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Massey PA, Sampognaro G, Fincher P, Vance S, Mody M, Barton RS. Earlier Return to Light Duty Is Associated With Successful Return to Full Duty of Workers’ Compensation Patients Treated With Shoulder Arthroscopic Surgery. Arthrosc Sports Med Rehabil 2022; 4:e927-e933. [PMID: 35747650 PMCID: PMC9210363 DOI: 10.1016/j.asmr.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate Workers’ Compensation (WC) patients who underwent arthroscopic shoulder surgery for workplace shoulder injuries and to determine whether there was an association between earlier return to light duty and earlier return to full duty. Methods After receiving institutional review board approval, we performed a retrospective chart review of all WC patients treated with shoulder arthroscopic surgery by 2 senior authors between 2011 and 2018. The patients were divided into 2 groups: Group 1 went back to light-duty work within the first 100 days after surgery, whereas group 2 performed light-duty work after 100 days or performed no light-duty work. The primary outcomes included the length of time from surgery to light-duty work and the length of time from surgery to return to the full-duty work level. Results A total of 59 patients met the inclusion criteria. There was a moderate correlation between the number of days at which the patients were released to light duty and the days they were able to be released to full duty (r = 0.35). In group 1 (light duty ≤ 100 days), 18 patients (75%) went back to full duty, whereas only 16 patients (46%) in group 2 were able to return to full-duty work (P = .025). Conclusions Earlier return to light duty is associated with earlier return to full duty after shoulder arthroscopic surgery in patients with a Workers’ Compensation claim. Additionally, WC patients who returned to early light duty in the first 100 days postoperatively had a higher rate of return to full duty than did patients who did not return to early light duty. Level of Evidence Level III, case-control study.
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Affiliation(s)
- Patrick A. Massey
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, Louisiana, U.S.A
- Address correspondence to Patrick A. Massey, M.D., Department of Orthopaedic Surgery, Louisiana State University, 1501 Kings Hwy, Shreveport, LA 71103, U.S.A.
| | - Gabriel Sampognaro
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, Louisiana, U.S.A
| | - Phillip Fincher
- School of Medicine, Louisiana State University, Shreveport, Louisiana, U.S.A
| | - Samantha Vance
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, Louisiana, U.S.A
| | - Milan Mody
- Willis-Knighton Health System, Shreveport, Louisiana, U.S.A
| | - R. Shane Barton
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, Louisiana, U.S.A
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Jansen MC, van der Oest MJW, de Haas NP, Selles PhD RW, Zuidam Md PhD JM. The Influence of Illness Perception and Mental Health on Return to Work After Carpal Tunnel Release Surgery. J Hand Surg Am 2021; 46:748-757. [PMID: 34481633 DOI: 10.1016/j.jhsa.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 01/28/2021] [Accepted: 04/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Although multiple factors influencing return to work after a carpal tunnel release (CTR) have been identified, little is known about the influence of psychological patient factors on return to work. Therefore, this study aimed to identify the psychological factors that play a role in the return to work after a CTR surgery. METHODS Patients who planned to undergo a CTR were asked to fill out the Brief Illness Perception Questionnaire and the Patient Health Questionnaire before surgery to measure their illness perceptions and mental health status, respectively. Return to work was defined as the time until returning to work for 50% of normal hours and was measured using a questionnaire at 6 weeks, 3 months, and 6 months. To identify associations between nonpsychological and psychological patient factors and the return to work after CTR surgery, a Cox proportional hazards model was constructed. RESULTS In total, 615 patients were included in our study. Six months after surgery, 91% of the patients returned to work. For the psychological patient factors, we found that increases of 1 point on the items of worrying about carpal tunnel syndrome and having faith preoperatively in a beneficial effect of the CTR surgery were associated with hazard ratios of 0.92 (95% confidence interval, 0.88-0.96) and 1.10 (95% confidence interval, 1.02-1.19), respectively, for returning to work in the first 6 months after surgery. An increase of 1 point on the depression subscale of the Patient Health Questionnaire was associated with a hazard ratio of 0.88 (95% confidence interval, 0.78-0.99) for returning to work in the first 6 months after surgery. CONCLUSIONS Our study showed that multiple psychological patient factors are associated with return to work after a CTR surgery. Addressing these psychological factors before surgery might be a low-cost intervention to improve return to work after the CTR surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Miguel C Jansen
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinic, the Netherlands.
| | - Mark J W van der Oest
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinic, the Netherlands
| | - Nicoline P de Haas
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Ruud W Selles PhD
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - J Michiel Zuidam Md PhD
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
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Sasaki Y, Terao T, Saito E, Ohara K, Michishita S, Kato N, Tani S, Murayama Y. Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study. BMC Musculoskelet Disord 2020; 21:725. [PMID: 33160354 PMCID: PMC7648948 DOI: 10.1186/s12891-020-03750-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/28/2020] [Indexed: 12/26/2022] Open
Abstract
Background Carpal tunnel syndrome is a common peripheral nerve compression disorder. However, there is no established opinion regarding the predictors of symptom improvement after surgery. This study aimed to identify the predictors of surgical outcomes of severe carpal tunnel syndrome patients. Methods In the patients who underwent a carpal tunnel syndrome surgery, we selected the patients who had a preoperative Bland’s classification of grade 5 or 6, and assessed for the changes in Bland’s classification grade before and after surgery. Those who showed improvement from preoperative grades 5–6 to postoperative grades 1–4 comprised the improvement group. In contrast, those who did not show improvement and had postoperative grades 5 or 6 comprised the non-improvement group. In a nerve conduction study, amplitudes of the compound muscle action potential and sensory nerve action potential of the palms were assessed between the improvement and non-improvement groups. Results Among the 60 hands of 46 patients who had a preoperative Bland’s classification of grade 5 or 6, 49 hands of 37 patients comprised the improvement group, and 11 hands of 9 patients comprised the non-improvement group. The amplitudes of the compound muscle action potential and sensory nerve action potential of the palms before surgery were significantly higher in the improvement group. The degree of improvement in Bland’s classification grade was correlated with the degree of clinical symptom improvement. Conclusions Amplitudes of compound muscle action potential and sensory nerve action potential before surgery induced by palmar stimulation can predict improvements in nerve conduction study scores and clinical findings after surgical treatment.
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Affiliation(s)
- Yuichi Sasaki
- Department of Neurosurgery, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, 243-8588, Japan.
| | - Tohru Terao
- Department of Neurosurgery, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, 243-8588, Japan
| | - Emiko Saito
- Department of Neurosurgery, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, 243-8588, Japan
| | - Keiichiro Ohara
- Department of Neurosurgery, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, 243-8588, Japan
| | - Shotaro Michishita
- Department of Neurosurgery, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi-shi, Kanagawa, 243-8588, Japan
| | - Naoki Kato
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
| | - Satoshi Tani
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University Hospital, Tokyo, Japan
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Stirling PHC, Jenkins PJ, Clement ND, Duckworth AD, McEachan JE. Occupation classification predicts return to work after carpal tunnel decompression. Occup Med (Lond) 2020; 70:415-420. [DOI: 10.1093/occmed/kqaa061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The relationship between hand function, employment status and return to work (RTW) after carpal tunnel decompression (CTD) is unclear.
Aims
To investigate predictors of RTW following CTD.
Methods
We prospectively collected pre-operative and 1-year post-operative outcomes and RTW data for all patients undergoing CTD at one centre between 29 May 2014 and 29 May 2017. We used the Standard Occupation Classification 2010.
