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Kluit L, van Bennekom CAM, Beumer A, Sluman MA, de Boer AGEM, de Wind A. Clinical Work-Integrating Care in Current Practice: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2023:10.1007/s10926-023-10143-1. [PMID: 37966538 DOI: 10.1007/s10926-023-10143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Clinical work-integrating care (CWIC) refers to paying attention to work participation in a clinical setting. Working patients may benefit from CWIC. The purpose of this study is to explore the extent and nature to which medical specialists provide CWIC and what policies and guidelines oblige or recommend specialists to do. METHODS A scoping review was conducted. The databases MEDLINE, EMBASE, Psychinfo, CINAHL, and Web of Science were searched for studies on the extent and nature of CWIC and supplemented by gray literature on policies and guidelines. Six main categories were defined a priori. Applying a meta-aggregative approach, subcategories were subsequently defined using qualitative data. Next, quantitative findings were integrated into these subcategories. A separate narrative of policies and guidelines using the same main categories was constructed. RESULTS In total, 70 studies and 55 gray literature documents were included. The main findings per category were as follows: (1) collecting data on the occupation of patients varied widely; (2) most specialists did not routinely discuss work, but recent studies showed an increasing tendency to do so, which corresponds to recent policies and guidelines; (3) work-related advice ranged from general advice to patient-physician collaboration about work-related decisions; (4) CWIC was driven by legislation in many countries; (5) specialists sometimes collaborated in multidisciplinary teams to provide CWIC; and (6) medical guidelines regarding CWIC were generally not available. CONCLUSION Medical specialists provide a wide variety of CWIC ranging from assessing a patient's occupation to extensive collaboration with patients and other professionals to support work participation. Lack of medical guidelines could explain the variety of these practices.
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Affiliation(s)
- Lana Kluit
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands.
| | - Coen A M van Bennekom
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Research and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands
| | - Annechien Beumer
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Upper Limb Unit Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Maayke A Sluman
- Department of Cardiology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Angela G E M de Boer
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Astrid de Wind
- Department of Public and Occupational Health, Amsterdam UMC Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands
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Obigbesan O, Hayden KA, Benzies KM. Scoping Review of Education for Women About Return to Driving After Abdominal Surgery. J Obstet Gynecol Neonatal Nurs 2023; 52:106-116. [PMID: 36463949 DOI: 10.1016/j.jogn.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To conduct a scoping review to examine the evidence on education provided to women about when to return to driving after abdominal surgery and to assess variation in this education by type of abdominal surgery and source of education. DATA SOURCES We searched MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Scopus, and CINAHL for peer-reviewed articles. We searched the publications of professional associations, clinical guidelines, driver's licensing agencies, and clinical trial registries for gray literature. Searches generated 2,908 peer-reviewed titles and abstracts and 20 documents in the gray literature. STUDY SELECTION We included articles and documents published in English in which authors reported education, advice, counseling, or recommendations about return to driving after abdominal surgery for women ages 16 to 50 years. DATA EXTRACTION We identified 16 peer-reviewed articles and eight documents in the gray literature. We extracted data including the title, authors, country of origin, study design, study purpose, sample size, type of abdominal surgery, education about return to driving, source of evidence to support the education, source of education, outcomes, and relevance to the review question. DATA SYNTHESIS We found that recommendations about when to return to driving after abdominal surgery ranged from 1 to 10 weeks after surgery, and 6 weeks after surgery was the most common. Recommended times were shorter for laparoscopic surgeries and longer for nonlaparoscopic surgeries, including cesarean. Most recommendations were provided by health care providers, and some recommendations were provided in leaflets. Evidence to support these recommendations was limited, and they were based on common sense, traditional practice, perceptions of insurance policies, a women's comfort level, or her ability to deploy the emergency brake. CONCLUSION Education provided to women about return to driving after abdominal surgery varies substantially and has a weak evidence base.
