Patients' expectations of returning to work, co-morbid disorders and work capacity at discharge from cardiac rehabilitation

Return to Work Experience of Young and Middle-Aged Patients With Acute Myocardial Infarction: A Longitudinal Qualitative Study

BACKGROUND

Return to work (RTW) is a critical component of rehabilitation for most young and middle-aged patients after an acute myocardial infarction (AMI). Its success is related to the quality of life and social psychological function of patients, and their social economic growth. However, healthcare professionals often do not deeply understand the patients' experience and their difficulties and coping methods during this process, which limits their ability to institute effective management and support.

OBJECTIVE

In this study, we aimed to explore the lived experiences and change processes of young and middle-aged patients with AMI at the different stages of RTW.

METHODS

A descriptive qualitative approach was used. Patients aged 20 to 59 years with AMI were recruited from the Department of Cardiology of 3 general hospitals. Data were collected via semistructured interviews. Data analysis was performed by conventional content analysis methods.

RESULTS

In total, 18 participants were included. Five main themes emerged: (1) "chaos," (2) "rebuilding," (3) "conflict," (4) "coping," and (5) "benefits." Patients may be more concerned about physical recovery during the initial clinical event. They then begin to plan and adjust for an RTW. Patients in the maintenance phase need strategies to prevent, identify, and respond to conflicts and challenges to maintain long-term stable work.

CONCLUSION

We identified several post-AMI stages spanning from the initial illness event to the maintenance of stable work. We described their perceived barriers, coping strategies, and support needs at these various stages. These data are crucial for healthcare professionals to develop improved vocational rehabilitation strategies for patients with AMI.

Return to work among workers recovering from severe COVID-19 in Slovenia: a focus group study

PURPOSE

For working age adults, return to work (RTW) after severe COVID-19 can be an essential component of rehabilitation. We explored the expectations and experiences related to RTW in a group of workers recovering from severe COVID-19 in Slovenia.

MATERIALS AND METHODS

Four focus groups were conducted between May 2021 and August 2021. Fifteen men and three women, aged between 39 and 65 years, participated. We analysed data using reflexive thematic analysis.

RESULTS

Four main themes were developed in the analysis, pertaining to (1) work identity, (2) challenges to work re-entry, (3) personal strengths and support systems, and (4) possible adaptations at work. The disruption of work triggered sentiments about its role in identity. Workers' personal agency and self-advocacy helped participants cope with various barriers that were beyond their control, such as physical limitations and lack of systematic routines to address RTW. Workers recovering from severe COVID-19 were at risk of developing negative expectations regarding their work re-entry.

CONCLUSIONS

RTW after severe COVID-19 involves different personal, organizational and systemic dimensions that need to be considered and carefully aligned. Due to the individuality of the process, the worker should be involved as a key partner in the RTW process.IMPLICATIONS FOR REHABILITATIONLack of clinical pathways can negatively impact return to work (RTW) after severe COVID-19.RTW processes should start early but timely and include individual follow up.Patients expect the interdisciplinary team of experts to work together and involve them in all phases of decision-making regarding their rehabilitation and RTW process.Positive expectations regarding work re-entry are essential for the RTW process.

Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review

Objective

The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR).

Methods

A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted.

Results

The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices.

Conclusion

ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.

The Relation of Work Ability and Return to Work Among Iranian Cancer Survivors

OBJECTIVE

Cancerous diseases are known to disrupt a person's ability and inflict physical, psychological, financial, and social complications on the person, thereby challenging an individual's returning to work. The aim of this study was to investigate the ability of cancer patients to work after returning to work.

METHODS

This descriptive-correlational study examined a total of 227 surviving cancer patients, having picked the participants through convenience sampling. Data were collected by the return to work and work ability index (WAI) questionnaires and analyzed by descriptive statistics and inferential statistics using SPSS software.

RESULTS

A total of 166 (73.2%) of the participants had returned to work after completing the basic treatment. The mean (standard deviation) of the work ability score was 29.52 (9.43), ranging from 9 to 43 while the average daily work hours dropped from 12.30 to 5.50. The chi-square test showed a significant relationship between the work ability score and the type of return to work. Moreover, the rank logistic regression analysis revealed that work ability was the most important predictor of return to work.