Results
Pre- and post-operative results were available for 469 (79%) of the 597 patients who had CTD surgery. Pre-operatively, 219 (47%) were employed, 216 (46%) were retired, 26 (6%) were not working due to long-term illness and eight (2%) were unemployed. Complete data sets were available for 178 (81%) of the 219 employed patients, of whom 161 (90%) were able to RTW. Of the rest, five (3%) had changed jobs and 12 (7%) were unable to work. Median RTW time was 4 weeks (interquartile range [IQR] 2–6 weeks). Significantly more patients undertaking manual labour were unable to RTW (15% versus 5%; P < 0.05). There was no significant difference in mean number of weeks absent between manual (5.7; 95% confidence interval [CI] 4.9–6.5) and non-manual workers (6.2; 95% CI 4.8–7.6) (P > 0.05). Median pre-operative (difference 15.9; 95% CI 4.5–25) and post-operative (difference 43.2; 95% CI 13.6–43.2) hand function scores were significantly worse in patients who did not RTW (P < 0.05).
Conclusions
Most patients can RTW within 1 year of CTD. Failure to RTW is more likely in manual workers and patients with poorer pre-operative hand function.
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Affiliation(s)
- P H C Stirling
- Queen Margaret Hospital, Dunfermline KY, UK
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK
| | | | - N D Clement
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK
| | - A D Duckworth
- Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK
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Alimohammadi E, Bagheri SR, Hadidi H, Rizevandi P, Abdi A. Carpal tunnel surgery: predictors of clinical outcomes and patients' satisfaction. BMC Musculoskelet Disord 2020; 21:51. [PMID: 31992298 PMCID: PMC6988299 DOI: 10.1186/s12891-020-3082-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. Moreover, carpal tunnel release (CTR) surgery generally has excellent results. The present study aimed to investigate the predictors of clinical outcomes and satisfaction in patients with CTR. Methods In this observational prospective cohort study, 152 patients with open carpal tunnel release surgery were investigated. Complete clinical examinations were performed and recorded before the surgery, two weeks after the surgery and 6 months after the surgery. The Boston Carpal Tunnel Questionnaire (BCTQ) were assessed on admission and at last follow-up visits to evaluate clinical outcomes. Patients’ satisfaction was determined by a 10-point verbal descriptor nominal scale (1 = very poor, 5 = fair and 10 = excellent) and recorded during the last follow -up visits. Results Among 152 patients who were investigated, there were 118 (77.6%) females and 34 (22.36%) males. Overall, surgery improved the outcomes based on Symptom Severity Scale (SSS) and Functional Status Scale (FSS) (P < 0.05). Most of the considered variables did not show significant effects on clinical outcomes and patients’ satisfaction. However, duration of symptoms and electrophysiological severity were the predictors of the change score in SSS(P < 0.05). As well as, age was the only predictor of the change score in FSS (P < 0.05). Finally, according to the linear regression model, the pre-operative grip strength and age were the independent predictors of post-operative satisfaction (P < 0.05). Conclusions Results of the present study revealed that there was a significant improvement in clinical outcomes after CTS surgery. Stronger pre-operative grip strength and younger age were independent predictors of higher post-operative satisfaction. These results can be used in pre-operative counseling and management of post-operative expectations.
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Affiliation(s)
- Ehsan Alimohammadi
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran.
| | - Seyed Reza Bagheri
- Department of Neurosurgery, University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran
| | - Homa Hadidi
- Clinical Research Development Center, Taleghani and Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Rizevandi
- operating room department, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran
| | - Alireza Abdi
- nursing and midwifery school, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran
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Bowman A, Rudolfer S, Weller P, Bland JDP. A prognostic model for the patient-reported outcome of surgical treatment of carpal tunnel syndrome. Muscle Nerve 2018; 58:784-789. [PMID: 29981160 DOI: 10.1002/mus.26297] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Many prognostic factors have been studied in carpal tunnel decompression, but most studies consider only a subset of variables. METHODS Three thousand three hundred thirty-two operations were used to develop prognostic models, and 885 operations were used for validation. Outcome recorded on a Likert scale was dichotomized into success or failure. Modeling was performed with both logistic regression and artificial neural networks using 87 candidate variables. RESULTS Both approaches produced predictive multivariate models for outcome with areas under a receiver operating characteristic curve of 0.7 in the validation data set. Patients with moderately severe nerve conduction abnormalities, night waking, a family history of carpal tunnel syndrome, a good response to corticosteroid injection, and women have better outcomes. Greater functional impairment, diabetes, hypertension, and surgery on the dominant hand are associated with poorer outcomes. DISCUSSION A multivariate model partially predicts the outcome of carpal tunnel surgery, aids decision making, and helps to manage patient expectations. Muscle Nerve 58:784-789, 2018.
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Affiliation(s)
- Angela Bowman
- Department of Health Informatics, Norfolk and Suffolk NHS Foundation Trust, Ipswich, Suffolk, United Kingdom
| | - Stephan Rudolfer
- Centre for Biostatistics, School of Health Sciences, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Peter Weller
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Jeremy D P Bland
- Department of Clinical Neurophysiology, East Kent Hospitals University NHS Foundation Trust, Ethelbert Road, Canterbury, Kent, United Kingdom, CT1 3NG
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Newington L, Stevens M, Warwick D, Adams J, Walker-Bone K. Sickness absence after carpal tunnel release: a systematic review of the literature. Scand J Work Environ Health 2018; 44:557-567. [PMID: 30110115 DOI: 10.5271/sjweh.3762] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objectives The aim of this systematic review was to provide an overview of time to return to work (RTW) after carpal tunnel release (CTR), including return to different occupations and working patterns. Methods A systematic search from inception to 2016 was conducted using nine electronic databases, trial registries and grey literature repositories. Randomized controlled trials and observational studies reporting RTW times after CTR were included. Study risk of bias was assessed using Cochrane risk of bias assessment tools. Time to RTW was summarized using median and range. Results A total of 56 relevant studies were identified: 18 randomized controlled trials and 38 observational studies. Only 4 studies were rated as having a low risk of bias. Reported RTW times ranged from 4-168 days. Few studies reported occupational information. Among 6 studies, median time to return to non-manual work was 21 days (range 7-41), compared with 39 days for manual work (range 18-101). Median time to return to modified or full duties was 23 days (ranges 12-50 and 17-64, respectively), as reported by 3 studies. There was no common method of defining, collecting or reporting RTW data. Conclusions This review highlights wide variation in reported RTW times after CTR. Whilst occupational factors may play a role, these were poorly reported, and there is currently limited evidence to inform individual patients of their expected duration of work absence after CTR. A standardized definition of RTW is needed, as well as an agreed method of collecting and reporting related data.
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Affiliation(s)
- Lisa Newington
- MRC Lifecourse Epidemiology Unit (University of Southampton), Southampton General Hospital (MP 95), Tremona Road, Southampton, SO16 6YD, UK.
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Nuckols TK, Conlon C, Robbins M, Dworsky M, Lai J, Roth CP, Levitan B, Seabury S, Seelam R, Benner D, Asch SM. Quality of care and patient-reported outcomes in carpal tunnel syndrome: A prospective observational study. Muscle Nerve 2018; 57:896-904. [PMID: 29272038 DOI: 10.1002/mus.26041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Higher quality care for carpal tunnel syndrome (CTS) may be associated with better outcomes. METHODS This prospective observational study recruited adults diagnosed with CTS from 30 occupational health centers, evaluated physicians' adherence to recommended care processes, and assessed results of the Boston Carpal Tunnel Questionnaire (BCTQ) and Short Form Health Survey version 2 (SF-12v2) at recruitment and at 18 months. RESULTS Among 343 individuals, receiving better care (80th vs. 20th percentile for adherence) was associated with greater improvements in BCTQ Symptom Severity scores (-0.18, 95% confidence interval [CI] -0.32 to -0.05), BCTQ Functional Status scores (-0.21, 95% CI -0.34 to -0.08), and SF12-v2 Physical Component scores (1.75, 95% CI 0.33-3.16). Symptoms improved more when physicians assessed and managed activity, patients underwent necessary surgery, and employers adjusted job tasks. DISCUSSION Efforts should be made to ensure that patients with CTS receive essential care processes including necessary surgery and activity assessment and management. Muscle Nerve 57: 896-904, 2018.
