Does the return to work have a negative impact on the lifestyle of cardiovascular patients? Comments on the ICAROS results

Adaptation and validation of the cardiovascular version of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES-CVD) to the Italian context

PURPOSE

Effective cardiac rehabilitation interventions must provide adequate support to overcome psychosocial return-to-work (RTW) barriers. No validated instrument is available for this aim for cardiovascular patients. The Return-to-work Obstacles and Self-Efficacy Scale (ROSES) measures RTW obstacles workers perceive and the self-efficacy for overcoming them through 46 items and ten dimensions. This study aimed to adapt and validate ROSES for cardiovascular disease (CVD) in the Italian context.

METHODS

This prospective study involved 183 CVD working patients at baseline and 121 six months later. ROSES-CVD internal consistency, construct, and predictive validity was evaluated with Cronbach's α, Confirmatory factor analyses (CFA), and ANCOVAs.

RESULTS

CFAs adequately replicated the original ROSES model (CFI = .92-.96; TLI = .91-.94; RMSEA = .042-.057; SRMR = .046-.071) with α close or higher than .70 for all dimensions. Four ROSES-CVD dimensions significantly predicted the number of days to RTW controlling for age, gender, educational level, and surgery type. Workers who perceived salient RTW obstacles and low self-efficacy in any of these dimensions in mean returned to work from 38 to 53 days later.

CONCLUSIONS

The study supported the validity and reliability of ROSES-CVD. This tool can be used in rehabilitation to detect CVD patients at risk of a longer RTW process and define appropriate cardiac rehabilitation intervention.IMPLICATIONS FOR REHABILITATIONVocational rehabilitation interventions should provide tailor-made support to overcome RTW barriers based on individual risk assessmentThe Italian translation of ROSES-CVD is a valid and reliable tool to measure psychosocial barriers to RTW among CVD working patientsThe use of ROSES-CVD would allow detection of CVD patients at risk of longer RTW processAdministering ROSES-CVD can help focus traditional vocational intervention on individually relevant obstacles to RTW.

The role of cardiac rehabilitation in vocational reintegration Belgian working group of cardiovascular prevention and rehabilitation position paper

Cardiovascular disease is one of the main causes of morbidity and sick leave in Belgium, imposing a great socio-economic burden on the contemporary healthcare system and society. Cardiac rehabilitation is an evidence-based treatment strategy that not only improves the cardiac patients' health state but also holds promise so as to facilitate vocational reintegration in the society. This position paper was developed and endorsed by the Belgian Working Group of Cardiovascular Prevention and Rehabilitation. It provides an overview of the currently available Belgian data with regard to the role of cardiac rehabilitation in return to work after an initial cardiac event. It identifies the relevant barriers and facilitators of vocational integration of cardiac patients and summarises the contemporary Belgian legal and medical framework in this regard. Cardiac rehabilitation remains a primordial component of the post-acute event management of the cardiac patient, facilitating vocational reintegrating and thereby decreasing the pressure on social security. Despite the availability of a relevant legislative framework, there is a need for well-defined algorithms to assess readiness for return to work that can be used in daily clinical practice.

Health Literacy of Patients Attending Cardiac Rehabilitation

PURPOSE

Cardiac rehabilitation (CR) is effective at reducing further cardiac events. However, dropout rates are high, and maintenance of behavioral change post-CR is challenging. Health literacy (HL) may influence self-management of cardiac risk, yet few studies have explored this association. This study aimed to describe HL among CR attendees; first to describe the HL profiles of people commencing CR and second to examine HL changes between program entry and completion.

METHODS

CR attendees in Melbourne, Australia, completed the Health Literacy Questionnaire (HLQ) at program admission and completion. The HLQ measures HL across 9 scales. Cluster analysis grouped participants according to their HL profile. Effect sizes were used to determine changes in HLQ scores. Post-program interviews explored the role of HL in participant recovery.

RESULTS

Participants completed baseline (n = 60) and post-program (n = 38) data collection. Mean age was 60.3 ± 11.7 yr, and 38.3% had myocardial infarction and/or percutaneous coronary intervention. Approximately 18% of participants did not complete the program. Five HL clusters were revealed. The clusters most likely to drop out were confident users of the health system. The cluster least likely to drop out reported lower confidence in their ability to find health information and navigate services. Information-seeking ability improved over time, but no other HL improvements were seen.

CONCLUSION

There is a wide range of HL profiles in people attending CR. Findings suggest that CR programs should consider a variety of approaches to meet the diverse HL requirements of attendees.

Work-Life Balance: Weighing the Importance of Work-Family and Work-Health Balance

To date, research directed at the work–life balance (WLB) has focused mainly on the work and family domains. However, the current labor force is heterogeneous, and workers may also value other nonworking domains besides the family. The aim of this study was to investigate the importance of other nonworking domains in the WLB with a particular focus on health. Moreover, the importance of the effects of the work–family balance (WFB) and the work–health balance (WHB) on job satisfaction was investigated. Finally, we explored how the effects of the WFB and the WHB on job satisfaction change according to worker characteristics (age, gender, parental status, and work ability). This study involved 318 workers who completed an online questionnaire. The importance of the nonworking domains was compared with a t-test. The effect of the WFB and the WHB on job satisfaction was investigated with multiple and moderated regression analyses. The results show that workers considered health as important as family in the WLB. The WHB explained more of the variance in job satisfaction than the WFB. Age, gender and parental status moderated the effect of the WFB on job satisfaction, and work ability moderated the effect of the WHB on job satisfaction. This study highlights the importance of the health domain in the WLB and stresses that it is crucial to consider the specificity of different groups of workers when considering the WLB.

Return to work after coronary revascularization procedures and a patient's job satisfaction: A prospective study

INTRODUCTION

Research into work reintegration following invasive cardiac procedures is limited. The aim of this prospective study was to explore predictors of job satisfaction among cardiac patients who have returned to work after cardiac rehabilitation (CR).

MATERIAL AND METHODS

The study population consisted of 90 cardiac patients who have recently been treated with coronary angioplasty or heart surgery. They were evaluated during their CR and 12 months after the discharge using validated self-report questionnaires measuring job satisfaction, work stress-related factors, emotional distress and illness perception. Information on socio-demographic, medical and occupational factors has also been collected.

RESULTS

After adjusting for demographic, occupational and medical variables, baseline job satisfaction (p < 0.001), depression (p < 0.01) and ambition (p < 0.05) turned out to be independent, significant predictors of job satisfaction following return to work (RTW). Patients who had a partial RTW were more satisfied with their job than those who had a full RTW, controlling for baseline job satisfaction.

CONCLUSIONS

These findings recommend an early assessment of patients' psychosocial work environment and emotional distress, with particular emphasis on job satisfaction and depressive symptoms, in order to promote satisfying and healthy RTW after cardiac interventions.