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Dedden SJ, Bouwsma EVA, Geomini PMAJ, Bongers MY, Huirne JAF. Predictive factors of return to work after hysterectomy: a retrospective study. BMC Surg 2022; 22:84. [PMID: 35246078 PMCID: PMC8896112 DOI: 10.1186/s12893-022-01533-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Although hysterectomy is one of the most frequently performed gynaecological surgeries, there is a dearth of evidence on perioperative care. The aim of the current study was to identify sociodemographic, surgical-related and work-related predictors of recovery following different approaches of hysterectomy. Methods Eligible patients for this retrospective cohort study were women who underwent vaginal, abdominal or laparoscopic hysterectomy for both benign and malignant gynaecological disease in 2014 in Máxima Medical Centre in the Netherlands. The main outcome measure was full return to work (RTW). Data were collected using a patient survey. Potential prognostic factors for time to RTW were examined in univariate Cox regression analyses. The strongest prognostic factors were combined in a multivariable model. Results In total 83 women were included. Median time to full return to work was 8 weeks (interquartile range [IQR] 6–12). The multivariable analysis showed that higher age (hazard ratio [HR] 1.053, 95% confidence interval [CI] 1.012–1.095) and same day removal of indwelling catheter (HR 0.122, 95% CI 0.028–0.539) were predictors of shorter duration until full RTW after hysterectomy. Conclusions This study provided insight in the predictors of recovery after hysterectomy. By identifying patient specific factors, pre-operative counselling can be individualized, changes can be made in perioperative care and effective interventions can be designed to target those factors.
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Affiliation(s)
- Suzanne J Dedden
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, The Netherlands. .,GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Esther V A Bouwsma
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peggy M A J Geomini
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, The Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
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4
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IMACTIV: A Pilot Study of the Impact of Unrestricted Activity Following Urethral Sling Surgery. Urology 2021; 156:85-89. [PMID: 34010679 DOI: 10.1016/j.urology.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare continence outcomes and health-related quality of life (HRQOL) among women with limited activity restrictions vs traditional restrictions following mid-urethral sling (MUS) surgery. METHODS Thirty-six women who underwent MUS surgery were randomized: (1) the Restrictions group was given traditional postoperative restrictions for 6 weeks while (2) the Limited Restrictions group was instructed to resume normal activities other than pelvic rest. Patients undergoing concomitant surgery for Stage III and IV prolapse were excluded. Participants completed questionnaires related to urinary symptoms (UDI-6, IIQ-7) for continence outcomes and HRQOL (SF-12) at baseline, 1 to 6 weeks, 3 months, 6 months, and at least 1 year after surgery. RESULTS There was no difference in mean scores on the UDI-6 or IIQ-7 between groups at baseline or any time after surgery. The Limited Restrictions group reported better scores than the Restrictions group on the SF-12 mental health component at 1 week (56.7 vs 50.2, P = .01) and 4 weeks (58.4 vs 53.3, P = .04). The Restrictions group reported better SF-12 physical health scores at 5 weeks (55.7 vs 53.0, P = .02) but there was no difference in HRQOL scores between the two groups at any other time. CONCLUSION In this pilot study, there was no difference in continence outcomes for women with traditional vs limited activity restrictions following MUS surgery. There were differences in HRQOL in the early post-operative period, but these differences were not sustained. Larger prospective studies are needed, but it appears that activity restrictions after MUS surgery may not be necessary.
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Strozyk S, Wernecke KD, Sehouli J, David M. Factors Influencing Postoperative Recovery and Time Off Work of Patients with Benign Indications for Surgery - Results of a Prospective Study. Geburtshilfe Frauenheilkd 2020; 80:723-732. [PMID: 32675834 PMCID: PMC7360394 DOI: 10.1055/a-1157-8996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/08/2020] [Indexed: 10/28/2022] Open
Abstract
Objectives The study aimed to answer a number of questions: Which medical, psychological and sociodemographic factors affect the recovery of women after gynecological surgery for benign indications? Does patients' health-related quality of life improve after surgical intervention? How long are patients signed off work postoperatively? How do patients assess their own capacity to work? Method Study population: All women between the ages of 18 and 67 years who underwent gynecological surgery for benign indications at the Charité Campus Virchow Clinic over a 7-month period were consecutively enrolled in the study. Four standardized patient surveys (the first survey [T0] was carried out in hospital, T1 at 1 week, T2 at 6 weeks and T3 at 7 - 8 months after discharge by telephone interview) were carried out using evaluated questionnaires to record patients' recovery (Recovery Index), quality of life (RAND-36), satisfaction, complications, sociodemographic information and time off work with a medical sick note. Relevant medical and demographic data were also collected. Statistical analysis was carried out using univariate statistical tests for descriptive analysis and complex multifactorial statistical procedures to record observations over time. Results A total of 182 patients were included in this study (participation rate: 70%). Relevant prior operations (p = 0.01), in-hospital (p = 0.004) and postoperative complications (p < 0.001), preoperative psychological wellbeing (p = 0.01), physical functioning (p = 0.005) and postoperative anxiety (p = 0,006) had a significant impact on recovery (Recovery Index) and changed significantly over time (p < 0.001). The invasiveness of the surgery or sociodemographic parameters (including migration background) had no significant effect. Health-related quality of life (measured with the RAND-36 questionnaire) also improved postoperatively. More invasive surgical interventions were associated with longer sick leave times and, to a certain extent, with a poorer evaluation of patients' capacity to work. Conclusion Recovery after gynecological surgery is a multifactorial process. This survey of a patient population identified psychological and physical factors which influence recovery but did not find significant sociodemographic parameters affecting recovery. Irrespective of these findings, gynecological surgery for benign indications resulted in an improvement in health-related quality of life. Prospective studies need to investigate whether psychological interventions could reduce preoperative fear and thereby improve postoperative recovery.
