human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Chronic diseases of the musculoskeletal system rank first as causes of early retirement in Germany . Therefore orthopaedic rehabilitation has to identify patients with work-related problems and to promote return to work through differential treatment and vocational counselling . In the framework of the IopKo-Project such measures were developed and evaluated . These measures encompass : ( 1 ) an intensive and multiprofessional diagnostic pathway which allows early detection and treatment of mental disorders and job related problems ; ( 2 ) homogeneous treatment groups based on multiprofessional diagnostics ; ( 3 ) differential treatments , among these a multidisciplinary programme for patients with chronic low back pain or high risk of chronification ( Rückenfit ) ; ( 4 ) interactive training modules which mediate principles of performance and disability expertise , the legal bases of retirement pensioning , and measures to support occupational rehabilitation ; and ( 5 ) a work hardening training programme . METHOD To evaluate the effects of these measures in comparison to a control group with usual care , a prospect i ve longitudinal study was conducted . A total of 307 patients were assigned to the multidisciplinary in-patient treatment programme , whereas 176 patients in the control group had a st and ard rehabilitation programme .  RESULTS The results show positive moderate and strong effects in the intervention group concerning function , pain , psychic strains as well as the number of sick days and return to work rates 10 months after discharge . The effects in the intervention group exceeded the effects achieved in the control group . PATIENTS WITH HIGH RISK OF CHRONIFICATION : Beside the full sample , a subgroup of patients with chronic pain or high risk of chronification was analyzed , who had received a multidisciplinary functional restoration treatment . Also for this subgroup we found moderate and strong effects of treatment for function , psychic strains and sick days superior to those in the control group . CONCLUSION By this study we were able to show that orthopedic rehabilitation in a multimodal and multidisciplinary setting with a focus on activating and motivating therapy can have sustainable positive effects on pain , function and psychic well-being as well as on economic parameters . We interpret these persistent and superior effects in the treatment group ( 1 ) as a result of multiprofessional diagnosis and assignment which helps to subdivide the inhomogeneous group of patients with unspecific back pain into more homogeneous and thus more effective subgroups , ( 2 ) as a result of increased motivation by closed treatment groups , ( 3 ) as a result of intense and multilevel counselling of work related problems , ( 4 ) as a result of work hardening modules , and ( 5 ) as a result of direct and efficient treatment of psychic strains . The results also demonstrate the significance of inpatient rehabilitation , which will be efficient if differential treatment - adequate to the problems of the patient - is offered BACKGROUND Breast cancer may adversely affect work experience . We assessed whether there was evidence of discrimination at work , defined as negative or involuntary changes in employment situation ( including changes in position , wages , and other conditions ) , associated with a breast cancer diagnosis in a population -based retrospective cohort study conducted in Quebec , Canada . METHODS The study was based on the consecutive series of women aged less then 60 years when first treated for breast cancer ( identified through the Quebec Tumor Registry ) and a r and om sample of frequency-matched women living in Quebec ( identified from provincial health care files ) who had never been diagnosed with cancer . Eligibility for the study was restricted to women who were employed at the time of diagnosis ( for breast cancer survivors ) or the same calendar period ( for women in the comparison group ) . We conducted telephone interviews of eligible  women 3 years after diagnosis for 646 survivors or after the matched calendar period for 890 women in the comparison group . Binomial regression was used to evaluate the relationship between having breast cancer and work situation . All statistical tests were two-sided . RESULTS Working conditions were similar between the two groups at the beginning of follow-up . After 3 years , slightly more survivors ( 21 % ) than women in the comparison group ( 15 % ) were unemployed ( adjusted relative risk for being unemployed = 1.29 , 95 % confidence interval = 1.05 to 1.59 ) , although most women who were not working ( 84 % of unemployed survivors and 76 % of unemployed women in the comparison group ) said that the decision to stop working was their own . Among women still employed , no deterioration in working conditions was observed in either group . CONCLUSION We found little evidence that women diagnosed with breast cancer experience discrimination at work . This information may be helpful for working women concerned about employment after