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Tamburrino G, Rovere G, Marcovici LL, Migliorini F, Fulchignoni C, Fidanza A. Return to Work After Subcutaneous Transposition of the Extensor Indicis Proprius to Repair Inveterate Ruptures of Extensor Pollicis Longus. J Clin Med 2025; 14:814. [PMID: 39941485 PMCID: PMC11818803 DOI: 10.3390/jcm14030814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Revised: 01/15/2025] [Accepted: 01/22/2025] [Indexed: 02/16/2025] Open
Abstract
Background/Objectives: An Extensor Pollicis Longus (EPL) subcutaneous rupture is a substantial complication in post-traumatic or degenerative wrist and tendinous lesions. The diagnosis is essentially dictated by a clinical evaluation; in fact, it is characterized by the inability to extend the thumb interphalangeal joint and to retropose the thumb while the hand is resting on a surface. The tendinous transposition using the Extensor Indicis Proprius (EIP) as a donor tendon is a well-known surgical technique performed to restore functional activity to the thumb, and it is preferred for the closer cerebellar network with the thumb itself. However, there is a dearth of clinical results and scientific evidence in the literature. The aim of this study is to evaluate the return-to-work eligibility after an inveterate EPL subcutaneous rupture repaired with a transposition of the EIP. Methods: Patients who reported a subcutaneous rupture of the EPL due to rheumatic diseases or who had undergone previous hand or wrist surgery were excluded; however, all patients tested positive for traumatic wrist hypertension. The surgical technique involves three small incisions to achieve tenorrhaphy of the EIP at the distal head of the EPL. Dynamic tests are carried out intraoperatively to verify the tightness and sufficient rigidity of the suture. The objective evaluation involves the range of motion, pinch strength, and power extension of the thumb and the index finger. Patient-reported outcome measures for pain and patient satisfaction include the Numeric Pain Rating Scale and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Results: A total of 12 patients were eligible (7 W, 5 M, mean age 56.3 years) and were followed for at least one year. There were no surgery-related complications. After the cast was removed 3 weeks after surgery, patients could extend their thumbs, put them back, and use their index fingers. An immediate improvement in objective and subjective assessments was reported. At 10 weeks, nine patients (75%) returned to full work with no pain and without the aid of rehabilitation; two patients (17%) returned to full work with no symptoms 2 weeks later; and only one patient (8%) with a neurological disease required physical therapy, achieving pain control and restoration of full mobility approximately six months after surgery. Conclusions: This surgical technique seems to address satisfactory results in terms of skill recovery and rapid return to work. A tailored rehabilitation program should be implemented for selected patients with neurological conditions that may prolong the adaptation process of the transposed tendon, the coordination, and the independent function of the thumb and index finger.
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Affiliation(s)
- Gabriele Tamburrino
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L’Aquila (IT), 67100 L’Aquila, Italy;
| | - Giuseppe Rovere
- Section of Orthopaedics and Traumatology, Department of Clinical Science and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Hand Surgery Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168 Rome, Italy;
| | | | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Via Lorenz Böhler 5, 39100 Bolzano, Italy;
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165 Rome, Italy
| | - Camillo Fulchignoni
- Hand Surgery Unit, Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A.Gemelli IRCCS, 00168 Rome, Italy;
| | - Andrea Fidanza
- Unit of Orthopaedics, Department of Life, Health and Environmental Sciences, University of L’Aquila (IT), 67100 L’Aquila, Italy;
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Al-Thani H, El-Menyar A, Asim M, Afifi I. Clinical patterns and outcomes of hospitalized patients with grinder-related neurovascular injuries: A decade of experience from a Level I Trauma center. Injury 2025; 56:111914. [PMID: 39366879 DOI: 10.1016/j.injury.2024.111914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/16/2024] [Accepted: 09/16/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND Occupational injuries impose a substantial global burden, affecting millions of workers annually, which demands urgent attention to enhance workplace safety and health standards. We aimed to outline the frequency, patterns of injury, and clinical characteristics of patients injured by high-rotation cutting tools (grinders) and to pinpoint the neurovascular (nerves and blood vessels) injuries. METHODS A retrospective study was conducted and included all adult patients hospitalized because of grinder-related injuries at the only level I Trauma Center in the country. The characteristics of patients, mechanism of injury, management and outcomes were analyzed based on the anatomical location of injuries. RESULTS 127 patients were hospitalized with grinder-related injuries over ten years. The incidence of GRIs showed an increasing trend over the years. All patients were males with a mean (SD) age of 34.9 (9.8) years. The majority were general laborers (66.1 %), injured by portable grinders (86.6 %), and direct blade contact (64.6 %). The median Injury Severity Score (ISS) was 5.0(IQR 4.0-9.0), and the median Glasgow Coma Scale (GCS) at ED was 15 (3-15). The most frequently injured part was the upper extremity (36.2 %), followed by the lower extremity (33.9 %) and the face (27.6 %). One-third of cases had vascular injuries, and 23.6 % had nerve injuries. Suturing was done for all patients; repairs and debridements were performed in 62 % and 58 % of cases, respectively, and 21 % required vascular surgery. Amputations were required in 9.4 % of cases. Thirty patients had nerve injuries involving the median (11 %) and radial (9.4 %) nerves. Among patients who had neurovascular injuries, 30 % (12/40) experienced complications during the hospital stay, while 60 % (24/40) ended up with physical disabilities. CONCLUSION Individuals affected by power-tool accidents were predominantly young males, mainly general laborers, with a significant proportion being expatriates. The trend of grinder-related injuries increases over time, with portable grinders being a primary source of injuries due to direct contact with the blade. The anatomical injuries mainly include fractures of the upper and lower extremities. Further studies are warranted to understand the cultural aspects and training requirements of workers handling power tools, aiming to achieve sustainable injury prevention effectively.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ibrahim Afifi
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Yamamoto K, Motomiya M, Ono K, Matsui Y, Yasui K, Iwasaki N. Initial patient demographics affecting return to original work after traumatic hand injury in a rural area in Japan: A retrospective single-center study. J Orthop Sci 2024; 29:1280-1286. [PMID: 37839976 DOI: 10.1016/j.jos.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Time off work after traumatic hand injury not only affects individuals but also has socioeconomic repercussions, becoming a serious problem from the viewpoint of labor shortages. In depopulated rural areas, the impact of labor shortages due to time off work is more serious than in urban areas; however, few studies have examined return to original work in rural areas. The purpose of this study was to investigate the patient demographics at the time of hand injury that affect return to original work in a rural area of Japan. METHODS We retrospectively examined 246 patients with traumatic hand and/or forearm injuries who were working at the time of injury, and who underwent surgical operations and postoperative rehabilitation in a level II hospital in a rural agricultural area. We examined patients' initial demographic data, including gender, age, occupation (white or blue collar), employment status (self-employed, full-time, or part-time workers), complications other than hand injury, workers' compensation, dominant hand injury, and injury severity as determined using the modified Hand Injury Severity Score. Multivariate logistic regression analysis examined the association between initial patient demographics and return to original work within 150 days after injury. RESULTS In total, 186 patients (76 %) were able to return to original work within 150 days. A multivariate logistic regression analysis showed that three explanatory variables (i.e., severity of injury, complications other than hand injury, and female gender) significantly compromised return to original work. CONCLUSIONS In the treatment of traumatic hand injury, intensive support should be provided for return to original work for patients who are expected to have difficulty returning to work quickly. In addition, labor shortages can be mitigated by sharing information with the workplace about patients' prospects of return to original work.