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Affiliation(s)
- Sophie Strozyk
- Klinik für Chirurgie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Klaus-Dieter Wernecke
- Charité - Universitätsmedizin Berlin, Berlin, Germany.,Sostana GmbH, Berlin, Germany
| | - Jalid Sehouli
- Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias David
- Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Harpham ME, Nassar N, Leung S, Lainchbury A, Shand AW. Maternal car driving capacity after birth: a pilot prospective study randomizing postnatal women to early verses late driving in a driving simulator. J Matern Fetal Neonatal Med 2018; 33:1385-1392. [PMID: 30173574 DOI: 10.1080/14767058.2018.1519537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Women are commonly advised to avoid driving following cesarean section (CS), however, this advice is based upon little evidence.Aims: We aimed to assess a woman's capacity to drive a car postbirth using a driving simulator to objectively examine driving behavior and competencies.Materials and methods: We conducted a pilot, prospective, randomized study from a tertiary referral hospital in Sydney, Australia. Postnatal women who were regular drivers and had given birth by vaginal delivery (VD), elective cesarean section (ElCS) or emergency cesarean section (EmCS) were randomized to early (2-3 weeks post birth) or late (5-6 weeks post birth) driver simulator testing. Driving performance was measured by reaction time to simulated impediments, awareness, attention, braking ability, traffic infringements, and accidents. Analysis was by intention to treat. Outcomes were assessed using contingency analysis via two-sample t-tests and Wilcoxen rank-sum tests.Results: 66 women were randomized and 38 attended simulator testing (57.6%; 19 early, 19 late; 8 VD, 14 ElCS, 16 EmCS). There was no difference in reaction times, driver awareness, braking times, or traffic infringements by early versus late testing (all p > .05), nor by mode of birth (p > .05) amongst the women who completed driver testing. At 7-8 weeks, all women were driving, without an accident.Conclusions: Although the study is limited by small sample size, there was no difference in driving capability by early versus late driving time since birth, nor by mode of birth. Further research is needed, but we cannot provide evidence to discourage well women from driving from 2-3 weeks post birth.
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Affiliation(s)
- Margaret E Harpham
- Department of Obstetrics, Royal Hospital for Women, Randwick, NSW, Australia.,Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Children's Hospital at Westmead Clinical School, NSW, Australia
| | - Stefanie Leung
- Discipline of Addiction Medicine, Sydney Medical School, University of Sydney, NSW, Australia.,Drug and Alcohol Services, South Eastern Sydney Local Health District, NSW, Australia
| | - Anne Lainchbury
- Department of Obstetrics, Royal Hospital for Women, Randwick, NSW, Australia
| | - Antonia W Shand
- Department of Obstetrics, Royal Hospital for Women, Randwick, NSW, Australia.,Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Nelson DB, Lapid DJ, Mitchell KG, Correa AM, Hofstetter WL, Mehran RJ, Rice DC, Sepesi B, Walsh GL, Vaporciyan AA, Swisher SG, Roth JA, Antonoff MB. Perioperative Outcomes for Stage I Non-Small Cell Lung Cancer: Differences Between Men and Women. Ann Thorac Surg 2018; 106:1499-1503. [PMID: 30118712 DOI: 10.1016/j.athoracsur.2018.06.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/26/2018] [Accepted: 06/22/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous studies have highlighted important biologic and survival-related differences among men and women with non-small cell lung cancer (NSCLC). However, differences in perioperative or short-term outcomes have not been as well characterized. In this study, we investigated differences in the perioperative period and postoperative emergency department (ED) visits among men and women after lobectomy for stage I NSCLC. METHODS A retrospective review was performed of patients who underwent a lobectomy for clinical stage I NSCLC at a single institution from 2010 to 2015. RESULTS We identified 559 patients for inclusion, including 293 women (52%) and 266 men (48%). Women were more likely to present with clinical T1 status (p = 0.005) and to undergo a minimally invasive operation (p = 0.058). To reduce confounding, 206 case-matched pairs were identified. After matching, no differences were found in length of stay (p = 0.551) or pulmonary complications (p = 0.509); however, men experienced more cardiac complications (18% versus 7%, p = 0.001). Of importance, although rates of 30- and 90-day ED visits between sexes were similar (p = 0.531, p = 0.890, respectively) and no sex-related differences were found in presenting symptom on return to the ED (p = 0.478), women were more likely to be readmitted after presenting to the ED within 30 days (p = 0.038). CONCLUSIONS Women demonstrated an increased likelihood of being admitted after presenting to the ED within 30 days after discharge, indicating important differences between men and women in the short-term period after lobectomy. Further research will be required to further understand the cause for these differences.