breast cancer Objective To evaluate the effectiveness of an integrated care programme , combining a patient directed and a workplace directed intervention , for patients with chronic low back pain . Design Population based r and omised controlled trial . Setting Primary care ( 10 physiotherapy practice s , one occupational health service , one occupational therapy practice ) and secondary care ( five hospitals ) . Participants 134 adults aged 18 - 65 sick listed for at least 12 weeks owing to low back pain . Intervention Patients were r and omly assigned to usual care ( n=68 ) or integrated care ( n=66 ) . Integrated care consisted of a workplace intervention based on participatory ergonomics , involving a supervisor , and a grade d activity programme based on cognitive behavioural principles . Main outcome measures The primary outcome was the duration of time off work ( work disability ) due to low back pain until full sustainable return to work . Secondary outcome measures were intensity of pain and functional status . Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group ( P=0.003 ) . Integrated care was effective on return to work ( hazard ratio 1.9 , 95 % confidence interval 1.2 to 2.8 , P=0.004 ) . After 12 months , patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group ( P=0.01 ) . Improvement of pain between the groups did not differ significantly . Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life . Trial registration Current Controlled Trials IS RCT N28478651 Study Design . R and omized parallel-group comparative trial with a 6-month follow-up period . Objective . To compare , in chronic low back pain patients , the effectiveness of a functional restoration program , including intensive physical training , occupational therapy , and psychological support to an active individual therapy consisting of 3 hours physical therapy per week during 5 weeks . Summary of Background Data . Controlled studies conducted in the United States showed a benefit of functional restoration in patients with low back pain , especially on return to work . R and omized Canadian and European trials had less favorable results . In France , there has been up to now no r and omized study . Controlled studies suggested a positive effect of functional restoration programs . Methods . Eighty-six patients with low back pain were r and omized to either the functional restoration ( 44 patients ) or the active individual therapy ( 42 patients ) program . One person in each group never started the program . Two patients did not complete the functional restoration program , and one was lost to follow-up at 6 months . The mean number of sick-leave days in the 2 previous years was 6 months . Results . After adjustment on the variable ≪ workplace enrolled in an ergonomic program ≫ , the mean number of sick-leave days was significantly lower in the functional restoration group . Physical criteria and treatment appreciation were also better . There was no significant difference in the intensity of pain , the quality of life and functional indexes , the psychological characteristics , the number of contacts with the medical system , and the drug intake . Conclusions . This study demonstrates the effectiveness of a functional restoration program on important outcome measures , such as sick leave , in a country that has a social system that protects people facing difficultiesat work Background The causes of prolonged disability due to back pain are multiply determined , involving medical , social , and environmental factors . Possible solutions to the problem of prolonged back pain disability have emerged from recent research but few efforts have been made to transfer evidence -based programs to large community setting s. Objective This article describes three phases of the process of transfer of evidence from rehabilitation research to community practice in the province of Quebec . Methods and Results Phase A : Based on literature review and expert knowledge , the Sherbrooke model was developed and assessed through a population -based , r and omized clinical trial . Results at 1-year follow-up showed quicker return to regular work and improvement of quality of life ; the 6-year follow-up showed the cost-effectiveness of the method .Phase B : Based on the Sherbrooke model experience and recent evidence , a new program addressing the disability paradigm was developed and implemented in the province of Quebec ( Canada ) . Results at 1- and 3-year follow-ups showed that only 24 % of workers were not working owing to their musculoskeletal disorder . The program is presently being tested through a population -based , r and omized clinical trial in a population of construction workers . Phase C : To implement the program at a provincial level , a network for management , research and education in work rehabilitation was developed . An external assessment is presently planned to evaluate return to work and economic outcomes and quality of implementation of the program in various setting BACKGROUND Major depression has far-reaching consequences for work functioning and absenteeism . In most cases depression is treated by medication and clinical management . The addition of occupational therapy ( OT ) might improve outcome . We determined the cost-effectiveness of the addition of OT to treatment as usual ( TAU ) . METHOD Sixty-two adults with major depression and a mean absenteeism of 242 days were r and omized to TAU ( out-patient psychiatric treatment ) or TAU+OT [ 6 months , including ( i ) diagnostic phase with occupational history and work reintegration plan , and ( ii ) therapeutic phase with individual sessions and group sessions ] . Main outcome domains were depression , work resumption , work stress and costs . Assessment s were at baseline and at 3 , 6 , 12 and 42 months . RESULTS The addition of OT to TAU : ( i ) did not improve depression outcome , ( ii ) result ed in a reduction in work-loss days during the first 18 months , ( iii ) did not increase work stress , and ( iv ) had a 75.5 % probability of being more cost-effective than TAU alone . CONCLUSION Addition of OT to good clinical practice does not improve depression outcome , improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness Coronary catheter revascularisation is less costly than bypass surgery due to lower direct ( medical ) and indirect costs ( loss of work ) . Many studies show that the time patients stay out of work following coronary intervention is much longer than necessary . This leads to a considerable increase of indirect costs , which can far exceed the medical costs of the treatment . This prospect i ve r and omised study was done to determine whether specific information to patient and family doctor results in an earlier return to work .  After catheter revascularisation 100 working patients ( mean age 52.4 years ) were r and omised either to the intervention group ( information to patient and family doctor ) or to the control group ( no specific information about return to work ) . Four months later 81 patients had returned to their previous jobs ( mean sick leave 18.9 + /- 24.8 days ) while 19 were still out of work . In the control group , the rate was 79 % and the mean sick leave was 16.4 + /- 22.0 days ( median 7 ) ; in the intervention group 83 % had returned to work after a mean of 21.5 + /- 27.4 days ( median 10 ) . There was no significant difference between the two groups , neither according to the rate of returned workers nor to the duration of sick leave . In the subgroup of patients with a private insurance ( 23 % of all ) 96 % started to work again ( mean sick leave 5.7 + /- 5.1 days median 3.5 ) , while the rate was 77 % in the group of panel patients ( mean sick leave 23.7 + /- 27.4 days , median 11 ) . The difference in sick leave between these two groups was highly significant ( p = 0.0003 ) . Specific information to the patient and family doctor has no effect on the time patients stay out of work following catheter revascularisation . It seems that the observed delay depends on social and psychological factors that can not be influenced directly OBJECTIVES --The aim was to combat occurrence of  chronic occupational back pain .  METHODS --A multidisciplinary model to manage back pain that includes both clinical and ergonomic approaches has been developed . Early detection , early clinical and ergonomic evaluations , and early active treatment make up the cornerstone of management . Detection of cases starts after four weeks of absence from work . An ergonomic intervention is implemented at six weeks . A medical specialist is involved at eight weeks . If return to work is not possible after 12 weeks , a functional recovery therapy followed by a therapeutic return to work is implemented . A multidisciplinary team decides if return to original or modified work is possible or if vocational rehabilitation is necessary . This model has been implemented by the investigators in the Sherbrooke ( Quebec , Canada ) area , and is presently being evaluated through a r and omised trial in 31 industrial settlements ( about 20,000 workers ) . A cluster r and omisation of industries and workers will allow separate testing of ergonomic and clinical interventions . RESULTS --One year after implementation , 31 of 35 of the eligible industrial sites participated in the study and 79 of 88 of the eligible workers affected by recent back pain had agreed to participate .  Ergonomic and clinical interventions  have been implemented as planned . Only three workers dropped out . Hence this global clinical and ergonomic management programme has been shown to be feasible in a general population . CONCLUSION --A global management programme of back pain joining ergonomic and clinical intervention with a multidisciplinary approach has not been tested yet . Linking these two strategies in a same multidisciplinary team represents a systemic approach to this multifactorial ailment . During the first year of this trial we did not find any conflict between these two intervent 
    Output:
    
agent
Results show systematic review ing of OTIs on RTW was challenging due to varying population s , different outcome measures , and poor descriptions of methodology .