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Affiliation(s)
- Kazuhiro Yamamoto
- Department of Medical Technology Occupational Therapy, Obihiro Kosei Hospital, Obihiro, Japan
| | - Makoto Motomiya
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital Hand Center, Obihiro, Japan.
| | - Kota Ono
- Ono Biostat Consulting (Kota Ono is also an employee of AbbVie GK.), Japan
| | - Yuichiro Matsui
- Section for Clinical Education, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan; Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keigo Yasui
- Department of Orthopaedic Surgery, Obihiro Kosei Hospital, Obihiro, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Notermans BJW, Teunissen JS, Selles RW, de Boer LHL, the Hand Wrist Study Group, van der Heijden BEPA. Type of Work and Preoperative Ability to Perform Work Affect Return to Usual Work Following Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis. Hand (N Y) 2024; 19:648-655. [PMID: 36540945 PMCID: PMC11141417 DOI: 10.1177/15589447221141485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The time until return to work (RTW) and possible factors affecting this time after proximal interphalangeal (PIP) joint arthroplasty are unknown. Therefore, we aim to evaluate the RTW after PIP joint arthroplasty for osteoarthritis and assess factors affecting the time until return to their usual work. METHODS We used prospectively gathered data from 74 patients undergoing PIP joint arthroplasty with daily hand surgery practice routine outcome collection. Standardized RTW questionnaires were completed at 6 weeks and 3, 6, and 12 months after surgery. Return to work was defined as the first time a patient reported returning to work and performing the original work for a minimum of 50% of the original hours a week, as stated in the patient's contract. Second, we evaluated baseline factors affecting the time until RTW. RESULTS The probability of RTW within 12 months after surgery was 88%. The median time until RTW was 8 weeks (interquartile range: 4-10). Physical occupational intensity (hazard ratio [HR]: 0.36, P = .001) and the baseline Michigan Hand Outcomes Questionnaire work scores (HR: 1.02, P = .005) were independently associated with RTW. CONCLUSION In conclusion, patients returned to work after a median of 8 weeks following PIP arthroplasty. Patients with medium or heavy physical occupations returned to work later than patients with light physical occupations. Better patient-reported work outcomes at baseline also led to an earlier RTW. This information can be valuable for providing adequate information during the preoperative consultation.
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Affiliation(s)
| | - Joris S. Teunissen
- Radboudumc, Nijmegen, The Netherlands
- Erasmus MC, Rotterdam, The Netherlands
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Núñez-Cortés R, Espin A, Pérez-Alenda S, López-Bueno R, Cruz-Montecinos C, Vincents-Seeberg KG, Püschel TA, Calatayud J, Andersen LL. Association Between Pain Coping and Symptoms of Anxiety and Depression, and Work Absenteeism in People With Upper Limb Musculoskeletal Disorders: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:781-791. [PMID: 37490961 DOI: 10.1016/j.apmr.2023.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/02/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To determine the prospective association of pain coping strategies and symptoms of anxiety and depression with work absenteeism in people with upper limb musculoskeletal disorders. DATA SOURCES A systematic search of PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases was conducted from inception to September 23, 2022. STUDY SELECTION Prospective observational studies of adults with upper limb musculoskeletal disorders were included. Included studies had to provide data on the association of pain coping strategies (catastrophizing, kinesiophobia, self-efficacy or fear avoidance) or symptoms of anxiety and depression with work absenteeism. DATA EXTRACTION Study selection, data extraction, and assessment of methodological quality (Newcastle Ottawa Scale) were performed by 2 independent authors. Random-effects models were used for quantitative synthesis. DATA SYNTHESIS Eighteen studies (n=12,393 participants) were included. Most studies (77.8%) reported at least 1 significant association between 1 or more exposure factors (pain coping strategies or symptoms of anxiety and depression) and work absenteeism. Meta-analyses showed a statistically significant correlation between the exposure factors of catastrophizing (r=0.28, 95% confidence interval [CI]: 0.15 to 0.40; P<.0001) and symptoms of anxiety and depression (r=0.23, 95% CI: 0.10 to 0.34; P=.0003) with work absenteeism. The correlation between self-efficacy and work absenteeism was non-significant (r=0.24, 95% CI: -0.02 to 0.47; P=.0747). CONCLUSIONS Rehabilitation teams should consider assessing catastrophizing and symptoms of anxiety and depression to identify patients at risk for work absenteeism. Addressing these variables may also be considered in return-to-work programs for individuals with upper limb disorders.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ander Espin
- National Research Centre for the Working Environment, Copenhagen, Denmark; Ageing On Research Group, Department of Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Rubén López-Bueno
- National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Division of Research, Development and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | | | - Thomas A Püschel
- Ecology and Evolutionary Biology Division, School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Joaquín Calatayud
- National Research Centre for the Working Environment, Copenhagen, Denmark; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain.
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Kankam HKN, Ibrahim H, Liew MS, Hauff E, Tullie S, Parthiban S, Chester DL. Epidemiology of adult hand injuries presenting to a tertiary hand surgery unit: a review of 4216 cases. J Hand Surg Eur Vol 2024; 49:48-53. [PMID: 37656976 DOI: 10.1177/17531934231195499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
This study investigates the pattern of hand injuries presenting to a UK regional tertiary centre. All referrals to our Hand Surgery Unit in 2019 were reviewed. Subgroup analyses of sex, deprivation, occupational injuries and assault cases were carried out. Over the study period, 4216 cases were referred. Most were male (70%), with a median age of 36 years and from a deprived area (75.2%). Soft tissue injury was documented in 53.6% and bone injury (fracture/dislocation) in 52.4%. Surgical management was required in 2214 (52.5%) cases. Work-related injuries accounted for 16.7% of cases and were more likely to require surgery. Assault-related injuries accounted for 8% of cases, with a male preponderance. Our findings can help facilitate service provision and guide regional and national prevention policies.Level of evidence: III.