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Affiliation(s)
- David B Nelson
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Danica J Lapid
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Bouwsma EVA, Huirne JAF, van de Ven PM, Vonk Noordegraaf A, Schaafsma FG, Schraffordt Koops SE, van Kesteren PJM, Brölmann HAM, Anema JR. Effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: cluster controlled trial with randomised stepped-wedge implementation. BMJ Open 2018; 8:e017781. [PMID: 29382673 PMCID: PMC5829654 DOI: 10.1136/bmjopen-2017-017781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate the implementation and effectiveness of an internet-based perioperative care programme for patients following gynaecological surgery for benign disease. DESIGN Stepped-wedge cluster randomised controlled trial. SETTING Secondary care, nine hospitals in the Netherlands, 2011-2014. PARTICIPANTS 433 employed women aged 18-65 years scheduled for hysterectomy and/or laparoscopic adnexal surgery. INTERVENTIONS An internet-based care programme was sequentially rolled out using a multifaceted implementation strategy. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or the care programme (n=227). The care programme included an e-health intervention equipping patients with tailored personalised convalescence advice. MAIN OUTCOME MEASURES The primary outcome was duration until full sustainable return to work (RTW). The degree of implementation of the care programme was evaluated at the level of the patient, healthcare provider and organisation by indicators measuring internet-based actions by patients and providers. RESULTS Median time until RTW was 49 days (IQR 27-76) in the intervention group and 62 days (42-85) in the control group. A piecewise Cox model was fitted to take into account non-proportionality of hazards. In the first 85 days after surgery, patients receiving the intervention returned to work faster than patients in the control group (HR 2.66, 95% CI 1.88 to 3.77), but this effect was reversed in the small group of patients that did not reach RTW within this period (0.28, 0.17 to 0.46). Indicators showed that the implementation of the care programme was most successful at the level of the patient (82.8%) and professional (81.7%). CONCLUSIONS Implementation of an internet-based care programme has a large potential to lead to accelerated recovery and improved RTW rates following different types of gynaecological surgeries. TRIAL REGISTRATION NUMBER NTR2933; Results.
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Affiliation(s)
- Esther V A Bouwsma
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Statistics, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Frederieke G Schaafsma
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Paul J M van Kesteren
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Hans A M Brölmann
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Bouwsma EVA, Bosmans JE, van Dongen JM, Brölmann HAM, Anema JR, Huirne JAF. Cost-effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: economic evaluation alongside a stepped-wedge cluster-randomised trial. BMJ Open 2018; 8:e017782. [PMID: 29358423 PMCID: PMC5780709 DOI: 10.1136/bmjopen-2017-017782] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness and cost-utility of an internet-based perioperative care programme compared with usual care for gynaecological patients. DESIGN Economic evaluation from a societal perspective alongside a stepped-wedge cluster-randomised controlled trial with 12 months of follow-up. SETTING Secondary care, nine hospitals in the Netherlands, 2011-2014. PARTICIPANTS 433 employed women aged 18-65 years scheduled for a hysterectomy and/or laparoscopic adnexal surgery. INTERVENTION The intervention comprised an internet-based care programme aimed at improving convalescence and preventing delayed return to work (RTW) following gynaecological surgery and was sequentially rolled out. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or to the intervention (n=227). MAIN OUTCOME MEASURES The primary outcome was duration until full sustainable RTW. Secondary outcomes were quality-adjusted life years (QALYs), health-related quality of life and recovery. RESULTS At 12 months, there were no statistically significant differences in total societal costs (€-647; 95% CI €-2116 to €753) and duration until RTW (-4.1; 95% CI -10.8 to 2.6) between groups. The incremental cost-effectiveness ratio (ICER) for RTW was 56; each day earlier RTW in the intervention group was associated with cost savings of €56 compared with usual care. The probability of the intervention being cost-effective was 0.79 at a willingness-to-pay (WTP) of €0 per day earlier RTW, which increased to 0.97 at a WTP of €76 per day earlier RTW. The difference in QALYs gained over 12 months between the groups was clinically irrelevant resulting in a low probability of cost-effectiveness for QALYs. CONCLUSIONS Considering that on average the costs of a day of sickness absence are €230, the care programme is considered cost-effective in comparison with usual care for duration until sustainable RTW after gynaecological surgery for benign disease. Future research should indicate whether widespread implementation of this care programme has the potential to reduce societal costs associated with gynaecological surgery. TRIAL REGISTRATION NUMBER NTR2933; Results.