There is evidence that OTIs as part of rehabilitation programs , increase RTW rates , although the method ological evidence of most studies is weak .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Chronic diseases of the musculoskeletal system rank first as causes of early retirement in Germany . Therefore orthopaedic rehabilitation has to identify patients with work-related problems and to promote return to work through differential treatment and vocational counselling . In the framework of the IopKo-Project such measures were developed and evaluated . These measures encompass : ( 1 ) an intensive and multiprofessional diagnostic pathway which allows early detection and treatment of mental disorders and job related problems ; ( 2 ) homogeneous treatment groups based on multiprofessional diagnostics ; ( 3 ) differential treatments , among these a multidisciplinary programme for patients with chronic low back pain or high risk of chronification ( Rückenfit ) ; ( 4 ) interactive training modules which mediate principles of performance and disability expertise , the legal bases of retirement pensioning , and measures to support occupational rehabilitation ; and ( 5 ) a work hardening training programme . METHOD To evaluate the effects of these measures in comparison to a control group with usual care , a prospect i ve longitudinal study was conducted . A total of 307 patients were assigned to the multidisciplinary in-patient treatment programme , whereas 176 patients in the control group had a st and ard rehabilitation programme .  RESULTS The results show positive moderate and strong effects in the intervention group concerning function , pain , psychic strains as well as the number of sick days and return to work rates 10 months after discharge . The effects in the intervention group exceeded the effects achieved in the control group . PATIENTS WITH HIGH RISK OF CHRONIFICATION : Beside the full sample , a subgroup of patients with chronic pain or high risk of chronification was analyzed , who had received a multidisciplinary functional restoration treatment . Also for this subgroup we found moderate and strong effects of treatment for function , psychic strains and sick days superior to those in the control group . CONCLUSION By this study we were able to show that orthopedic rehabilitation in a multimodal and multidisciplinary setting with a focus on activating and motivating therapy can have sustainable positive effects on pain , function and psychic well-being as well as on economic parameters . We interpret these persistent and superior effects in the treatment group ( 1 ) as a result of multiprofessional diagnosis and assignment which helps to subdivide the inhomogeneous group of patients with unspecific back pain into more homogeneous and thus more effective subgroups , ( 2 ) as a result of increased motivation by closed treatment groups , ( 3 ) as a result of intense and multilevel counselling of work related problems , ( 4 ) as a result of work hardening modules , and ( 5 ) as a result of direct and efficient treatment of psychic strains . The results also demonstrate the significance of inpatient rehabilitation , which will be efficient if differential treatment - adequate to the problems of the patient - is offered BACKGROUND Breast cancer may adversely affect work experience . We assessed whether there was evidence of discrimination at work , defined as negative or involuntary changes in employment situation ( including changes in position , wages , and other conditions ) , associated with a breast cancer diagnosis in a population -based retrospective cohort study conducted in Quebec , Canada . METHODS The study was based on the consecutive series of women aged less then 60 years when first treated for breast cancer ( identified through the Quebec Tumor Registry ) and a r and om sample of frequency-matched women living in Quebec ( identified from provincial health care files ) who had never been diagnosed with cancer . Eligibility for the study was restricted to women who were employed at the time of diagnosis ( for breast cancer survivors ) or the same calendar period ( for women in the comparison group ) . We conducted telephone interviews of eligible  women 3 years after diagnosis for 646 survivors or after the matched calendar period for 890 women in the comparison group . Binomial regression was used to evaluate the relationship between having breast cancer and work situation . All statistical tests were two-sided . RESULTS Working conditions were similar between the two groups at the beginning of follow-up . After 3 years , slightly more survivors ( 21 % ) than women in the comparison group ( 15 % ) were unemployed ( adjusted relative risk for being unemployed = 1.29 , 95 % confidence interval = 1.05 to 1.59 ) , although most women who were not working ( 84 % of unemployed survivors and 76 % of unemployed women in the comparison group ) said that the decision to stop working was their own . Among women still employed , no deterioration in working conditions was observed in either group . CONCLUSION We found little evidence that women diagnosed