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Affiliation(s)
- Teryl K Nuckols
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA.,Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Craig Conlon
- Employee Health, The Permanente Medical Group, Oakland, California, USA
| | - Michael Robbins
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Michael Dworsky
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Julie Lai
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Carol P Roth
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Barbara Levitan
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | - Seth Seabury
- University of Southern California, USC Schaeffer Center, Los Angeles, California, USA
| | - Rachana Seelam
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA
| | | | - Steven M Asch
- RAND Corporation, 1776 Main Street Santa Monica, California, 90407, USA.,VA Palo Alto Health Care System, Menlo Park, California, USA.,Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, California, USA
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Wang JC, Liao KK, Lin KP, Chou CL, Yang TF, Huang YF, Wang KA, Chiu JW. Efficacy of Combined Ultrasound-Guided Steroid Injection and Splinting in Patients With Carpal Tunnel Syndrome. Arch Phys Med Rehabil 2017; 98:947-956. [DOI: 10.1016/j.apmr.2017.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/31/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
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Kho JY, Gaspar MP, Kane PM, Jacoby SM, Shin EK. Prognostic Variables for Patient Return-to-Work Interval Following Carpal Tunnel Release in a Workers' Compensation Population. Hand (N Y) 2017; 12:246-251. [PMID: 28453350 PMCID: PMC5480659 DOI: 10.1177/1558944716661991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We hypothesize that depressive and anxiety disorders, chronic pain conditions, and work-related factors are significant determinants of the time interval for return to work (RTW) in the workers' compensation (WC) population following carpal tunnel release (CTR) surgery. METHODS We retrospectively reviewed records of all WC patients who underwent open CTR surgery over a 5-year period by 1 of 3 fellowship-trained hand surgeons. One hundred fifty-two wrists in 108 patients (64 unilateral, 44 bilateral) met the inclusion criteria. Demographic, medical, and surgical data were obtained from patient records. Bivariate and multivariate analyses were performed to assess predictors of RTW. RESULTS Eighty-nine percent of all patients returned to work full-duty. Average RTW duration in all wrists was 12.5 ± 11.3 weeks. Predictors of delayed RTW in bivariate and multivariate analyses were depression with or without anxiety, chronic pain disorders including fibromyalgia, preoperative opioid use, and modified preoperative work status. Job type, motor nerve conduction velocity, and bilateral surgery were not predictive of delayed RTW interval. CONCLUSIONS WC patients with depression, anxiety, or fibromyalgia and other chronic pain disorders were significantly more likely to have delayed RTW following CTR than were WC patients without these conditions. In addition, those who use opioid medications preoperatively and those with preoperative work restrictions were also found to have a significantly delayed RTW after CTR. Knowledge of these risk factors may help care providers and employers identify those WC patients who are most likely to have a protracted postoperative recovery period.
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Affiliation(s)
- Jenniefer Y. Kho
- Sutter Gould Medical Foundation, Modesto, CA, USA,The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael P. Gaspar
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA,Michael P. Gaspar, The Philadelphia Hand Center, P.C., The Franklin Building, Suite G114, 834 Chestnut Street, Philadelphia, PA 19107, USA.
| | - Patrick M. Kane
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
| | - Sidney M. Jacoby
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
| | - Eon K. Shin
- The Philadelphia Hand Center, PA, USA,Thomas Jefferson University, Philadelphia, PA, USA
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Kraiem AM, Hnia H, Bouzgarrou L, Henchi MA, Khalfallah T. [Socio professional impact of surgical release of carpal tunnel syndrome]. Pan Afr Med J 2016; 24:234. [PMID: 27800089 PMCID: PMC5075478 DOI: 10.11604/pamj.2016.24.234.9259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/15/2016] [Indexed: 11/11/2022] Open
Abstract
The objective was studying the socio-professional impact of release surgery for carpal tunnel syndrom (CTS). We conducted a cross-sectional study of patients operated for work-related CTS; data were collected in the Occupational Health Department at the University Hospital Tahar Sfar in Mahdia, Tunisia over a period of 8 years, from 1 January 2006 to December 2013. Data collection was performed using a survey form focusing on participants' socio-professional and medical characteristics and on their professional future. We used Karasek's questionnaire to study psychosocial constraints at work. The duration of a work stoppage following release surgery for CTS was significantly related to the existence of musculoskeletal disorders other than CTS, to a statement that the carpal tunnel syndrome was work related and to job seniority. As regards the professional future of operated employees, 50.7% remained in the same position, 15.3% were given customized workstation and 33.8% were offered a different position within the same company. The professional future of these employees was related to their occupational qualifications and to the type of sensory and/or motor impairment of median nerve detected during EMG test. A number of nonlesional factors determines the duration of the work stoppage, while the professional future of patients operated for CTS essentially depends on their professional qualifications and on EMG data. Certainly much broader studies would allow to refine these results.
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Affiliation(s)
| | - Hajer Hnia
- Département de Médecine de Travail et d'Ergonomie-Faculté de Médecine de Monastir, Tunisie
| | - Lamia Bouzgarrou
- Département de Médecine de Travail et d'Ergonomie-Faculté de Médecine de Monastir, Tunisie
| | - Mohamed Adnène Henchi
- Département de Médecine de Travail et d'Ergonomie-Faculté de Médecine de Monastir, Tunisie
| | - Taoufik Khalfallah
- Département de Médecine de Travail et d'Ergonomie-Faculté de Médecine de Monastir, Tunisie
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Peters S, Johnston V, Hines S, Ross M, Coppieters M. Prognostic factors for return-to-work following surgery for carpal tunnel syndrome. ACTA ACUST UNITED AC 2016; 14:135-216. [DOI: 10.11124/jbisrir-2016-003099] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Conzen C, Conzen M, Rübsamen N, Mikolajczyk R. Predictors of the patient-centered outcomes of surgical carpal tunnel release - a prospective cohort study. BMC Musculoskelet Disord 2016; 17:190. [PMID: 27121725 PMCID: PMC4848854 DOI: 10.1186/s12891-016-1046-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/22/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) causes a substantial burden of disease in society. While CTS can be resolved by surgical carpal tunnel release, it still remains unclear as to what degree outcomes depend on patients' characteristics. This study assesses patient-centered outcomes after surgical carpal tunnel release in a large outpatient clinic in Germany. METHODS Patients with CTS were recruited prospectively between August 1st and December 31st, 2013. We assessed socio-demographic and psychological factors as well as nerve conduction velocities at baseline (before the surgery) and at three and six months after surgery. We analyzed the improvement of patient-centered outcomes (symptoms and function of the affected hand as well as measures of well-being and subjective quality of life) at the two follow-up time points and investigated if socio-demographic characteristics and CTS-related variables predict the success of the surgery with respect to nerve conduction velocities and patient-centered outcomes by means of analysis of covariance (ANCOVA). Factors influencing the duration of sick leave were investigated by means of Cox regression. RESULTS The study sample consisted of 71 CTS cases. Surgical carpal tunnel release generally improved nerve conduction velocity and patient-centered outcomes. Regarding the former, the improvement was proportional to the severity score at baseline. The presence of muscular atrophy in the thenar area at baseline displayed medium size effects for the patient-centered outcomes. Other socio-demographic characteristics and CTS-related variables did not have a strong predictive effect on the improvement of nerve conduction velocity and patient-centered outcomes. CONCLUSIONS There is a significant improvement of clinical and subjective outcomes after CTS surgery in the outpatient sector. The improvement is largely independent of socio-demographic and clinical characteristics of the patients.
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Affiliation(s)
- Catharina Conzen
- Neurosurgical outpatients' clinic Dr. med. Dr. PH Michael A. Conzen and partners, Bielefeld, Germany
| | - Michael Conzen
- Neurosurgical outpatients' clinic Dr. med. Dr. PH Michael A. Conzen and partners, Bielefeld, Germany
| | - Nicole Rübsamen
- ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany
| | - Rafael Mikolajczyk
- ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,Hannover Medical School, Hannover, Germany.