CONCLUSION

Survivors of cancer face reduced working hours and limited ability to work after returning to work, and it is possible to facilitate the return to work in these patients by identifying their job needs in relation to their abilities and barriers of returning to work through the appropriate interventions.

Facilitators and barriers to return to work in patients after heart surgery

BACKGROUND

Recognition of the factors influencing returning to work by people after heart surgery is very significant in performing supportive interventions. Factors affecting return to work of Iranian patients after surgery are unknown. Therefore, a qualitative study is in demand in order to close this knowledge gap. This study was aimed to explore the facilitators and barriers of return to work after heart surgery.

MATERIALS AND METHODS

This qualitative study was conducted during 2020-2021. People after heart surgery were studied in this research. Nineteen interviews were performed with 17 participants. The main participants were selected from the cardiac surgery ward of Golestan Province Hospital. The sampling method was purposeful. Data were collected through semi-structured interviews. Questions were asked in an unguided and open-ended manner. Data analysis was performed by qualitative content analysis.

RESULTS

According to the results, "perceived psychosocial support," "individual characteristics," and "occupational factors" were considered as facilitators and "effects of heart surgery" and "limited support of public and private institutions" were introduced as barriers to return to work in patients after heart surgery.

CONCLUSIONS

The effects caused by heart surgery and limited support of public and private institutions were identified as barriers to return to work. Cardiac rehabilitation after surgery can reduce the impact of heart surgery and can help people to return to work. It is recommended that the planners of the Ministry of Labor and Social Welfare and Health, with the support of insurance organizations, help solve the work problems of people after heart surgery.

Barriers That Obstruct Return to Work After Coronary Bypass Surgery: A Qualitative Study

Purpose Coronary artery bypass grafting is the most frequently performed cardiac surgical procedure. Despite its benefits on survival and quality of life, it is associated with a considerable financial burden on society including sick leave. Our study aimed to explore the barriers that obstruct return to work after coronary artery bypass grafting. Methods We performed a qualitative study with in-depth interviewing of patients 6 months after their surgery. We included ten working patients and interviewed them and their spouses at home. The interviews were transcribed and two investigators independently searched the transcriptions for barriers that had obstructed return to work. Results Based on the interviews we were able to distinguish four main groups of barriers: 'personal', 'healthcare', 'work' and 'law & regulation.' The personal barriers were subgrouped in affective, physical, cognitive, social and individually determined factors. Conclusion In a qualitative study we showed that personal barriers as well as barriers regarding healthcare, work and law & regulation, were perceived by patients as important factors obstructing return to work after coronary artery bypass grafting. To overcome the identified barriers, the process of return to work could preferably be initiated during the hospital phase, started during cardiac rehabilitation, and coordinated by a case-managing professional.

Perceptions and understanding about mesh and hernia surgery: What do patients really think?

BACKGROUND

Surgical mesh and hernia repair have come under increasing scrutiny with large amounts of press, Internet, and social media reportage regarding ongoing mesh litigation, recalls, and patient testimonials. The aim of this study was to evaluate patient perceptions of mesh in hernia surgery.

METHODS

A 16-question survey was given to patients presenting for hernia surgery at a tertiary hernia center by trained data analysts before surgeon interaction.

RESULTS

Two hundred and two patients were surveyed. Patients believed mesh caused complications (45.1%) and reported concerns about mesh (38.2%). Those who performed their own research, females, and patients with recurrent hernias were more likely to have concerns about mesh (P ≤ 0.03). Most patients (81.7%) thought they were at average risk or less for complications; patients with recurrent hernias (versus primary hernias) and incisional hernias (compared with inguinal or umbilical hernias) had more negative outlooks on complications (all P < .05). Recovery expectations varied, but the failed repair and incisional hernia groups were more likely to expect prolonged recovery (>3 months) (all P < .05). After surgeon-directed education and a mesh education handout, all but one patient agreed to and underwent a mesh repair as indicated.

CONCLUSION

Patients had concerns about mesh and were aware of mesh related complications. Patients performing their own research, as well as females and recurrent hernia patients, had worse perceptions of mesh. Recurrent and incisional hernia patients had greater concerns about complications, recurrence, and recovery. Preoperative education concerning mesh and mesh choice for each operation eased patient anxiety.