with breast cancer experience discrimination at work . This information may be helpful for working women concerned about employment after breast cancer Objective To evaluate the effectiveness of an integrated care programme , combining a patient directed and a workplace directed intervention , for patients with chronic low back pain . Design Population based r and omised controlled trial . Setting Primary care ( 10 physiotherapy practice s , one occupational health service , one occupational therapy practice ) and secondary care ( five hospitals ) . Participants 134 adults aged 18 - 65 sick listed for at least 12 weeks owing to low back pain . Intervention Patients were r and omly assigned to usual care ( n=68 ) or integrated care ( n=66 ) . Integrated care consisted of a workplace intervention based on participatory ergonomics , involving a supervisor , and a grade d activity programme based on cognitive behavioural principles . Main outcome measures The primary outcome was the duration of time off work ( work disability ) due to low back pain until full sustainable return to work . Secondary outcome measures were intensity of pain and functional status . Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group ( P=0.003 ) . Integrated care was effective on return to work ( hazard ratio 1.9 , 95 % confidence interval 1.2 to 2.8 , P=0.004 ) . After 12 months , patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group ( P=0.01 ) . Improvement of pain between the groups did not differ significantly . Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life . Trial registration Current Controlled Trials IS RCT N28478651 Study Design . R and omized parallel-group comparative trial with a 6-month follow-up period . Objective . To compare , in chronic low back pain patients , the effectiveness of a functional restoration program , including intensive physical training , occupational therapy , and psychological support to an active individual therapy consisting of 3 hours physical therapy per week during 5 weeks . Summary of Background Data . Controlled studies conducted in the United States showed a benefit of functional restoration in patients with low back pain , especially on return to work . R and omized Canadian and European trials had less favorable results . In France , there has been up to now no r and omized study . Controlled studies suggested a positive effect of functional restoration programs . Methods . Eighty-six patients with low back pain were r and omized to either the functional restoration ( 44 patients ) or the active individual therapy ( 42 patients ) program . One person in each group never started the program . Two patients did not complete the functional restoration program , and one was lost to follow-up at 6 months . The mean number of sick-leave days in the 2 previous years was 6 months . Results . After adjustment on the variable ≪ workplace enrolled in an ergonomic program ≫ , the mean number of sick-leave days was significantly lower in the functional restoration group . Physical criteria and treatment appreciation were also better . There was no significant difference in the intensity of pain , the quality of life and functional indexes , the psychological characteristics , the number of contacts with the medical system , and the drug intake . Conclusions . This study demonstrates the effectiveness of a functional restoration program on important outcome measures , such as sick leave , in a country that has a social system that protects people facing difficultiesat work Background The causes of prolonged disability due to back pain are multiply determined , involving medical , social , and environmental factors . Possible solutions to the problem of prolonged back pain disability have emerged from recent research but few efforts have been made to transfer evidence -based programs to large community setting s. Objective This article describes three phases of the process of transfer of evidence from rehabilitation research to community practice in the province of Quebec . Methods and Results Phase A : Based on literature review and expert knowledge , the Sherbrooke model was developed and assessed through a population -based , r and omized clinical trial . Results at 1-year follow-up showed quicker return to regular work and improvement of quality of life ; the 6-year follow-up showed the cost-effectiveness of the method .Phase B : Based on the Sherbrooke model experience and recent evidence , a new program addressing the disability paradigm was developed and implemented in the province of Quebec ( Canada ) . Results at 1- and 3-year follow-ups showed that only 24 % of workers were not working owing to their musculoskeletal disorder . The program is presently being tested through a population -based , r and omized clinical trial in a population of construction workers . Phase C : To implement the program at a provincial level , a network for management , research and education in work rehabilitation was developed . An external assessment is presently planned to evaluate return to work and economic outcomes and quality of implementation