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Affiliation(s)
- Esther V A Bouwsma
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Hans A M Brölmann
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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10
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Bouwsma EVA, Anema JR, Vonk Noordegraaf A, de Vet HCW, Huirne JAF. Using patient data to optimize an expert-based guideline on convalescence recommendations after gynecological surgery: a prospective cohort study. BMC Surg 2017; 17:129. [PMID: 29212492 PMCID: PMC5719670 DOI: 10.1186/s12893-017-0317-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/20/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Convalescence advice is often based on tradition and anecdote from health care providers, rather than being based on experiences from patients themselves. The aim of this study was to analyse recovery in terms of resumption of various daily activities including work, following different laparoscopic and abdominal surgery in order to optimize an expert-based guideline on convalescence recommendations. METHODS This is a prospective cohort study conducted in nine general and one university hospital in the Netherlands. Women aged 18-65 years and scheduled for a hysterectomy (laparoscopic, vaginal, abdominal) and/or laparoscopic adnexal surgery (n = 304) were eligible to participate. Preoperatively, participants were provided with tailored expert-based convalescence recommendations on the graded resumption of several daily activities including sitting, standing, walking, climbing stairs, bending, lifting, driving, cycling, household chores, sport activities and return to work (RTW). Postoperatively, time until the resumption of these activities was tracked. Convalescence recommendations were considered correct when at least 25% and less than 50% of the women were able to resume an activity before or at the recommended recovery time. RESULTS There was a wide variation in the duration until the resumption of daily activities within and between groups of patients undergoing different types of surgery. Recovery times lengthened with increasing levels of physical burden as well as with increasing levels of invasiveness of the surgery. For the majority of activities actual recovery times exceeded the recovery time recommended by the expert panel. CONCLUSIONS This study provided insight in the resumption of daily activities after gynecological surgery and the adequacy of an expert-based convalescence guideline in clinical practice. Patient data was used to optimize the convalescence recommendations. TRIAL REGISTRATION Dutch trial registry, NTR2087 (August 2009) and NTR2933 (June 2011).
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Affiliation(s)
- Esther V. A. Bouwsma
- Department of Obstetrics and Gynecology, VU University Medical Center, P.O. Box 7057, Amsterdam, 1007 MB The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - A. Vonk Noordegraaf
- Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands
| | - Henrica C. W. de Vet
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith A. F. Huirne
- Department of Obstetrics and Gynecology, VU University Medical Center, P.O. Box 7057, Amsterdam, 1007 MB The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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11
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Huff KO, Aref-Adib M, Magama Z, Vlachodimitropoulou EK, Oliver R, Odejinmi F. Returning to work after laparoscopic myomectomy: a prospective observational study. Acta Obstet Gynecol Scand 2017; 97:68-73. [DOI: 10.1111/aogs.13246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Keren O Huff
- Department of Gynecology; Whipps Cross University Hospital; London UK
| | | | - Zwelihle Magama
- Department of Gynecology; Whipps Cross University Hospital; London UK
| | | | - Reeba Oliver
- Department of Gynecology; Whipps Cross University Hospital; London UK
| | - Funlayo Odejinmi
- Department of Gynecology; Whipps Cross University Hospital; London UK
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12
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Shand AW, Harpham ME, Lainchbury A, McCormack L, Leung S, Nassar N. Knowledge, advice and attitudes toward women driving a car after caesarean section or hysterectomy: A survey of obstetrician/gynaecologists and midwives. Aust N Z J Obstet Gynaecol 2016; 56:460-465. [DOI: 10.1111/ajo.12496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/26/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Antonia W. Shand
- Clinical and Population Perinatal Health Research; Kolling Institute; Northern Sydney Local Health District; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; Sydney New South Wales Australia
- Department of Obstetrics; Royal Hospital for Women; Randwick New South Wales Australia
| | - Margie E. Harpham
- Clinical and Population Perinatal Health Research; Kolling Institute; Northern Sydney Local Health District; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; Sydney New South Wales Australia
- Department of Obstetrics; Royal Hospital for Women; Randwick New South Wales Australia
| | - Anne Lainchbury
- Department of Obstetrics; Royal Hospital for Women; Randwick New South Wales Australia
| | - Lalla McCormack
- Department of Obstetrics; Royal Hospital for Women; Randwick New South Wales Australia
