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

Abstract

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

The Effectiveness of Case-management Rehabilitation Intervention in Facilitating Return to Work and Maintenance of Employment After Myocardial Infarction: Results of a Randomized Controlled Trial

“…Rather, it has been shown to be related to the same demographic factors that were found to be positively related to return-to-work in the literature: male gender, married status, longer tenure, low intensity of physical effort, and higher income prior to the cardiac event. 3,7 Moreover, our study shows that negative psychological factors turned out to be determinants of the detachment from employment at one-and two years of follow-up: negative expectations concerning return-to-work, daily functioning, and depressive symptoms, all congruent with the findings of other studies. 8,16,29,30 Nonetheless, the intervention programs proved to be a powerful determinant of long-term employment over and above the demographic, occupational, and psychological factors.…”

“…4,6,26 The success of the comprehensive case-management program in facilitating long-term maintenance of employment may be explained, in addition to the factors mentioned above, by containing other components of disability management/vocational rehabilitation programs, suggested by rehabilitation specialists as important for enhancing work re-integration, namely: occupational counseling, monitoring and providing support and alleviating any difficulties during work reintegration, addressing personal and work related-obstacles that might affect an individual's decision to return-to-work, and providing coordination between all relevant parties. 6,7,27,28 The majority of the participants in this study participated in a regular cardiac rehab program (see Methods). However, the findings here showed that rehab participation had no effect on employment status either at one year or two years of follow-up.…”

“…blue-collar work), and psychological factors (such as depression and expectations concerning work,. 3,[7][8][9][10][11][12] The significance of occupational assessment, provision of individualized clinical data, physical possibilities and vocational information has been shown to increase the return-to-work rate, promote early return-to-work, and reduce medical costs. [10][11][12] In their study, Froom et al have shown the importance of early intervention by showing a 30% decrease in the chance for full employment 24 months after an acute myocardial infarction for each month's delay in referral.…”

Return to work after acute coronary syndrome: Time for action

“…These patients can usually also return to work after a period of cardiac rehabilitation. 3 However, a significant proportion of ACS patients may experience problems in the process of returning to work.…”

“…Also, patients in a cardiac rehabilitation programme return to work earlier and are less often taking up easier or lighter work. 3,5 There is, however, still plenty of room for improvement in including eligible patients in cardiac rehabilitation, as well as for the content of cardiac rehabilitation programmes themselves as these programmes often focus on the underlying cardiac disease and pay little or no attention to workrelated factors or even RTW. Clear advice concerning RTW should be present in every cardiac rehabilitation programme for patients of working age.…”