of the program in various setting BACKGROUND Major depression has far-reaching consequences for work functioning and absenteeism . In most cases depression is treated by medication and clinical management . The addition of occupational therapy ( OT ) might improve outcome . We determined the cost-effectiveness of the addition of OT to treatment as usual ( TAU ) . METHOD Sixty-two adults with major depression and a mean absenteeism of 242 days were r and omized to TAU ( out-patient psychiatric treatment ) or TAU+OT [ 6 months , including ( i ) diagnostic phase with occupational history and work reintegration plan , and ( ii ) therapeutic phase with individual sessions and group sessions ] . Main outcome domains were depression , work resumption , work stress and costs . Assessment s were at baseline and at 3 , 6 , 12 and 42 months . RESULTS The addition of OT to TAU : ( i ) did not improve depression outcome , ( ii ) result ed in a reduction in work-loss days during the first 18 months , ( iii ) did not increase work stress , and ( iv ) had a 75.5 % probability of being more cost-effective than TAU alone . CONCLUSION Addition of OT to good clinical practice does not improve depression outcome , improves productivity without increasing work stress and is superior to TAU in terms of cost-effectiveness Coronary catheter revascularisation is less costly than bypass surgery due to lower direct ( medical ) and indirect costs ( loss of work ) . Many studies show that the time patients stay out of work following coronary intervention is much longer than necessary . This leads to a considerable increase of indirect costs , which can far exceed the medical costs of the treatment . This prospect i ve r and omised study was done to determine whether specific information to patient and family doctor results in an earlier return to work .  After catheter revascularisation 100 working patients ( mean age 52.4 years ) were r and omised either to the intervention group ( information to patient and family doctor ) or to the control group ( no specific information about return to work ) . Four months later 81 patients had returned to their previous jobs ( mean sick leave 18.9 + /- 24.8 days ) while 19 were still out of work . In the control group , the rate was 79 % and the mean sick leave was 16.4 + /- 22.0 days ( median 7 ) ; in the intervention group 83 % had returned to work after a mean of 21.5 + /- 27.4 days ( median 10 ) . There was no significant difference between the two groups , neither according to the rate of returned workers nor to the duration of sick leave . In the subgroup of patients with a private insurance ( 23 % of all ) 96 % started to work again ( mean sick leave 5.7 + /- 5.1 days median 3.5 ) , while the rate was 77 % in the group of panel patients ( mean sick leave 23.7 + /- 27.4 days , median 11 ) . The difference in sick leave between these two groups was highly significant ( p = 0.0003 ) . Specific information to the patient and family doctor has no effect on the time patients stay out of work following catheter revascularisation . It seems that the observed delay depends on social and psychological factors that can not be influenced directly OBJECTIVES --The aim was to combat occurrence of  chronic occupational back pain .  METHODS --A multidisciplinary model to manage back pain that includes both clinical and ergonomic approaches has been developed . Early detection , early clinical and ergonomic evaluations , and early active treatment make up the cornerstone of management . Detection of cases starts after four weeks of absence from work . An ergonomic intervention is implemented at six weeks . A medical specialist is involved at eight weeks . If return to work is not possible after 12 weeks , a functional recovery therapy followed by a therapeutic return to work is implemented . A multidisciplinary team decides if return to original or modified work is possible or if vocational rehabilitation is necessary . This model has been implemented by the investigators in the Sherbrooke ( Quebec , Canada ) area , and is presently being evaluated through a r and omised trial in 31 industrial settlements ( about 20,000 workers ) . A cluster r and omisation of industries and workers will allow separate testing of ergonomic and clinical interventions . RESULTS --One year after implementation , 31 of 35 of the eligible industrial sites participated in the study and 79 of 88 of the eligible workers affected by recent back pain had agreed to participate .  Ergonomic and clinical interventions  have been implemented as planned . Only three workers dropped out . Hence this global clinical and ergonomic management programme has been shown to be feasible in a general population . CONCLUSION --A global management programme of back pain joining ergonomic and clinical intervention with a multidisciplinary approach has not been tested yet . Linking these two strategies in a same multidisciplinary team represents a systemic approach to this multifactorial ailment . During the first year of this trial we did not find any conflict between these two intervent 
    Output:
    