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Affiliation(s)
- Hadyn K N Kankam
- Department of Hands, Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Hussein Ibrahim
- Department of Hands, Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mei Sien Liew
- Department of Hands, Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ellie Hauff
- Department of Hands, Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sebastian Tullie
- Department of Hands, Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sunil Parthiban
- Department of Hands, Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Darren L Chester
- Department of Hands, Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Naylor JM, Bhandari P, Descallar J, Yang OO, Rider M, Mayland EC, Tang C, Brady B, Lim D, Santalucia Y, Gabbe BJ, Hassett G, Baker E. Comparison of short-term outcomes between people with and without a pre-morbid mental health diagnosis following surgery for traumatic hand injury: a prospective longitudinal study of a multicultural cohort. BMC Musculoskelet Disord 2023; 24:805. [PMID: 37821871 PMCID: PMC10568865 DOI: 10.1186/s12891-023-06931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Following traumatic hand injury, few studies have compared outcomes between people with and without a pre-morbid mental health diagnosis. This study aimed to compare sub-acute outcomes in a multicultural patient cohort with surgically managed traumatic hand injury with and without a pre-morbid mental health diagnosis. METHODS A prospective, observational cohort study of people with traumatic hand injury presenting pre- surgically to a high-volume hand injury centre in a region of cultural and language diversity was conducted. Participants were assessed face-to-face (baseline) then via telephone (3-months post-surgery) and categorized according to a pre-morbid medically diagnosed mental health diagnosis. Baseline and follow-up assessments included global mental health, and the EuroQol (EQ) 'Health Today' analogue scale (0-100) and health domains. Return-to-work status, complications/symptomatic complaints, and hand function (QuickDASH) were also collected at follow-up. Adjusted analyses-accounting for covariates including cultural identity-were conducted to determine whether 3-month outcomes were associated with a pre-morbid mental health diagnosis. RESULTS From 405 eligible patients, 386 were enrolled (76% male, mean age 38.9 (standard deviation 15.6)); 57% self-identified as Australian and 22% had a pre-morbid mental health diagnosis. Common injuries regardless of pre-morbid mental health diagnosis were skin (40%), tendon (17%) and bone (17%) injuries. None were complex mutilating injuries. Seventy-eight per cent of the cohort was followed-up. In adjusted analyses, a pre-morbid mental health diagnosis was associated with lower odds for reporting 'good or better' global mental health (Odds Ratio (OR) 0.23 (95% Confidence Interval (CI) 0.18, 0.47), p < 0.001), 'no' anxiety or depression (OR 0.21 (0.11, 0.40), p < 0.001) and no pain (OR 0.56 (0.31, 0.98), p = 0.04)(EQ domains), and worse EQ 'Health Today' (10 points on average (95%CI -14.9, -5.1, p < 0.001). QuickDASH scores, rates of complications/symptomatic complaints and return-to-work profiles were similar. CONCLUSIONS Despite reporting worse mental and health-related quality-of-life outcomes post-surgery, people with a pre-morbid mental health diagnosis regardless of cultural identity experienced similar clinical and return-to-work outcomes. Future research assessing the value of screening for pre-morbid mental health conditions on post-surgical outcomes is required and should include people with more complex hand injuries.
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Affiliation(s)
- Justine M Naylor
- Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia.
| | - Pratibha Bhandari
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Joseph Descallar
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia
| | - Owen Ou Yang
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Mark Rider
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Elizabeth C Mayland
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Clarice Tang
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Bernadette Brady
- Department of Pain Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Yvonne Santalucia
- Multicultural Health Service, South West Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Geraldine Hassett
- Rheumatology, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
- South Western Sydney Clinical School, Faculty of Medicine, UNSW, Liverpool, BC 1871, NSW, Australia
| | - Elise Baker
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- South Western Sydney Local Health District, Liverpool, Locked Bag 7279, Liverpool BC, 1871, Australia
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Sivakumar BS, Vaotuua DL, McCarron L, Graham DJ. Cost Analysis of Intramedullary Screw versus Plate Osteosynthesis for Phalangeal and Metacarpal Fractures: An Observational Study. J Hand Surg Asian Pac Vol 2023; 28:369-376. [PMID: 37173145 DOI: 10.1142/s242483552350039x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: To compare the observed healthcare and societal costs of intramedullary screw (IMS) and plate fixation of extra-articular metacarpal and phalangeal fractures in a contemporary Australian context. Methods: A retrospective analysis, based on previously published data, was performed utilising information from Australian public and private hospitals, the Medicare Benefits Schedule (MBS) and the Australian Bureau of Statistics. Results: Plate fixation demonstrated longer surgical lengths (32 minutes, compared to 25 minutes), greater hardware costs (AUD 1,088 vs. AUD 355), more extended follow-up requirements (6.3 months, compared to 5 months) and higher rates of subsequent hardware removal (24% compared to 4.6%), resulting in an increased healthcare expenditure of AUD 1,519.41 in the public system, and AUD 1,698.59 in the private sector. Wage losses were estimated at AUD 15,515.78 when the fracture cohort is fixed by a plate, and AUD 13,542.43 when using an IMS - a differential of AUD 1,973.35. Conclusions: There is a substantial saving to both the health system and the patient when using IMS fixation over dorsal plating for the fixation of extra-articular metacarpal and phalangeal fractures. Level of Evidence: Level III (Cost Utility).
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Affiliation(s)
- Brahman S Sivakumar
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
- Discipline of Surgery, the Faculty of Medicine and Health, Sydney Medical School, the University of Sydney, Camperdown, NSW, Australia
| | - Darren L Vaotuua
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
| | - Luke McCarron
- Bond University Occupational Therapy Department, Robina, QLD, Australia
| | - David J Graham
- Australian Research Collaboration on Hands (ARCH), Mudgeeraba, QLD, Australia
- Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
- Griffith University School of Medicine and Dentistry, Southport, QLD, Australia
- Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Is EE, Gudek K, Oral A, Sindel D. Shedding light on work-related and non-work-related hand injuries from the social work perspective. Work 2023:WOR211146. [PMID: 36683524 DOI: 10.3233/wor-211146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Upper extremity injuries may cause not only physical but also serious social and psychological problems in workers. OBJECTIVE The aim of this study was to compare demographic and work-related features of persons with hand injuries who sustained a work-related or a non-work-related injury to gain insights into possible predisposing factors for work-related injuries as well as psychosocial consequences of hand injuries from the social work perspective. METHODS This case-control study was conducted on 30 work-related and 30 non-work-related hand injury patients. The patients were evaluated using a questionnaire designed by the authors based on the principles of social work involving demographics, work-related features, thought-emotion-behaviour features, family and friend relationships, need for family support and professional psychosocial support. Survey data from both groups were statistically analysed using descriptive statistics, Chi-square and Fisher Exact test. RESULTS When compared with the non-work-related hand injury group, the majority of the subjects of the work-related hand injury group were blue-collar workers (p = 0.003), had a lower level of education (p < 0.001), worked off-the-clock (p = 0.015), held the employer responsible for the accident (p < 0.001), needed more time to return to work (p = 0.014), were worried about the future (p = 0.045), and expressed loss of joy (p = 0.004). CONCLUSION Hand injuries, regardless of their relation to work, lead to important psychosocial problems which need to be evaluated widely and carefully focusing on the patient and patient's environment, work environment in this case.