| | - Stefanie Leung
- Discipline of Addiction Medicine; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Drug and Alcohol Services; South Eastern Sydney Local Health District; Sydney New South Wales Australia
| | - Natasha Nassar
- Clinical and Population Perinatal Health Research; Kolling Institute; Northern Sydney Local Health District; St Leonards New South Wales Australia
- Sydney Medical School Northern; University of Sydney; Sydney New South Wales Australia
- Menzies Centre for Health Policy; University of Sydney; Sydney New South Wales Australia
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13
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A modified Delphi method toward multidisciplinary consensus on functional convalescence recommendations after abdominal surgery. Surg Endosc 2016; 30:5583-5595. [PMID: 27139706 PMCID: PMC5112288 DOI: 10.1007/s00464-016-4931-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 04/09/2016] [Indexed: 01/03/2023]
Abstract
Background Evidence-based information on the resumption of daily activities following uncomplicated abdominal surgery is scarce and not yet standardized in medical guidelines. As a consequence, convalescence recommendations are generally not provided after surgery, leading to patients’ insecurity, needlessly delayed recovery and prolonged sick leave. The aim of this study was to generate consensus-based multidisciplinary convalescence recommendations, including advice on return to work, applicable for both patients and physicians. Method Using a modified Delphi method among a multidisciplinary panel of 13 experts consisting of surgeons, occupational physicians and general practitioners, detailed recommendations were developed for graded resumption of 34 activities after uncomplicated laparoscopic cholecystectomy, laparoscopic and open appendectomy, laparoscopic and open colectomy and laparoscopic and open inguinal hernia repair. A sample of occupational physicians, general practitioners and surgeons assessed the recommendations on feasibility in daily practice. The response of this group of care providers was discussed with the experts in the final Delphi questionnaire round. Results
Out of initially 56 activities, the expert panel selected 34 relevant activities for which convalescence recommendations were developed. After four Delphi rounds, consensus was reached for all of the 34 activities for all the surgical procedures. A sample of occupational physicians, general practitioners and surgeons regarded the recommendations as feasible in daily practice. Conclusion Multidisciplinary convalescence recommendations regarding uncomplicated laparoscopic cholecystectomy, appendectomy (laparoscopic, open), colectomy (laparoscopic, open) and inguinal hernia repair (laparoscopic, open) were developed by a modified Delphi procedure. Further research is required to evaluate whether these recommendations are realistic and effective in daily practice.
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Results of Postdischarge Nursing Telephone Assessments: Persistent Symptoms Common Among Pulmonary Resection Patients. Ann Thorac Surg 2016; 102:276-81. [PMID: 27083250 DOI: 10.1016/j.athoracsur.2016.01.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/23/2015] [Accepted: 01/04/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND After hospital discharge, patients may have questions or complaints that surface or remain inadequately addressed. However, the dominant concerns and indications for further intervention among recently discharged patients after pulmonary resection have not been well described. The aims of this study were to characterize dominant concerns of pulmonary resection patients after discharge and to elucidate any relevant risk factors for their development. METHODS A single-institution, retrospective review was conducted of all patients who underwent pulmonary resection over a 12-month period and included records of standardized, nurse-initiated follow-up phone calls to discharged patients. Records of postdischarge telephone calls were reviewed, and data collected pertaining to complaints requiring counseling over the phone or escalation to higher care level. Demographic, operative, and hospital data were examined by multivariate analyses to assess predictors of need for counseling or escalation of care. RESULTS In all, 523 patients underwent pulmonary resection during the study, and 245 (46.8%) had nursing-documented telephone conversations at 4.6 days (±0.18) days after discharge. Among those reached, 81 (33.1%) had problems requiring counseling during the call; 31 (12.7%) reported concerns requiring escalation of care, handled by subsequent telephone call for 7 (22.6%), clinic appointment for 22 (71.0%), or emergency room referral for 2 (6.5%). Age, sex, race, and residential proximity to the hospital did not predict need for counseling nor escalation of care. CONCLUSIONS Patient complaints after pulmonary resection were frequent, with most problems resolved by telephone counseling. Despite highly prevalent concerns, predictors of need for counseling or care escalation were not identified, suggesting ongoing utility in the practice of telephoning all patients. Further, this study serves as a needs assessment, highlighting the importance of patient education and discharge planning.