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[Delay of professional activity recovery after implant based breast augmentation surgery: Influence of healthcare coverage]. ANN CHIR PLAST ESTH 2015; 60:262-7. [PMID: 26066855 DOI: 10.1016/j.anplas.2015.05.003] [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: 03/20/2015] [Accepted: 05/16/2015] [Indexed: 11/21/2022]
Abstract
AIM OF THE STUDY The main goal is to determine if the delay before going back to work after implant-based breast augmentation surgery is influenced by the healthcare coverage criteria. MEANS AND METHODS In this retrospective, single center based study, patients who underwent implant-based breast augmentation surgery (excluding reconstructive surgery) in the past 3 years with a minimum follow-up of 1 month were questioned by telephone. Patients who had early postoperative complications, or no professional activity, were excluded. The demographic and perioperative data were collected and two groups were compared: those who were covered by the healthcare system and those who were not. RESULTS Sixty patients were included. The two groups were comparable concerning the demographic (age, BMI, children, work intensity, smoking status, comorbidity) and surgical data (surgical approach, type, volume and position of the implant, operative time and drainage). There was a significant difference between the groups concerning the delay of return to work (P=0.0001): 18.4 days for reimbursed patients versus 9.45 days for patients without healthcare coverage. CONCLUSION For the same implant-based breast augmentation surgery, and for the same population, the duration of postoperative recovery period doubles for the patients for whom surgery is reimbursed by the healthcare system.
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Atroshi I, Zhou C, Jöud A, Petersson IF, Englund M. Sickness absence from work among persons with new physician-diagnosed carpal tunnel syndrome: a population-based matched-cohort study. PLoS One 2015; 10:e0119795. [PMID: 25803841 PMCID: PMC4372214 DOI: 10.1371/journal.pone.0119795] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/27/2015] [Indexed: 12/03/2022] Open
Abstract
Background Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population. Methods In Skåne region in Sweden we identified all subjects, aged 17–57 years, with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004–2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73% women; mean age 43 years). We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those with carpal tunnel syndrome 2111 women (53%) and 710 men (48%) underwent surgery within 24 months of diagnosis. We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery. Results Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort. A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12% of the women (n = 492) and 11% of the men (n = 170) and with surgery in 53% (n = 1121) and 58% (n = 408) of the surgically treated, respectively; median duration in conjunction with surgery was 35 days (IQR 27–45) for women and 41 days (IQR 28–50) for men. Conclusions Persons with physician-diagnosed carpal tunnel syndrome have substantially more sickness absence from work than age and sex-matched persons from the general population from1 year before to 2 years after diagnosis. Gender differences were small.
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Affiliation(s)
- Isam Atroshi
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Orthopedics Hässleholm-Kristianstad, Hässleholm Hospital, Hässleholm, Sweden
- * E-mail:
| | - Caddie Zhou
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anna Jöud
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Epidemiology and Register Centre South, Skåne University Hospital Lund, Lund, Sweden
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Ingemar F. Petersson
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Epidemiology and Register Centre South, Skåne University Hospital Lund, Lund, Sweden
| | - Martin Englund
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Epidemiology and Register Centre South, Skåne University Hospital Lund, Lund, Sweden
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, Massachusetts, United States of America
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Mirza A, Mirza JB, Lee BK, Adhya S, Litwa J, Lorenzana DJ. An anatomical basis for endoscopic cubital tunnel release and associated clinical outcomes. J Hand Surg Am 2014; 39:1363-9. [PMID: 24881897 DOI: 10.1016/j.jhsa.2014.04.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/11/2014] [Accepted: 04/12/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the ulnar nerve in fresh-frozen cadavers as related to endoscopic release of the cubital tunnel and to present a retrospective review of patients treated with decompression via endoscopic visualization. METHODS To further our understanding of relevant anatomy, we dissected 26 cadaver limbs. We paid special attention to fascial membranes as potential sites of constriction as well as the position of nerves, vessels, and aberrant anatomy. These findings facilitated our understanding of the extent of release in 80 patients (92 cases) with endoscopic cubital tunnel simple decompression. Outcome measures included Disabilities of the Arm, Shoulder, and Hand score, Gabel and Amadio score, and grip and pinch strengths. RESULTS We noted fascial bands proximal to the medial epicondyle in 12 of 26 cadaver specimens, 2 of which could be the so-called arcade of Struthers. We observed a high degree of variability in the anatomy of the flexor pronator aponeurosis distal to the medial epicondyle. Where present (n = 10), medial antebrachial cutaneous nerve branches crossed the ulnar nerve at an average distance of 2.9 cm from the medial epicondyle (range, 1.0-4.5 cm). Aberrant structures were noted in 8 of the 26 specimens, including an anconeus epitrochlearis muscle in 2 specimens, a basilic vein crossing the ulnar nerve in 4 specimens, and an accessory origin of the medial head of the triceps from the medial intermuscular septum in 2 specimens. In the clinical portion of this study, the average Disabilities of the Arm, Shoulder, and Hand score before surgery was 49 (n = 34) and after surgery was 25 (n = 56). The Gabel and Amadio outcome scores were 24 excellent, 40 good, 25 fair, and 3 poor (n = 92). Average follow-up was 8.2 months (range, 0.1-35 mo). CONCLUSIONS Cadaveric dissections shed light on vulnerable anatomical structures during release, including branches of the medial antebrachial cutaneous nerve, ulnar nerve, brachial artery, fascial bands, and basilic vein. The high degree of anatomical variability in this study highlights the advantage of endoscopic visualization in allowing surgeons to minimize surgical trauma. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Justin B Mirza
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Brian K Lee
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Shawn Adhya
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joshua Litwa
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Daniel J Lorenzana
- North Shore Surgi-Center, Smithtown, NY; Department of Orthopaedics, Plainview Hospital, North Shore-Long Island Jewish, Plainview, NY; College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY; Keck School of Medicine, University of Southern California, Los Angeles, CA
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Evanoff B, Zeringue A, Franzblau A, Dale AM. Using job-title-based physical exposures from O*NET in an epidemiological study of carpal tunnel syndrome. HUMAN FACTORS 2014; 56:166-177. [PMID: 24669551 PMCID: PMC4036526 DOI: 10.1177/0018720813496567] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE We studied associations between job-title-based measures of force and repetition and incident carpal tunnel syndrome (CTS). BACKGROUND Job exposure matrices (JEMs) are not commonly used in studies of work-related upper-extremity disorders. METHOD We enrolled newly hired workers in a prospective cohort study. We assigned a Standard Occupational Classification (SOC) code to each job held and extracted physical work exposure variables from the Occupational Information Network (O*NET). CTS case definition required both characteristic symptoms and abnormal median nerve conduction. RESULTS Of 1,107 workers, 751 (67.8%) completed follow-up evaluations. A total of 31 respondents (4.4%) developed CTS during an average of 3.3 years of follow-up. Repetitive motion, static strength, and dynamic strength from the most recent job held were all significant predictors of CTS when included individually as physical exposures in models adjusting for age, gender, and BMI. Similar results were found using time-weighted exposure across all jobs held during the study. Repetitive motion, static strength, and dynamic strength were correlated, precluding meaningful analysis of their independent effects. CONCLUSION This study found strong relationships between workplace physical exposures assessed via a JEM and CTS, after adjusting for age, gender, and BMI. Though job-title-based exposures are likely to result in significant exposure misclassification, they can be useful for large population studies where more precise exposure data are not available. APPLICATION JEMs can be used as a measure of workplace physical exposures for some studies of musculoskeletal disorders.