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Affiliation(s)
- Enes Efe Is
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey
| | - Kemal Gudek
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dilsad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Assessment of the factors affecting the loss of workforce in patients with traumatic hand injury. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1186710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: This study aimed to examine the factors affecting the loss of workforce, including the time to return to work and workrelated
situations in patients with traumatic hand injury who were taken to a hand rehabilitation program.
Materials and Methods: The patients aged between 18-65 years with a history of traumatic hand injury in the last five years were
analyzed retrospectively. Demographic and clinic data were taken from the medical records, and work-related problems were obtained
by telephone calls. The severity of hand injury was assessed with Modified Hand Injury Severity Score (MHISS).
Results: A total of 147 patients (129 males, 18 females; mean age 39.83±10.4 years) were included. The duration of return to work
was correlated with total MHISS (rho=0.262 p=0.003) while not related to age, education level, gender, or injured hand’s dominance
(p>0.05). Duration of return to work after hand injury and total MHISS were lower in the patients who had job modifications
(p
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11
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Mohamad Sabri MQ, Judd J, Ahmad Roslan NF, Che Daud AZ. Hand characteristics and functional abilities in predicting return to work in adult workers with traumatic hand injury. Work 2022; 73:1245-1253. [DOI: 10.3233/wor-205164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Hand injuries affect a person’s functioning, thus impeding their abilities to return to work. There is a limited understanding in return to work of the overall predictors when including hand characteristics and functional abilities. Therefore, it is essential to identify the most relevant predictors in return to work among individuals with a hand injury. OBJECTIVES: (1) To compare hand function characteristics and functional abilities of injured workers who have or have not returned to work. (2) To estimate hand function characteristics and functional abilities as predictors to return to work. METHODS: One hundred and fifteen adult workers with hand injuries aged 18– 59 years old from five general hospitals in Malaysia participated in a cross-sectional study. Predictors were estimated using logistic regression. RESULTS: There was a significant association between occupational sector (p = 0.012), injury duration (p = 0.024), occupational performance (p = 0.009) and satisfaction with performance (p < 0.001), grip strength of injured hand (p = 0.045– 0.002) and the Disability of Arm, Shoulder and Hand (DASH) disability/symptom (p = 0.001) with the person’s return to work status. Significant predictors of return to work were identified using the Canadian Occupational Performance Measure (COPM) satisfaction’s score, DASH disability/symptoms’ score and duration of the injury. CONCLUSION: As two main predictors of return to work were COPM satisfaction and DASH disability/symptoms, occupational therapists working in rehabilitation should focus on achieving functional performance and satisfaction within the optimal time.
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Affiliation(s)
- Mohamad Qayum Mohamad Sabri
- Centre of Occupational Therapy, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), UiTM Kampus Puncak Alam, Bandar Puncak Alam, Selangor, Malaysia
| | - Jenni Judd
- School of Health Medical and Applied Sciences, Division of Higher Education, Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg Campus, Branyan, QLD, Australia
| | - Nor Faridah Ahmad Roslan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Kampus Sungai Buloh, Sungai Buloh, Selangor, Malaysia
| | - Ahmad Zamir Che Daud
- Centre of Occupational Therapy, Faculty of Health Sciences, Universiti Teknologi MARA (UiTM), UiTM Kampus Puncak Alam, Bandar Puncak Alam, Selangor, Malaysia
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12
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Bousfield K, Cheon JY, Harley S, Lampiris-Tremba A, Loseby J, Bianchi N, Barnes A, Escorpizo R. What are the Predictors of Return to Work for People With Elbow, Wrist, and Hand Conditions? A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:380-413. [PMID: 34309763 DOI: 10.1007/s10926-021-09997-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
Purpose Conditions affecting the elbow, forearm, wrist, and hand can cause debilitating pain and loss of function in the working population. While there is knowledge about intervention options for this region of the body, there is limited research on systematically identifying the predictors of return to work in this population. Methods A systematic literature review identified all English-language studies that assess predictors of return to work for people with elbow, wrist, and hand conditions from 2009 to 2021 using PRISMA guidelines. Studies that examined exclusively shoulder injuries, randomized control trials, non-human studies, case studies, case reports, case series, and narrative reviews were excluded. Participants of included studies must have a health-related condition of the fingers, wrist, forearm, and elbow that is preventing work participation and must be 16 years and older. Included studies must be observational, longitudinal, and include a return to work outcome. Results Nineteen out of 170 studies were included. Average time away from work varied between seven to 304 days. Positive predictors of early return to work include: demographics, type of injury, type of treatment, work status, physical factors, psychological factors, use of self-reported outcome measures, and self-reported pain. Conclusion Five clinician recommendations were developed based on the findings of our systematic review. Clinicians should consider the type of work, use of outcome measures, psychological factors, hospitalization, and salary. These recommendations are intended to influence the behavior of clinicians when determining prognosis for return to work of people with elbow, wrist, and hand conditions.
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Affiliation(s)
- Kayla Bousfield
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, The University of Vermont, 106 Carrigan Drive, Burlington, VT, 05452, USA
| | - Ju-Young Cheon
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, The University of Vermont, 106 Carrigan Drive, Burlington, VT, 05452, USA
| | - Sarah Harley
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, The University of Vermont, 106 Carrigan Drive, Burlington, VT, 05452, USA
| | - Amber Lampiris-Tremba
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, The University of Vermont, 106 Carrigan Drive, Burlington, VT, 05452, USA
| | - Justin Loseby
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, The University of Vermont, 106 Carrigan Drive, Burlington, VT, 05452, USA
| | - Nancy Bianchi
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, The University of Vermont, 106 Carrigan Drive, Burlington, VT, 05452, USA
| | - Andrew Barnes
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, The University of Vermont, 106 Carrigan Drive, Burlington, VT, 05452, USA
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, The University of Vermont, 106 Carrigan Drive, Burlington, VT, 05452, USA.
