, race, diabetes mellitus, mode of dialysis, and prior transplant were not associated with employment status. Similarly, mean hematocrit (30.2% ± 5% in the working patients v 30.5% ± 4% in the nonworking patients) and mean weekly delivered KT/V (1.4 ± 0.7 v 1.3 ± 0.6 for hemodialysis and 2.3 ± 0.7 v 2.3 ± 0.6 for peritoneal dialysis in the working and nonworking patients, respectively) were not different among the working and nonworking patients. Albumin was also not significantly different among the working and nonworking patients (4 ± 0.3 v 3.9 ± 0.4, respectively; P = 0.27). Additional study of psychosocial, socioeconomic, and biochemical factors, including the study of patients with a broad range of KT/V, hematocrit, and albumin values, would help to elucidate the factors influencing the chronic dialysis patient’s ability and desire to work.

The diagnosis of myasthenia gravis (MG)

Schoppen T, Boonstra A, Groothoff JW, de Vries J, Göeken LNH, Eisma WH. Employment status, job characteristics, and work-related health experience of people with a lower limb amputation in The Netherlands. Arch Phys Med Rehabil 2001;82:239-45. Objectives: To describe the occupational situation of people with lower limb amputations in The Netherlands and to compare the health experience of working and nonworking amputee patients with a nonimpaired reference population. Design: Cross-sectional study in which patients completed a questionnaire about their job participation, type of job, workplace adjustments to their limb loss, their position in the company, and a general health questionnaire. Setting: Orthopedic workshops in The Netherlands with a population of lower limb amputees. Patients: Subjects were recruited from orthopedic workshops in the Netherlands. They ranged in age from 18 to 60 years (mean, 44.5yr) and had a lower limb amputated at least 2 years (mean, 19.6yr) before this study. Main Outcome Measures: A self-report questionnaire, with 1 part concerning patient characteristics and amputation-related factors, and the other concerning job characteristics, vocational handicaps, work adjustments, and working conditions; and a general health questionnaire (RAND-36) to measure health status. Results: Responses were received from 652 of the 687 patients (response rate, 95%) who were sent the questionnaire. Sixty-four percent of the respondents were working at the time of the study (comparable with the employment rate of the general Dutch population), 31% had work experience but were not presently working, and 5% had no work experience. After their amputations, people shifted to less physically demanding work. The mean delay between the amputation and the return to work was 2.3 years. Many people wished their work was better adjusted to the limitations presented by their disability and they mentioned having problems concerning possibilities for promotion. Seventy-eight percent of those who stopped working within 2 years after the amputation said that amputation-related factors played a role in their decision. Thirty-four percent said that they might have worked longer if certain adjustments had been made. The health experience of people who were no longer working was significantly worse than that of the working people with amputations. Conclusions: Although amputee patients had a relatively good rate of job participation, they reported problems concerning the long delay between amputation and return to work, problems in finding suitable jobs, fewer possibilities for promotion, and problems in obtaining needed workplace modifications. People who had to stop working because of the amputation showed a worse health experience than working people.

Sustained attention in methadone patients.

Sustained attention was examined in chronic, high-dose (70-120 mg) methadone patients with a modified Continuous Performance Test (Rosvold et al., 1956) 45 min in duration. Working and nonworking patient groups, and drug-free ex-addict and opiate-naive comparison groups were tested at high, moderate, and low signal rates. Groups did not differ overall in accuracy, response latencies, or commission errors. The working patients, however, performed better at the high than at the lower signal rates, and had poorer accuracy and longer latencies at the low rate than the comparison groups. The nonworking patients had different results; they made more commission errors at the high signal rate than the other three groups.

Emotional, intellectual and physiological predictors of vocational outcome of pulmonary rehabilitation patients.

Previous researchers have independently shown that pulmonary function measures, intelligence test scores, and a recently developed MMPI-derived scale can predict post-hospital employment among rehabilitation patients with chronic obstructive pulmonary disease. This study compared the effectiveness of the three variables in predicting employment among a group of vocational rehabilitation candidates with chronic obstructive pulmonary disease. Only the MMPI-derived scale (COPD-VR) identified the non-working patients significantly above base rate. While this finding does not necessarily mean that personality, or attitudinal, factors are more important than physiological or intellectual variables in vocational rehabilitation success among such patients, it gives further support to the validity of the COPD-VR scale.