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Affiliation(s)
- Bradley Evanoff
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Angelique Zeringue
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Alfred Franzblau
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ann Marie Dale
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Cowan J, Makanji H, Mudgal C, Jupiter J, Ring D. Determinants of return to work after carpal tunnel release. J Hand Surg Am 2012; 37:18-27. [PMID: 22137062 DOI: 10.1016/j.jhsa.2011.10.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The determinants of time to return to work-a common measure of treatment effectiveness-are incompletely defined. Our primary hypothesis was that employment circumstances are the strongest determinant of earlier return to work. Our secondary hypothesis was that return to work in patients with desk-based jobs is predicted by patient expectations and other psychosocial factors. METHODS We enrolled 65 employed patients with limited incision open carpal tunnel release in a prospective cohort study. Patients completed validated measures of depression, coping strategies, pain anxiety, and job burnout. Heavy lifting was not allowed for 1 month after surgery. Return to modified and full work duty was recorded in days. Although not specifically an exclusion criterion, none of the patients had a workers' compensation claim or other source of secondary gain. RESULTS Patients returned to modified duty an average of 11.8 days and full duty at an average of 18.9 days after surgery. Predictors of earlier return to modified duty in multivariate analyses included desk-based work and both the number of days patients expected to take off and the numbers of days they wanted to take off for the entire cohort, with an additional influence from catastrophic thinking in desk-based workers. Predictors of earlier return to full duty in multivariate analyses included desk-based work and number of days patients expected to take off before for the entire cohort, fewer days off desired in non-desk-based workers, fewer days off desired and change in work role in desk-based workers, and lower pain anxiety in part-time workers. CONCLUSIONS The most important determinant of return to full duty work after limited incision open carpal tunnel release is job type, but psychological factors such as patient expectations, catastrophic thinking, and anxiety in response to pain also have a role. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- James Cowan
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
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Parot-Schinkel E, Roquelaure Y, Ha C, Leclerc A, Chastang JF, Raimbeau G, Chaise F, Descatha A. Factors affecting return to work after carpal tunnel syndrome surgery in a large French cohort. Arch Phys Med Rehabil 2011; 92:1863-9. [PMID: 22032220 DOI: 10.1016/j.apmr.2011.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 05/24/2011] [Accepted: 06/02/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To evaluate occupational outcomes after surgical release of the median nerve in carpal tunnel syndrome (CTS). DESIGN Retrospective study 12 to 24 months after surgery. SETTING Hand centers (N=3) in 2 different areas. PARTICIPANTS Patients who had undergone surgical release of the median nerve in 2002 to 2003. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Duration of sick leave after surgery and associated factors were analyzed by using bivariate (log rank) and multivariate analyses of survival (Cox model). RESULTS Questionnaires mailed in 2004 regarding medical condition (history and surgery), employment (occupational category codes in 1 digit), and compensation were returned (N=1248; 62%), with 253 men and 682 women stating they were employed at the time of surgery (N=935). Most were working at the time of the study (n=851; 91.0%). Median duration of sick leave before returning to work was 60 days. The main factors associated with adverse occupational outcome (long duration of sick leave) were simultaneous intervention for another upper-extremity musculoskeletal disorder, belief (by the patient) in an occupational cause, and "blue-collar worker" occupational category (the strongest determinant). CONCLUSION This study emphasizes the multifactorial nature of the occupational outcome of CTS after surgery, including occupational category. The probability of return to work for each risk factor provides a fair description of prognosis for physicians and patients.
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Affiliation(s)
- Elsa Parot-Schinkel
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, France
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Nuckols TK, Maggard Gibbons M, Harness NG, Chang WT, Chung KC, Asch SM. Clinical quality measures for intraoperative and perioperative management in carpal tunnel surgery. Hand (N Y) 2011; 6:119-31. [PMID: 21776197 PMCID: PMC3092887 DOI: 10.1007/s11552-011-9325-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous research documents suboptimal preoperative or postoperative care for patients undergoing surgery. However, few existing quality measures directly address the fundamental element of surgical care: intra-operative care processes. This study sought to develop quality measures for intraoperative, preoperative, and postoperative care for carpal tunnel surgery, a common operation in the USA. METHODS We applied a variation of the well-established RAND/UCLA Appropriateness Method. Adherence to measures developed using this method has been associated with improved patient outcomes in several studies. Hand surgeons and quality measurement experts developed draft measures using guidelines and literature. Subsequently, in a two-round modified-Delphi process, a multidisciplinary panel of 11 national experts in carpal tunnel syndrome (including six surgeons) reviewed structured summaries of the evidence and rated the measures for validity (association with improved patient outcomes) and feasibility (ability to be assessed using medical records). RESULTS Of 25 draft measures, panelists judged 22 (88%) to be valid and feasible. Nine intraoperative measures addressed the location and extent of surgical dissection, release after wrist trauma, endoscopic release, and four procedures sometimes performed during carpal tunnel surgery. Eleven measures covered preoperative and postoperative evaluation and management. CONCLUSIONS We have developed several measures that experts, including surgeons, believe to reflect the quality of care processes occurring during carpal tunnel surgery and be assessable using medical records. Although quality measures like these cannot assess a surgeon's skill in handling the instruments, they can assess many important aspects of intraoperative care. Intraoperative measures should be developed for other procedures.
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Affiliation(s)
- Teryl K. Nuckols
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407–2138 USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, 911 Broxton Plaza, Los Angeles, CA USA
| | - Melinda Maggard Gibbons
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA USA
- Olive View—UCLA Medical Center, Sylmar, CA USA
| | - Neil G. Harness
- Kaiser Permanente Medical Group, Fontana Medical Center, Fontana, CA USA
| | | | - Kevin C. Chung
- Section of Plastic Surgery, The University of Michigan School of Medicine, Ann Arbor, MI USA
| | - Steven M. Asch
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407–2138 USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, 911 Broxton Plaza, Los Angeles, CA USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
| | - The Carpal Tunnel Quality Group
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407–2138 USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, 911 Broxton Plaza, Los Angeles, CA USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA USA
- Olive View—UCLA Medical Center, Sylmar, CA USA
- Kaiser Permanente Medical Group, Fontana Medical Center, Fontana, CA USA
- Kaiser Permanente Medical Group, Yorba Linda, CA USA
- Section of Plastic Surgery, The University of Michigan School of Medicine, Ann Arbor, MI USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
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Board BJ, Brown J. Barriers and enablers to returning to work from long-term sickness absence: Part I-A quantitative perspective. Am J Ind Med 2011; 54:307-24. [PMID: 20737423 DOI: 10.1002/ajim.20889] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Long-term sickness absence (LTSA) in the United Kingdom labor market has become a major health issue in recent years. In contrast to short-term sickness absence, rates for LTSA have been on the increase. This paper, part 1 of a two-part paper, identifies individual domain barriers to returning to work (RTW) from LTSA across the work disability timeline in the UK labor market. METHODS This is a retrospective cohort study of 6,246 workers from an occupationally diverse Police Force within the UK using a large administrative database. A series of chi-squared analyses were conducted to analyze the between and within group associations. Next, multiple logistic regression analyses using the Enter method were performed to develop a predictive model for RTW and Absence Phase. RESULTS Findings substantiated the presence of individual domain barriers to RTW and predictors of RTW outcome and established the absence phase specificity of a number of risk factors of prolonged work disability. In particular, injury/illness especially mental ill health (MIH), physical job demands, sex, and number of episodes of LTSA are significant individual domain barriers to RTW and represent important risk factors for prolonged work disability. CONCLUSIONS Duration of work disability is associated with medical diagnosis, especially MIH, physical job demands, sex, and number of LTSA episodes. Findings also support the importance of using the outcome measure of absence phase of risk factors in addition to RTW outcome.