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13
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Teunissen JS, Feitz R, Al Shaer S, Hovius S, Selles RW, Van der Heijden B. Return to Usual Work Following an Ulnar Shortening Osteotomy: A Sample of 111 Patients. J Hand Surg Am 2022; 47:794.e1-794.e11. [PMID: 34511292 DOI: 10.1016/j.jhsa.2021.07.022] [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: 06/16/2020] [Revised: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of this study was to analyze the median time until patients performed their usual work following an ulnar shortening osteotomy (USO). The secondary aim was to identify factors influencing the median time until return to their usual work. METHODS We used a retrospective cohort of patients with ongoing data collection from our institution in the Netherlands. Patients with paid employment who underwent USO were invited to complete a return-to-work questionnaire at 6 weeks, 3 months, 6 months, and 12 months after surgery. The probability of and median time until return to usual work were assessed using an inverted Kaplan-Meier analysis. Factors influencing the return to usual work were evaluated using multivariable Cox proportional hazard regression. RESULTS In total, 111 patients who underwent USO were included, with a mean age of 46 years. The probability of returning to usual work in the first year was 92%, and the median time was 12 weeks. The type of work was independently associated with a return to work, with median times of 8, 12, and 14 weeks for light, moderate, and heavy physical work, respectively. We did not find differences in return to usual work based on age, sex, duration of complaints until surgery, treatment side, smoking status, the preoperative Patient-Rated Wrist Evaluation score, or whether the osteotomy was performed freehand or with an external cutting device. CONCLUSIONS Half of the patients that underwent USO fully performed their usual work by 12 weeks following surgery. We found that 92% of the patients performed their usual work within 1 year after surgery. We found a large variation in the time until a return to work based on the type of work. Surgeons can use this data to inform patients on the rehabilitation phase after USO. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Joris Sebastiaan Teunissen
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands.
| | - Reinier Feitz
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands
| | - Sanharib Al Shaer
- Department of Plastic Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Steven Hovius
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Hand and Wrist Center, Xpert Clinic, Amsterdam, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Brigitte Van der Heijden
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
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14
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Prevalence of Comorbid Psychiatric Conditions and Chronic Pain in Patients Seeking Peripheral Nerve Surgery. Plast Reconstr Surg Glob Open 2022; 10:e4434. [PMID: 35923982 PMCID: PMC9287277 DOI: 10.1097/gox.0000000000004434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022]
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15
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Factors affecting orthosis adherence after acute traumatic hand tendon repairs: A prospective cohort study. J Hand Ther 2022; 35:32-40. [PMID: 33250394 DOI: 10.1016/j.jht.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 09/17/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Custom-made orthoses are used to prevent contractures and reinjury of tissues such as tendon rupture after traumatic tendon repairs. Despite their wide usage in hand rehabilitation, orthosis adherence is usually an overlooked problem. PURPOSE OF THE STUDY This study aims to evaluate the possible factors affecting the orthosis adherence in patients with acute traumatic tendon repairs. STUDY DESIGN This is a prospective cohort study. METHODS Two hundred twelve patients with acute traumatic hand tendon repair were included in this prospective cohort study. Patients were evaluated on the third day postoperatively and at three weeks. All patients were told to wear their orthosis 24 h a day for three weeks and allowed to take it off to wash the hand carefully once a day. Adherence was measured as fully adherent, partially adherent, and nonadherent. Factors that may affect orthosis adherence were evaluated according to the five dimensions of the multidimensional adherence model including socioeconomic, condition-related, treatment-related, patient-related, and health-care system-related factors. The Modified Hand Injury Severity Scale was used to assess the severity of the injury. Depression and anxiety symptoms were evaluated with the Beck Depression Inventory and Beck Anxiety Inventory. A multivariate logistic regression model was constructed for orthosis adherence. RESULTS One hundred thirty-three patients were analyzed. Forty-four (33.1%) patients were fully adherent with the prescribed orthosis, whereas 67 (50.4%) were partially adherent and 22 (16.5%) were nonadherent. Higher depression symptoms caused orthosis nonadherence [odds ratio = 1.2 (95% confidence interval = 1.1-1.3), P = .001] and partial adherence [odds ratio = 1.1 (95% confidence interval = 1.0-1.2), P = .01]. CONCLUSIONS Among our patients with acute traumatic tendon repair, only one-third of the patients were fully adherent with the orthosis wear program. Depression in the very acute period of injury impaired orthosis adherence.
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Buchanan H, Van Niekerk L, Grimmer K. Work transition after hand injury: A scoping review. J Hand Ther 2022; 35:11-23. [PMID: 33250399 DOI: 10.1016/j.jht.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/20/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic scoping review. INTRODUCTION Many factors are potentially associated with successful work-related transitions following hand injury. There is no current, comprehensive review of the literature to guide clinical practice. PURPOSE OF THE STUDY To comprehensively identify the current body of research evidence supporting return to work (RTW) after hand injury and identify gaps. METHODS A systematic search identified relevant, peer-reviewed, full text, English language primary qualitative or quantitative literature published since 2006. All authors independently determined whether studies should be included, assigned them to a hierarchy of evidence and extracted data. Decisions were defended and disagreements resolved in team meetings. Literature was summarized into key themes using common intent and constructs. RESULTS Of 259 potentially-relevant articles, 38 were relevant. Study designs included prospective observational, cross-sectional, and retrospective (n=9 each), mixed methods (n=3), qualitative (n=4), and opinion pieces (n=4). There were no experimental studies. The most commonly-reported key themes were prognostic factors for RTW (25 papers) and assessment tools (18 papers). Remaining themes of impact of injury on the individual, patient perspectives, other stakeholder perspectives, healthcare provider education, and treatment were reported in fewer than 10 papers each. There was little commonality in how research was conducted or reported. Gaps included lack of information on effective interventions, which prognostic factors should be routinely measured, and which assessment and outcome items to routinely use in practice. CONCLUSION Despite the impact of hand injury on capacity to RTW, there is limited evidence to inform successful work-related transitions.
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Affiliation(s)
- Helen Buchanan
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Lana Van Niekerk
- Division of Occupational Therapy, Department of Health and Rehabilitation Science, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Karen Grimmer
- Division of Physiotherapy, Department of Health and Rehabilitation Science, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
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Bohatko-Naismith J, McCormack L, Weerasekara I, James D, Marley J. Health screening questionnaires used in the management of mental distress acquired during an injured worker's return to work: A scoping review. Work 2022; 72:75-90. [PMID: 35431195 DOI: 10.3233/wor-205027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mental distress is often endured by injured workers participating in the rehabilitation or return to work process following a physical injury. Delays in detecting the onset and treating mental distress can lead to a diverse range of cognitive and behavioural changes that may precipitate psychological distress such as anxiety, depression, and posttraumatic stress. OBJECTIVE The objective of this scoping review was to provide an overview of existing health questionnaires utilised by health care providers and affiliated researchers. It reviewed their effectiveness and suitability to detect mental distress endured by injured workers engaged in the return to work process. METHODS A scoping review methodology was conducted using the Arksey and O'Malley framework which examined peer-reviewed articles published between 2000 and March 2020 comprising health questionnaires. Database searches included Medline, CINAHL, EMBASE and PsycINFO combining specific MeSH terms and key words. RESULTS The full search identified 3168 articles. Following full screening a total of 164 articles reviewed the use of health questionnaires and specific criteria to determine their suitability. Most of the health questionnaires reviewed were used as screening measures for identifying both work and non-work-related psychological hazards. However, they were found to be limited in their application when considering all potential predictors of delayed return to work such as poor or stressful interactions with stakeholders, financial stress and the injured workers experience of the RTW process. CONCLUSION Earlier identification of mental distress using an optimal MHSQ followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, early return to work can be achieved with significant cost saving to the economy.