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15
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Buss I, Gould L. Improving the provision of driving advice on discharge after abdominal surgery. BMJ QUALITY IMPROVEMENT REPORTS 2016; 4:bmjquality_uu203922.w1739. [PMID: 26734396 PMCID: PMC4693046 DOI: 10.1136/bmjquality.u203922.w1739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/27/2015] [Indexed: 11/03/2022]
Abstract
Ensuring the safety of patients is a vital duty of a doctor. It is their responsibility to advise patients about activity limitations on discharge from hospital. This study aims to assess the current provision of driving advice for patients after abdominal surgery and institute improvements to this provision of information in North Bristol NHS Trust. A preliminary questionnaire ascertained current doctor's knowledge regarding limitations of driving postoperatively and whether information was communicated to patients. Baseline retrospective data were collected from electronic discharge summaries to determine documentation of advice provision. Educational interventions were introduced, followed by data collection after each intervention. Initial questionnaires demonstrated poor knowledge amongst doctors and a lack of provision of driving advice postoperatively. After multiple educational interventions, the provision of driving advice on electronic discharge summaries increased from 0% (0) at baseline to 75% (9). Initially, the provision of driving advice postoperatively was poorly documented for inpatients undergoing abdominal surgery; following multiple educational interventions, the provision of written advice improved. Future plans include the introduction of prewritten sentences onto the electronic discharge summaries to facilitate ease of information provision and a reaudit in 12 months.
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Bouwsma EVA, Vonk Noordegraaf A, Szlávik Z, Brölmann HAM, Emanuel MH, Lips JP, van Mechelen W, Mozes A, Thurkow AL, Huirne JAF, Anema JR. Process evaluation of a multidisciplinary care program for patients undergoing gynaecological surgery. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:425-438. [PMID: 24057871 PMCID: PMC4118044 DOI: 10.1007/s10926-013-9475-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE This study describes the process evaluation of an innovative multidisciplinary care program for patients undergoing benign gynaecologic surgery. This care program aims at improving recovery and preventing delayed return to work and consists of two steps: (1) an interactive e-health intervention for all participants, and (2) integrated clinical and occupational care management for those participants whose sick leave exceeds 10 weeks. METHODS Eligible for this study were employed women aged between 18-65 years scheduled for a laparoscopic adnexal surgery and/or hysterectomy. Data were collected from patients, their supervisors and their gynaecologists, by means of electronic questionnaires during a 6 month follow-up period and an automatically generated, detailed weblog of the patient web portal ( www.ikherstel.nl ). Investigated process measures included: reach, dose delivered, dose received, and fidelity. In addition, attitudes towards the intervention were explored among all stakeholders. RESULTS 215 patients enrolled in the study and accounted to a reach of 60.2 % (215/357). All intervention group patients used their account at least once and total time spent on the patient web portal was almost 2 h for each patient (median 118 min, IQR 64-173 min). Most patients visited the website several times (median 11 times, IQR 6-16). Perceived effectiveness among patients was high (74 %). In addition, gynaecologists (76 %) and employers (61 %) were satisfied with the web portal as well. Implementation of the second step of the intervention was suboptimal. Motivating patients to consent to additional guidance and developing an accurate return-to-work-prognosis were two important obstacles. CONCLUSIONS The results of this study indicate good feasibility for implementation on a broad scale of the e-health intervention for patients undergoing benign gynaecological surgery. To enhance the implementation of the second step of the perioperative care program, adaptations in the integrated care protocol are needed.