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Tang D, Chen G, Xu YW, Hui-Lo KYL, Luo XY, Chan CCH. An emerging occupational rehabilitation system in the People's Republic of China. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21 Suppl 1:S35-S43. [PMID: 21365300 DOI: 10.1007/s10926-011-9299-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION China has become a major economic influence in Asia and globally. The country is in the position to further develop its workers' insurance and compensation system. This paper aims to introduce the existing workers' compensation policies, explain how these policies guide the operation of the occupational rehabilitation system for injured workers, and suggest ways to further develop an effective and sustainable system for the country. METHODS Major government policies and initiative documents and existing literature on occupational rehabilitation were critically reviewed. Shortfalls in our current system were identified and potential further development regimes were propose. RESULTS Since 2004, China has implemented its national policy on providing timely and comprehensive rehabilitation and return-to-work interventions for workers who are injured at work. The three-tier medical and occupational rehabilitation system appears effective for enabling injured workers to access these services. Such a system is regarded as the most optimal for the country in spearheading the development of quality occupational rehabilitation services, and at the same time incorporating the existing expertise in acute medical care and rehabilitation within the public medical and health system. Problems encountered in the system can be classified under the culture, system and competence building aspects. CONCLUSION The future workers' insurance and compensation system can probably put more emphasis on using bio-psychosocial and work disability prevention models in guiding its service development and delivery. Efforts need to be placed on building the competence of professionals in the system who provide services for injured workers. The empowerment of important stakeholders in the workers' insurance and compensation system and their inclusion in the planning of service delivery are crucial for developing a sustainable and effective system for China.
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Affiliation(s)
- Dan Tang
- Guangdong Provincial Work Injury Rehabilitation Centre, Guangzhou, The People's Republic of China
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Sandin KJ, Asch SM, Jablecki CK, Kilmer DD, Nuckols TK. Clinical quality measures for electrodiagnosis in suspected carpal tunnel syndrome. Muscle Nerve 2010; 41:444-52. [PMID: 20336661 DOI: 10.1002/mus.21617] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Extensive research has documented that medical care in the United States is not of optimal quality, meaning that well-established care processes are not consistently provided to the patients who would benefit from them. To assess and improve quality of care, specific measures are needed. The objective of this study was to develop quality measures for electrodiagnostic testing in suspected carpal tunnel syndrome (CTS). We used a variation of the well-established RAND/UCLA Appropriateness Method to develop the measures. A physiatrist and quality measurement experts developed draft measures based on guidelines and literature. Subsequently, in a two-round, modified-Delphi process, a multidisciplinary panel of 11 national experts in CTS reviewed a summary of the evidence and then rated the measures for validity and feasibility. Seven draft measures were developed. The expert panel combined two, modified the others, and then judged all resulting measures to be valid and feasible. The measures cover compelling indications for testing, essential test components when CTS is suspected, skin temperature measurement and normalization, and the appropriate interpretation of test results. These measures define a minimum standard of care for the use of electrodiagnostic tests in suspected CTS and are consistent with recent guidelines developed by the American Association of Neuromuscular and Electrodiagnostic Medicine. Provider organizations, insurance companies, and professional societies can use these measures in efforts to monitor and improve quality of care for this common and disabling condition.
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Affiliation(s)
- Karl J Sandin
- Karl Sandin, Sister Kenny Rehabilitation Institute, Minneapolis, Minnesota, USA
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Hansen TB, Dalsgaard J, Meldgaard A, Larsen K. A prospective study of prognostic factors for duration of sick leave after endoscopic carpal tunnel release. BMC Musculoskelet Disord 2009; 10:144. [PMID: 19930598 PMCID: PMC2784750 DOI: 10.1186/1471-2474-10-144] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 11/22/2009] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Endoscopic carpal tunnel release with a single portal technique has been shown to reduce sick leave compared to open carpal tunnel release, claiming to be a less invasive procedure and reducing scar tenderness leading to a more rapid return to work, and the purpose of this study was to identify prognostic factors for prolonged sick leave after endoscopic carpal tunnel release in a group of employed Danish patients. METHODS The design was a prospective study including 75 employed patients with carpal tunnel syndrome operated with ECTR at two hospitals. The mean age was 46 years (SD 10.1), the male/female ratio was 0.42, and the mean preoperative duration of symptoms 10 months (range 6-12). Only 21 (28%) were unable to work preoperatively and mean sick leave was 4 weeks (range 1-4). At base-line and at the 3-month follow-up, a self-administered questionnaire was collected concerning physical, psychological, and social circumstances in relation to the hand problem. Data from a nerve conduction examination were collected at baseline and at the 3-month follow-up. Significant prognostic factors were identified through multiple logistic regression analysis. RESULTS After the operation, the mean functional score was reduced from 2.3 to 1.4 (SD 0.8) and the mean symptom score from 2.9 to 1.5 (SD 0.7). The mean sick leave from work after the operation was 19.8 days (SD 14.3). Eighteen patients (24%) had more than 21 days of sick leave. Two patients (3%) were still unable to work after 3 months. Significant prognostic factors in the multivariate analysis for more than 21 days of postoperative sick leave were preoperative sick leave, blaming oneself for the hand problem and a preoperative distal motor latency. CONCLUSION Preoperative sick leave, blaming oneself for the hand problem, and a preoperative distal nerve conduction motor latency were prognostic factors for postoperative work absence of more than 21 days. Other factors may be important (clinical, demographic, economic, and workplace) in explaining the great variance in the results of sick leave after carpal tunnel release between studies from different countries.
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Affiliation(s)
- Torben Baek Hansen
- Department of Orthopaedics, Section of Hand Surgery, Regional Hospital Holstebro, Laegaardvej 12, DK-7500 Holstebro, Denmark.
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Boyer J, Galizzi M, Cifuentes M, d'Errico A, Gore R, Punnett L, Slatin C. Ergonomic and socioeconomic risk factors for hospital workers' compensation injury claims. Am J Ind Med 2009; 52:551-62. [PMID: 19479820 PMCID: PMC5860808 DOI: 10.1002/ajim.20702] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hospital workers are a diverse population with high rates of musculoskeletal disorders (MSDs). The risk of MSD leading to workers' compensation (WC) claims is likely to show a gradient by socioeconomic status (SES) that may be partly explained by working conditions. METHODS A single community hospital provided workforce demographics and WC claim records for 2003-2005. An ergonomic job exposure matrix (JEM) was developed for these healthcare jobs from direct observation of physical workload and extraction of physical and psychosocial job requirements from the O*NET online database. Occupational exposures and SES categories were assigned to workers through their O*NET job titles. Univariate and multivariate Poisson regression analyses were performed to estimate the propensity to file an injury claim in relation to individual factors, occupational exposures, and SES. RESULTS The jobs with the highest injury rates were nurses, semi-professionals, and semi-skilled. Increased physical work and psychological demands along with low job tenure were associated with an increase in risk, while risk decreased with psychosocial rewards and supervisor support. Both occupational and individual factors mediated the relationship between SES and rate of injury claims. CONCLUSIONS Physical and organizational features of these hospital jobs along with low job tenure predicted WC injury claim risk and explained a substantial proportion of the effects of SES. Further studies that include lifestyle risk factors and control for prior injuries and co-morbidities are warranted to strengthen the current study findings.
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Affiliation(s)
- Jon Boyer
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts 01854, USA.
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Abstract
Fifty years after its widespread recognition, a significant minority of patients with carpal tunnel syndrome continue to experience poor outcomes from treatment. Much current treatment is supported by an inadequate or nonexistent evidence base. Surgical decompression, often considered the definitive solution, gives excellent results in only 75% of cases in ordinary practice and leaves 8% of patients worse than previously. The only other interventions that are clearly of benefit are neutral-angle wrist splinting, with a success rate of 37%, and steroids, which are better given by local injection than as oral treatment. The initial response rate to injection is 70% but there are frequent relapses. Nevertheless, these conservative treatments have a negligible incidence of serious complications and should be used more widely until surgical failures can be reduced to similar levels.
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Affiliation(s)
- Jeremy D P Bland
- Department of Clinical Neurophysiology, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, UK.