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Affiliation(s)
- Joanna Bohatko-Naismith
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Lynne McCormack
- School of Psychology, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
| | - Ishanka Weerasekara
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Daphne James
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Jeffrey Marley
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
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18
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Gerg MJ, Hazak KM, Carrie BR, Melendez N, Jewell VD. Non-physical factors that impact return to work in individuals with upper extremity injuries: A scoping review. Work 2022; 73:93-106. [PMID: 35871385 DOI: 10.3233/wor-211059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Upper extremity injuries may prevent adults from returning to work, impacting productivity, and engagement in meaningful employment. OBJECTIVE The scoping review identified various non-physical factors that impact return to work (RTW) after an upper extremity injury. METHODS Database searches included: CINAHL, PsycINFO, PubMed, and the Cochrane Database of Systematic Reviews. The authors further hand searched the journals Work and The Journal of Hand Therapy. Inclusion criteria included articles published in English, published from 2000-2020, and addressed the following topics: upper extremity injury, the client's psychosocial perceptions of the injury, and return to work. RESULTS After title and abstract review, 9 studies were identified for full-text review that examined various patterns related to non-physical factors that impact RTW. Three themes emerged from the full-text reviews including client self-efficacy, social determinants of health, and the need for holistic intervention approaches. CONCLUSIONS Practitioners involved in the rehabilitation of working age clients with upper extremity injuries should remain cognizant of the non-physical factors that can impact return to work and incorporate holistic approaches like monitoring and addressing self-efficacy, psychosocial well-being, and social determinants of health into clinical practice.
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Affiliation(s)
- Michael J Gerg
- Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, Phoenix, AZ, USA
- Department of Occupational Therapy, Arizona School of Health Sciences, A. T. Still University, Mesa, AZ, USA
- Department of Occupational Therapy, School of Education Human and Health Sciences, Bay Path University, Longmeadow, MA, USA
| | - Kristin M Hazak
- Department of Occupational Therapy, Arizona School of Health Sciences, A. T. Still University, Mesa, AZ, USA
- Department of Rehabilitation Services, Arizona Burn Center, Valleywise Health, Phoenix, AZ, USA
| | - Brittany R Carrie
- Department of Occupational Therapy, Arizona School of Health Sciences, A. T. Still University, Mesa, AZ, USA
| | - Naomi Melendez
- Department of Occupational Therapy, Arizona School of Health Sciences, A. T. Still University, Mesa, AZ, USA
| | - Vanessa D Jewell
- Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
- Division of Occupational Science and Occupational Therapy, Department of Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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van der Oest MJW, Teunissen JS, Poelstra R, Feitz R, Burdorf A, Selles RW, the Hand-Wrist Study Group. Factors affecting return to work after surgical treatment of trapeziometacarpal joint osteoarthritis. J Hand Surg Eur Vol 2021; 46:979-984. [PMID: 33287620 PMCID: PMC8559178 DOI: 10.1177/1753193420978631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to identify factors contributing to the timing of return to work after surgical treatment of trapeziometacarpal joint osteoarthritis and to calculate the costs of lost productivity. We included 627 patients with paid employment who underwent trapeziectomy and ligament reconstruction with tendon interposition. Time to return to work was measured through filling online questionnaires and analysed using survival analysis at 6 weeks and 3, 6 and 12 months after the surgery. Patients also filled in the Michigan Hand Outcomes Questionnaire. Costs of lost productivity were calculated using the human capital method. After 1 year, 78% of the patients returned to work. The median time to return to work was 12 weeks. Factors that significantly affected the time to return to work were occupational intensity (light, moderate or heavy physical labour), whether the dominant hand was treated and the Michigan Hand Outcomes Questionnaire work score and hand function score of the unoperated side at baseline. The costs of lost productivity were estimated at €11,000 on the patient level, resulting in €16.8 million on the Dutch population level per year.Level of evidence: II.
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Affiliation(s)
- 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
| | - Joris S. Teunissen
- Department of Plastic, Reconstructive and Hand
Surgery, Erasmus MC, Rotterdam, The Netherlands,Department of Rehabilitation Medicine, Erasmus
MC, Rotterdam, The Netherlands,Plastic Surgery, Radboud University Medical
Centre, Nijmegen, The Netherlands,Joris S. Teunissen, Department of Plastic,
Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, Doctor Molewaterplein 40, 3015 GD
Rotterdam, The Netherlands.
| | - Ralph Poelstra
- 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
| | - Reinier Feitz
- Hand and Wrist Center, Xpert Clinic, The
Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC,
Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand
Surgery, Erasmus MC, Rotterdam, The Netherlands,Department of Rehabilitation Medicine, Erasmus
MC, Rotterdam, The Netherlands
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Berduszek RJ, Reinders-Messelink HA, Dijkstra PU, van der Sluis CK. Comparison between patient-reported and physician-estimated pain and disability in hand and wrist disorders. Musculoskeletal Care 2021; 20:354-362. [PMID: 34704346 PMCID: PMC9297919 DOI: 10.1002/msc.1598] [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: 08/08/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022]
Abstract
Background Pain and disability are important components of the assessment of hand problems, but it is unknown how physician estimates compare to patient self‐reports. Objective To analyse differences between patient‐reported and physician‐estimated pain and disability in patients with hand or wrist disorders and to analyse factors influencing these differences. Methods Observational study of patients with hand or wrist disorders seen during multidisciplinary outpatient consultations. Patients, rehabilitation medicine (RM) consultants, RM trainees and plastic surgeons completed visual analogue scales (VASs) to rate the level of self‐reported (patients) or estimated (physicians) pain and disability. Multilevel analyses were performed to evaluate differences in VAS‐pain and VAS‐disability scores between patients and physicians and to evaluate the influences of diagnosis, physician experience and medical specialty. Results Complete data were obtained for 250 patients. Levels of pain and disability estimated by physicians were lower compared to patient self‐reports. Ratings differed among medical specialties. Pain was underestimated to a greater extent by plastic surgeons compared to RM consultants. Disability was underestimated to a greater extent by RM consultants compared to plastic surgeons. Estimates of pain and disability did not differ between consultants and trainees in RM. Type of diagnosis did not influence the degree of underestimation of pain and disability. Conclusions Physicians underestimate pain and disability compared to self‐reports in patients with hand or wrist disorders. Ratings differ among medical specialties: plastic surgeons underestimate pain more, while RM consultants underestimate disability more. Physician experience and diagnosis do not influence the degree of underestimation of pain and disability.