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Affiliation(s)
- E V A Bouwsma
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands,
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Bouwsma EV, Anema JR, Vonk Noordegraaf A, Knol DL, Bosmans JE, Schraffordt Koops SE, van Kesteren PJ, van Baal WM, Lips JP, Emanuel MH, Scholten PC, Mozes A, Adriaanse AH, Brölmann HA, Huirne JA. The cost effectiveness of a tailored, web-based care program to enhance postoperative recovery in gynecologic patients in comparison with usual care: protocol of a stepped wedge cluster randomized controlled trial. JMIR Res Protoc 2014; 3:e30. [PMID: 24943277 PMCID: PMC4090379 DOI: 10.2196/resprot.3236] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/21/2014] [Indexed: 11/13/2022] Open
Abstract
Background The length of recovery after benign gynecological surgery and return to work frequently exceeds the period that is recommended or expected by specialists. A prolonged recovery is associated with a poorer quality of life. In addition, costs due to prolonged sick leave following gynecological surgery cause a significant financial burden on society. Objective The objective of our study was to present the protocol of a stepped wedge cluster randomized controlled trial to evaluate the cost effectiveness of a new care program for patients undergoing hysterectomy and/or adnexal surgery for benign disease, compared to the usual care. Methods The care program under study, designed to improve convalescence and to prevent delayed return to work, targets two levels. At the hospital level, guidelines will be distributed among clinical staff in order to stimulate evidence-based patient education. At the patient level, additional perioperative guidance is provided by means of an eHealth intervention, equipping patients with tailored convalescence advice, and an occupational intervention is available for those patients at risk of prolonged sick leave. Due to the stepped wedge design of the trial, the care program will be sequentially rolled out among the 9 participating hospitals, from which the patients are recruited. Eligible for this study are employed women, 18-65 years of age, who are scheduled for hysterectomy and/or laparoscopic adnexal surgery. The primary outcome is full sustainable return to work. The secondary outcomes include general recovery, quality of life, self-efficacy, coping, and pain. The data will be collected by means of self-reported electronic questionnaires before surgery and at 2, 6, 12, 26, and 52 weeks after surgery. Sick leave and cost data are measured by monthly sick leave calendars, and cost diaries during the 12 month follow-up period. The economic evaluation will be performed from the societal perspective. All statistical analyses will be conducted according to the intention-to-treat principle. Results The enrollment of the patients started October 2011. The follow-up period will be completed in August 2014. Data cleaning or analysis has not begun as of this article’s submission. Conclusions We hypothesize the care program to be effective by means of improving convalescence and reducing costs associated with productivity losses following gynecological surgery. The results of this study will enable health care policy makers to decide about future implementation of this care program on a broad scale. Trial Registration Netherlands Trial Register: NTR2933; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2933 (Archived by WebCite at http://www.webcitation.org/6Q7exPG84).
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Affiliation(s)
- Esther Va Bouwsma
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, Netherlands
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Vonk Noordegraaf A, Anema JR, Louwerse MD, Heymans MW, van Mechelen W, Brölmann HAM, Huirne JAF. Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands. BJOG 2013; 121:487-97. [PMID: 24245993 DOI: 10.1111/1471-0528.12494] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To measure the impact of the level of invasiveness of gynaecological procedures on time to full Return to Work (RTW) and to identify the most important preoperative sociodemographic, medical and work-related factors that predict the risk of prolonged sick leave. DESIGN Prospective cohort study. SETTING Dutch university hospital. POPULATION A total of 148 women aged 18-65 years scheduled for gynaecological surgery for benign indications. METHODS A questionnaire regarding the surgical procedure as well as perioperative and postoperative complications was completed by the attending resident at baseline and 6 weeks after surgery. All other outcome measures were assessed using self-reported patient questionnaires at baseline and 12 weeks post-surgery. The follow-up period was extended up to 1 year after surgery in women failing to return to work. Surgical procedures were categorised into diagnostic, minor, intermediate and major surgery. MAIN OUTCOME MEASURES Time to RTW and important predictors for prolonged sick leave after surgery. RESULTS Median time to RTW was 7 days (interquartile range [IQR] 5-14) for diagnostic surgery, 14 days (IQR 9-28) for minor surgery, 60 days (IQR 28-101) for intermediate surgery and 69 days (IQR 56-135) for major surgery. Multivariable analysis showed a strongest predictive value of RTW 1 year after surgery for level of invasiveness of surgery (minor surgery hazard ratio [HR] 0.51, 95% CI 0.32-0.81; intermediate surgery HR 0.20, 95% CI 0.12-0.34; major surgery HR 0.09, 95% CI 0.06-0.16), RTW expectations before surgery (HR 0.55, 95% CI 0.36-0.84), and preoperative functional status (HR 1.09, 95% CI 1.04-1.13). A prediction model regarding the probability of prolonged sick leave at 6 weeks was developed, with a sensitivity of 89% and a specificity of 86%. CONCLUSIONS RTW often takes a long time, especially after intermediate and major surgery. This study reveals important predictors for prolonged sick leave and provides a prediction model for the risk of sick leave extending 6 weeks after benign gynaecological surgery in the Netherlands.
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Affiliation(s)
- A Vonk Noordegraaf
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
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