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Guthrie R, Jansz J. Women's Experience in the Workers' Compensation System. JOURNAL OF OCCUPATIONAL REHABILITATION 2006; 16:485-99. [PMID: 16783529 DOI: 10.1007/s10926-006-9025-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Gender differences is a question of major importance within workers' compensation given the increased role of women in the workforce over the past several decades. This article reviews literature relating to women's experiences following work injury. METHODS An Australian study is used as background to exploring the broad issue of the question of gender equity in workers' compensation. In doing so it takes account of historical, legal and medical issues. RESULTS Women's experience in the workers' compensation system is different to that of men due to a range of factors. It is heavily influenced by the industrial environment in which they work. Women are paid less than men in many instances and work in gender-segregated circumstances, which often reduces their industrial bargaining power. Women also suffer different forms of injury and disease to men because of the different nature of their work. CONCLUSION The Australian experience suggests that as a consequence of the combination of lesser industrial bargaining power, lower wages and differing forms of injury and disease women often receive less than men in compensation payments, struggle to obtain equity in the dispute resolution process and experience greater difficulties in returning to work following injury or disease.
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Affiliation(s)
- Robert Guthrie
- School of Business Law, Curtin University of Technology, Bentley, Western Australia.
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Gimeno D, Amick BC, Habeck RV, Ossmann J, Katz JN. The role of job strain on return to work after carpal tunnel surgery. Occup Environ Med 2005; 62:778-85. [PMID: 16234404 PMCID: PMC1740908 DOI: 10.1136/oem.2004.016931] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS To examine the impact of job strain (that is, high psychological job demands and low job control) on return to work and work role functioning at two months, six months, or both, following carpal tunnel release surgery. METHODS A community based cohort of carpal tunnel syndrome (CTS) patients from physician practices was recruited between April 1997 and October 1998 throughout Maine (USA). 128 patients at two months and 122 at six months completed all relevant questions. A three level outcome variable indicated whether patients had: (1) returned to work functioning successfully, (2) returned to work functioning with limitations, or (3) not returned to work for health reasons. Two job strain measures were created: one, by combining psychological job demands and job control; and two, by dividing demands by control. Ordinal logistic regression was used to identify predictors of the three level work outcome variable. RESULTS After adjustment, workers with high demands and high control (active work) were less likely to successfully return to work (OR = 0.22; p = 0.014) at two months. Having a job with higher demands than job control (high strain) predicted not returning to work or returning to work but not successfully meeting job demands (OR = 0.14; p = 0.001), at six months. CONCLUSIONS The findings underscore the role of psychosocial work conditions, as defined by the Karasek demand-control model, in explaining a worker's return to work. Clinicians, researchers, and employers should consider a multidimensional and integrative model of successful work role functioning upon return to work. Moreover, since the evidence of the effects of work process changes on the reduction of CTS is very scarce, these findings point to the opportunity for collaborative workplace interventions to facilitate successful return to work.
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Affiliation(s)
- D Gimeno
- Southwest Center for Occupational and Environmental Health, School of Public Health, University of Texas-Houston Health Science Center, Houston, TX 77225-0186, USA.
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Ratzon N, Schejter-Margalit T, Froom P. Time to return to work and surgeons' recommendations after carpal tunnel release. Occup Med (Lond) 2005; 56:46-50. [PMID: 16286431 DOI: 10.1093/occmed/kqi194] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Time to return to work after carpal tunnel release is extremely variable suggesting that only a small proportion of total sick-leave is for medical reasons. AIMS To determine factors predicting a delayed return to work. METHODS Fifty consecutive employed patients undergoing carpal tunnel surgery were tested pre-operatively, and then at 1 month post-operatively using both questionnaires and objective testing. Further follow-up by telephone was carried out every 2 weeks up until 90 days. RESULTS Forty-nine of the 50 workers had returned to work by 3 months. Time to return to work was extremely variable ranging from 1 to 88 days in those who returned to work. Post-operative recommendations by the surgeon also varied widely from 1 to 36 days. The surgeons' recommendations were the strongest predictors of delayed return to work [odds ratio 30.5; 95% confidence interval (CI), 3.2-288], with physical work (odds ratio 27.7; 95% CI, 1.5-507) and lack of self-rated health (odds ratio 5.0; 95% CI, 1.11-100) adding significantly to the logistic regression model, which was highly predictive (area under the receiver-operator curve of 88%). Patient symptoms and objective findings of disability did not add significantly to a logistic regression model either predicting return to work or the surgeon's recommendations. CONCLUSIONS Our study suggests that workers will return to work in less than 3 weeks if recommended by the surgeon. A randomized controlled trial is warranted to determine if a higher proportion of workers returning in less than 3 weeks can be obtained by standardizing surgeons' recommendations.
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Affiliation(s)
- Navah Ratzon
- Department of Occupational Therapy, Tel Aviv University, PO Box 39040, Ramat Aviv, 69978 Tel Aviv, Israel.
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Katz JN, Amick BC, Keller R, Fossel AH, Ossman J, Soucie V, Losina E. Determinants of work absence following surgery for carpal tunnel syndrome. Am J Ind Med 2005; 47:120-30. [PMID: 15662641 DOI: 10.1002/ajim.20127] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The objective was to identify factors across multiple domains associated with return to work in a community-based cohort of workers with carpal tunnel syndrome. METHODS Workers scheduled for carpal tunnel release were recruited into this prospective study. Subjects completed questionnaires preoperatively and at 2, 6, and 12 months postoperatively. The questionnaires contained demographic, clinical, and psychosocial factors and physical and psychosocial workplace stressors. Predictors of work absence at 6 and 12 months were examined in bivariate and multivariate logistic regression analyses. RESULTS Six months following surgery of 181 subjects, 29 (19%) were out of work. Twelve months postoperatively 33 subjects (22%) were out of work. In bivariate analyses, the factors associated with work absence at 6 months, at P < or = 0.01, included preoperative physical functional status, change in self-efficacy between preoperative assessment and 2 months, lower income, workers' compensation, representation by an attorney, work exposure to force and repetition, higher psychological job demands and lower control, lower social support by coworkers, lower job security and more supportive organizational policies and practices. The factors associated with work absence at 12 months in bivariate analyses included preoperative physical functional status, lower self-efficacy at 2 months, workers' compensation, and less supportive organizational policies and practices. Multivariate analyses documented a multidimensional model, with predictors from multiple domains. CONCLUSIONS Clinical, demographic, economic, and workplace factors were associated with work absence. Strategies to reduce work absence following carpal tunnel release should address multiple dimensions of the worker and workplace.
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Affiliation(s)
- Jeffrey N Katz
- Robert Brigham Arthritis and Musculoskeletal Clinical Research Center, Section of Clinical Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Hagebeuk EEO, de Weerd AW. Clinical and electrophysiological follow-up after local steroid injection in the carpal tunnel syndrome. Clin Neurophysiol 2004; 115:1464-8. [PMID: 15134716 DOI: 10.1016/j.clinph.2004.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Local steroid injections are used for treatment for the carpal tunnel syndrome (CTS). Study of changes in neurophysiological parameters after such treatment for idiopathic CTS might be a supportive argument for the effectiveness of steroid treatment. METHODS Twenty-one patients with CTS were included and evaluated before and at 1, 3 and 6 months after treatment. At the inclusion date patients received a single 1 ml local steroid injection. Various electrophysiological tests were used. For clinical evaluation, we used the Boston Carpal Tunnel Questionnaire (BCTQ) and the General Outcome Score. RESULTS The mean nerve conduction parameters had significantly improved at 1 month, except the SNAP4 and CMAP. This improvement was still present at 3 months. At 6 months follow-up, the improvement in the SDL4, SNAP4, M-U, DML and CMAP remained significant. In 6 patients (29%), the nerve conduction parameters normalized and remained so until the end of the study. The BCTQ and the General Outcome Score significantly improved as well. However, there was no correlation between the electrophysiological data, the BCTQ and the General Outcome Score. CONCLUSIONS The improvements of nerve conduction parameters independently support the ideas on effectiveness of steroid injection therapy in CTS.