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Affiliation(s)
- Redmar J Berduszek
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Heleen A Reinders-Messelink
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Rehabilitation Center Revalidatie Friesland, Beetsterzwaag, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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21
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Pomares G, Coudane H, Dap F, Dautel G. Secondary finger amputation after a work accident. Orthop Traumatol Surg Res 2021; 107:102968. [PMID: 34033921 DOI: 10.1016/j.otsr.2021.102968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The main aim of the present study was to compare motives between patients requesting secondary finger amputation following or unrelated to a work accident. The secondary objective was to assess correlation between sick leave duration and motive for amputation following a work accident. METHOD A single-center retrospective study was conducted over an 11-year period in a hand clinic. Cases of secondary totalizing post-traumatic finger amputation at metacarpal base level were included. Exclusion criteria comprised non-traumatic amputation, age<16 years and thumb amputation. In all, 216 patients met the inclusion criteria. The main endpoints assessed motives in requests for secondary metacarpal base amputation: esthetic, functional or administrative. Secondary endpoints comprised accident-to-surgery interval, gender and age, amputated digit and dominant-side involvement. RESULTS Motive correlated significantly with gender (p<0.05). Administrative motives almost exclusively concerned males (21 males, 1 female) and predominantly concerned work accidents (19 vs. 3). Accident-to-surgery intervals were significantly longer in case of administrative motive (25.7 months, vs. 10.8 months for functional and 9 months for esthetic motives). Accident-to-surgery intervals were significantly longer in case of work accidents (15.2 vs. 9.5 months). DISCUSSION Age and gender influenced patients' attitudes in post-traumatic finger amputation. Work-accident status influenced attitudes in a quarter of cases; we consider it unlikely that this can be reduced to claims for compensation, but that it is rather a matter of undiagnosed pathological grief. These findings highlight the importance of early follow-up of victims of traumatic amputation and early screening for pathological grief.
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Affiliation(s)
| | | | - François Dap
- Pôle médico-chirurgical central, centre hospitalier universitaire de Nancy, 29, avenue Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Gilles Dautel
- Centre chirurgical Emile Gallé, 49, rue Hermite, 54000 Nancy, France
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Abstract
BACKGROUND Return to work is potentially an important factor in assessing the success of treatment. However, little is known about the return to work after treatment for Dupuytren's contracture. Therefore, the primary aim of this study was to assess return to work after limited fasciectomy and percutaneous needle fasciotomy. METHODS Patients who underwent either a limited fasciectomy or percutaneous needle fasciotomy were invited to complete a return-to-work questionnaire at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Median time to return to work was assessed using inverted Kaplan-Meier curves, and hazard ratios were calculated with Cox regression models. Finally, a cost analysis was carried out using the human capital method to determine indirect costs associated with loss of productivity. RESULTS The authors included 2698 patients in the study, of which 53 percent were employed at intake and included in the follow-up. After 1 year of follow-up, 90 percent of the patients had returned to work. Median time to return to work was 2 weeks after limited fasciectomy and within days after percutaneous needle fasciotomy. Furthermore, physically strenuous work, female sex, and higher age were associated with a longer time to return to work. Lost productivity per patient was estimated at €2614.43. CONCLUSIONS The majority of patients returned to work after treatment for Dupuytren's disease. Return to work is much faster after percutaneous needle fasciotomy compared to limited fasciectomy. These findings can be used for more evidence-based preoperative counseling with patients with Dupuytren's disease.
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Health Professionals' Perspectives on the Efficacy of Using Comprehensive Care to Improve Outcomes in Patients With Traumatic Injury. J Nurs Res 2021; 28:e126. [PMID: 32604337 PMCID: PMC7664980 DOI: 10.1097/jnr.0000000000000396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Barriers related to comprehensive posttrauma care and health outcome monitoring exist. The insights and perspectives of health professionals on this issue may help integrate care experiences to provide continuous care to patients with traumatic injury. Purpose The purpose of this study was to explore the perspectives of health professionals with regard to comprehensive care to improve the outcomes of patients with traumatic injury. Methods Data were collected at two teaching hospitals in Taiwan. In total, 28 health professionals across various disciplines were interviewed in five focus groups. Results Six themes were delineated, including “wound care is a primary concern for patients,” “ineffective health education during the hospital stay,” “patients and families worry about postinjury conditions,” “current continuity of care is not effective,” “lack of standards for discharge planning,” and “incorporation of interdisciplinary care to improve patient outcomes.” Conclusions The experiences of health professionals are useful to the establishment of a foundation for trauma case management and interdisciplinary care for hospitals.
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von Schroeder HP, Xue CR, Yak A, Gandhi R. Factors associated with unsuccessful return-to-work following work-related upper extremity injury. Occup Med (Lond) 2021; 70:434-438. [PMID: 32537651 DOI: 10.1093/occmed/kqaa106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Returning to work following occupational injury is a key outcome for both workers' compensation boards and injured workers. Predictive factors for returning remain unclear. AIMS To describe factors associated with unsuccessful return-to-work (RTW) in a hand injury population to identify target areas through which occupational rehabilitation programmes can help injured workers achieve successful RTW outcomes. METHODS Demographic data, functional, pain and psychosocial scores were recorded for injured workers discharged between April 2011 and September 2015 from a multidisciplinary upper extremity treatment programme. The primary outcome of RTW status was assessed at programme discharge. Bivariate analyses and multivariable logistic regression were used to identify factors associated with being unable to RTW. RESULTS Of 872 participants who met the inclusion criteria, 65% were male and the mean age was 46 (standard deviation [SD] 11) years. In unadjusted bivariate analyses, the group with an unsuccessful RTW outcome had higher mean baseline pain, catastrophizing and QuickDASH scores; a higher baseline prevalence of depression, and reported a high level of pain more frequently than those who were working at discharge. In the adjusted logistic regression model, not working at baseline, higher QuickDASH score and presence of depression at baseline were independently associated with unsuccessful work status outcome. CONCLUSIONS Negative baseline work status, greater self-reported functional disability and presence of depression were associated with greater odds of unsuccessful RTW following a workplace upper extremity injury. Integrating mental healthcare provision with occupational rehabilitation is a potential programmatic approach to improve RTW.