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Affiliation(s)
- E E O Hagebeuk
- Department of Clinical Neurophysiology, MCH, Westeinde Hospital, Lijnbaan 32, 2512 VA Den Haag, The Netherlands.
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Turner JA, Franklin G, Fulton-Kehoe D, Egan K, Wickizer TM, Lymp JF, Sheppard L, Kaufman JD. Prediction of chronic disability in work-related musculoskeletal disorders: a prospective, population-based study. BMC Musculoskelet Disord 2004; 5:14. [PMID: 15157280 PMCID: PMC428578 DOI: 10.1186/1471-2474-5-14] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 05/24/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disability associated with work-related musculoskeletal disorders is an increasingly serious societal problem. Although most injured workers return quickly to work, a substantial number do not. The costs of chronic disability to the injured worker, his or her family, employers, and society are enormous. A means of accurate early identification of injured workers at risk for chronic disability could enable these individuals to be targeted for early intervention to promote return to work and normal functioning. The purpose of this study is to develop statistical models that accurately predict chronic work disability from data obtained from administrative databases and worker interviews soon after a work injury. Based on these models, we will develop a brief instrument that could be administered in medical or workers' compensation settings to screen injured workers for chronic disability risk. METHODS This is a population-based, prospective study. The study population consists of workers who file claims for work-related back injuries or carpal tunnel syndrome (CTS) in Washington State. The Washington State Department of Labor and Industries claims database is reviewed weekly to identify workers with new claims for work-related back injuries and CTS, and these workers are telephoned and invited to participate. Workers who enroll complete a computer-assisted telephone interview at baseline and one year later. The baseline interview assesses sociodemographic, employment-related, biomedical/health care, legal, and psychosocial risk factors. The follow-up interview assesses pain, disability, and work status. The primary outcome is duration of work disability over the year after claim submission, as assessed by administrative data. Secondary outcomes include work disability status at one year, as assessed by both self-report and work disability compensation status (administrative records). A sample size of 1,800 workers with back injuries and 1,200 with CTS will provide adequate statistical power (0.96 for low back and 0.85 for CTS) to predict disability with an alpha of.05 (two-sided) and a hazard ratio of 1.2. Proportional hazards regression models will be constructed to determine the best combination of predictors of work disability duration at one year. Regression models will also be developed for the secondary outcomes.
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Affiliation(s)
- Judith A Turner
- Departments of Psychiatry & Behavioral Sciences and Rehabilitation Medicine, University of Washington School of Medicine, Box 356560, Seattle, WA, 98195-6560, USA
| | - Gary Franklin
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Box 358772, Seattle, WA, 98195, USA
- Washington State Department of Labor and Industries, P.O. Box 44321, Olympia, WA, 98504, USA
| | - Deborah Fulton-Kehoe
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Box 358772, Seattle, WA, 98195, USA
| | - Kathleen Egan
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Box 358772, Seattle, WA, 98195, USA
| | - Thomas M Wickizer
- Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, WA, 98195, USA
| | - James F Lymp
- Division of Biostatistics, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Lianne Sheppard
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Box 358772, Seattle, WA, 98195, USA
- Department of Biostatistics, University of Washington School of Public Health and Community Medicine, Seattle, WA, 98195-7232, USA
| | - Joel D Kaufman
- Department of Environmental & Occupational Health Sciences, University of Washington School of Public Health and Community Medicine, Box 358772, Seattle, WA, 98195, USA
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Amick BC, Habeck RV, Ossmann J, Fossel AH, Keller R, Katz JN. Predictors of Successful Work Role Functioning After Carpal Tunnel Release Surgery. J Occup Environ Med 2004; 46:490-500. [PMID: 15167398 DOI: 10.1097/01.jom.0000126029.07223.a0] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study identified the clinical, individual, and workplace predictors of successful work role functioning (WRF) after carpal tunnel release surgery (CTRS). A community-based cohort (n = 197) was followed for 6 months post-CTRS. Predictors of successful WRF were analyzed prospectively using ordinal logistic regression. Baseline WRF predicted successful WRF at 2 months, whereas being depressed and a workers' compensation claimant predicted being out of work. Baseline WRF, improved self-efficacy, and a supportive organization predicted 6-month successful WRF. Supportive organizations have an impact on the effectiveness of medical interventions for CTS. The significance of improved self-efficacy at 6 months and depression at 2 months postsurgery highlights the importance of psychosocial management of musculoskeletal disorders.
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Affiliation(s)
- Benjamin C Amick
- University of Texas, School of Public Health, Houston, Texas, USA.
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Manktelow RT, Binhammer P, Tomat LR, Bril V, Szalai JP. Carpal tunnel syndrome: cross-sectional and outcome study in Ontario workers. J Hand Surg Am 2004; 29:307-17. [PMID: 15043907 DOI: 10.1016/j.jhsa.2003.11.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2003] [Revised: 11/10/2003] [Accepted: 11/10/2003] [Indexed: 02/02/2023]
Abstract
PURPOSE To carry out an analytic cross-sectional study of Ontario workers with carpal tunnel syndrome (CTS) and to assess workers' symptoms, functional disabilities, recreational difficulties, and work capability 4 years after treatment of their CTS. METHODS Data were obtained by review of Ontario Workers Safety and Insurance Board (WSIB) files and by completion of self-assessment questionnaires. Inclusion criteria included all workers registered with the Ontario WSIB who were off work with newly diagnosed carpal tunnel syndrome in 1996. RESULTS There are 3 million workers covered by the WSIB in the province of Ontario. In 1996, 964 of them developed work-related CTS that required time off for treatment. Of these patients 53% were women and 75% had bilateral CTS. Eighty-one percent of the unilateral cases involved the dominant extremity. The average age at the time of claim was 41 years and workers were at the same job type for an average of 7.4 years (unilateral) and 8.5 years (bilateral), respectively. Thirty-nine percent of workers had a history of another tendonitis or epicondylitis. Seventy-five percent of workers had surgery and on average returned to work 3 months later. Four years after treatment, outcome was assessed by self-administered questionnaires, for which there was a 73% response rate. Forty-six percent of workers experienced moderate to severe pain, 47% had moderate to severe numbness, and 40% had difficulty grasping and using small objects. Only 14% were symptom free. Successful return to work was considered to be a return to the same job with or without modifications, and it occurred in 64% of cases. Better clinical outcome scores were found to occur with surgery and abnormal nerve conduction study results. Worse clinical outcome scores were present with repeat surgery and surgical complications. Concurrent diagnoses of either tendonitis or epicondylitis also resulted in worse clinical outcome scores and worse return-to-work outcomes. The average total cost in Canadian dollars to the WSIB exceeded $13,700 per worker for a total cost in excess of $13,200,000 per year. (In 1996, $1 Canadian = $1.365 US.) CONCLUSIONS These outcomes indicate that Canadian workers have a large amount of permanent pain and suffering, a large loss of work productivity, and incur a considerable financial cost as a result of work-related CTS.
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Affiliation(s)
- Ralph T Manktelow
- University Health Network, Toronto General Hospital, 200 Elizabeth Street, Eaton North, Toronto, Ontario 7-228, Canada
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Hanson BP, Kopjar B. [Outcome parameters for clinical studies: change of paradigm?]. Chirurg 2003; 74:1034-9. [PMID: 14605721 DOI: 10.1007/s00104-003-0740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the context of comparative clinical studies in surgery and in orthopedic surgery different therapies, techniques, or implants have been compared. Recent scientific publications mainly mention clinical outcome measurements such as fracture union, ROM, infection rate, as well as patient-related criteria such as pain or return to work (RTW) in order to evaluate the success of the treatment. It becomes obvious that more often than not the term "return to work" is not clearly defined. It is not mentioned who measures which criteria at which point in time, nor are part-time occupation, job change, or training on a new job part of the considerations.
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Affiliation(s)
- B P Hanson
- AO Clinical Investigation and Documentation, Davos, Schweiz.
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