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Affiliation(s)
- H P von Schroeder
- Altum Health, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Krembil 3-435, Toronto, ON, Canada.,Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, ON, Canada.,Division of Plastic and Reconstructive Surgery, University of Toronto, 149 College Street, Room 508, Toronto, ON, Canada
| | - C R Xue
- Altum Health, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Krembil 3-435, Toronto, ON, Canada
| | - A Yak
- Altum Health, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Krembil 3-435, Toronto, ON, Canada
| | - R Gandhi
- Altum Health, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Krembil 3-435, Toronto, ON, Canada.,Division of Orthopaedic Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, ON, Canada
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Williams S, Williams J. Traumatic stress sufferers: work as therapy or trigger? MANAGEMENT RESEARCH REVIEW 2021. [DOI: 10.1108/mrr-01-2020-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
While a return to work following trauma exposure can be therapeutic, this is not always so. As with many topics related to traumatic stress in organizations, several contingency factors complicate the effort to draw an overarching conclusion about whether returning to work is therapeutic. The purpose of this paper is to present important determinants of whether work is therapeutic or triggering for those with traumatic stress conditions. The need for contingency approaches in the study of traumatic stress in organizations is illustrated.
Design/methodology/approach
Literature on traumatic stress in organizations is reviewed.
Findings
Three of the key determinants of whether a return to work is therapeutic or triggering for traumatic stress sufferers are trauma-type contingencies, condition-type contingencies and work-setting contingencies. For instance, human-caused and task-related traumas are more likely than natural disasters to make a return-to-work triggering. Additionally, the time since developing a traumatic stress condition is inversely related to the degree of improvement in that condition through the experience of working. Moreover, managerial actions can affect how therapeutic an employee’s return to work is.
Practical implications
These findings suggest the challenges of reintegrating a traumatized employee to the workplace can be highly situation-specific. Careful consideration of the traumatic event suffered by each traumatic stress victim, their traumatic stress condition, and the work setting to which they would return are recommended.
Social implications
Promoting mental health in organizations can contribute to employers’ social performance.
Originality/value
Examination of the factors that complicate predicting whether work is therapeutic posttrauma demonstrates how contingency approaches can advance research on trauma in organizations.
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Pomares G, Coudane H, Dap F, Dautel G. Traumatic upper-limb amputation: The process toward acceptance. Orthop Traumatol Surg Res 2020; 106:1419-1423. [PMID: 33077407 DOI: 10.1016/j.otsr.2020.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/27/2020] [Accepted: 06/17/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION After traumatic upper-limb amputation (TULA), one-third of patients develop traumatic pathological grief (PG). However, are the other two-thirds unscathed? The main aim of the present study was to assess the rate of TULA victims claiming to have dealt with the consequences and showing no PG. The secondary objective was to determine positive and negative factors enabling and preventing coping. METHOD A retrospective clinical study was conducted over an 11-year period in all adult TULA cases in our department. Assessment was on questionnaire. PG was assessed on the ICG (Inventory of Complicated Grief). Factors were assessed on physical, psychological, social, functional, esthetic and epidemiological criteria. Statistical analysis used StatView software, with the significance threshold set at p<0.05. RESULTS Functional and social impacts were significantly greater in case of PG. Thumb amputation was significantly associated with PG, while PG was significantly less frequent in case of amputation at the metacarpal base. Patients in PG had significantly more often undergone neuroma resection or stump revision surgery. DISCUSSION Fewer than a half of TULA victims achieved cure. Long-term prognosis depends on the patient's ability to accept the new situation, much more than on amputation level. Patients need support from the very first minutes, with follow-up extended well belong scar healing. Onset and healing of the narcissistic wound are inevitably delayed compared to skin healing.
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Affiliation(s)
- Germain Pomares
- Institut Européen de la Main - Hôpital Kirchberg, 9, rue Edward Steichen, 2540 Luxembourg.
| | - Henry Coudane
- EA 7299, ETHOS, Faculté de Médecine, Université de Lorraine, 9, avenue de la Forêt-de-Haye, 54505 Vandœuvre-lès-Nancy, France
| | - François Dap
- Service de Chirurgie de la Main, Centre Chirurgical Emile Gallé-CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
| | - Gilles Dautel
- Service de Chirurgie de la Main, Centre Chirurgical Emile Gallé-CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
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Bhatti DS, Ain NU, Fatima M. Occupational Hand-Related Injuries at a Major Tertiary Care Burn and Reconstructive Center in Pakistan. Cureus 2020; 12:e10444. [PMID: 33072454 PMCID: PMC7557523 DOI: 10.7759/cureus.10444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Work-related hand injuries are usually a consequence of mechanical force on hand. This study retrospectively investigated the occurrence of work-related hand injuries in patients belonging to different age groups, gender, educational status, occupation, etc. Methodology This cross-sectional study was conducted from October 2018 to December 2019 at the Department of Burn and Plastic Surgery, Holy Family Hospital, Rawalpindi, Pakistan. Demographic and clinical characteristics were gathered through a structured questionnaire based on relevant literature. Patients were assessed using the purposive sampling technique and written informed consent was taken from each participant. A p-value of <0.05 was considered statistically significant. Statistical tests were performed using the Statistical Package for the Social Sciences (SPSS). Results One hundred and twenty participants were interviewed, and 87.5% of patients did not have a vascular injury, and 62.5% of patients had an associated fracture. Over half of them (57.5%) had injuries of their dominant hands. Most of the injuries (67.5%) involved fingers while the rest of the injuries were found either in the palm or the dorsum of the hand. Among the causes of accidents, the majority didn't wear or wore unfitted gloves (76.6%) and the main causes of the hand injuries were related to defects in the workplace (53.3%). Lack of concentration (11.7%), wearing loose or unfitted clothes or jewelry (19.2%), lack of machine maintenance (29.2%), and a patient’s chronic disease (1.66%) were among the less frequent causes. Conclusion It is important to understand the relationship between occupational and hand injuries. It provides an insight into the lack of protection and guidance of workers.
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Affiliation(s)
- Dujanah S Bhatti
- Plastic and Reconstructive Surgery, Rawalpindi Medical University, Rawalpindi, PAK
| | - Nur U Ain
- Plastic and Reconstructive Department, Holy Family Hospital, Rawalpindi, PAK
| | - Maryam Fatima
- Burn and Reconstructive Department, Holy Family Hospital, Rawalpindi, PAK
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Philip BA, Kaskutas V, Mackinnon SE. Impact of Handedness on Disability After Unilateral Upper-Extremity Peripheral Nerve Disorder. Hand (N Y) 2020; 15:327-334. [PMID: 30417700 PMCID: PMC7225876 DOI: 10.1177/1558944718810880] [Citation(s) in RCA: 8] [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: Impairment of the dominant hand should lead to greater disability than impairment of the nondominant hand, but few studies have tested this directly, especially in the domain of upper-extremity peripheral nerve disorder. The aim of this study was to identify the association between hand dominance and standardized measures of disability and health status after upper-extremity peripheral nerve disorder. Methods: An existing database was reanalyzed to identify the relationship between affected-side (dominant vs nondominant) on individuals with unilateral upper-extremity peripheral nerve disorder (N = 400). Primary measure of disability was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: We found no differences in standardized measures of disability or health status between patients with affected dominant hand and patients with an affected nondominant hand. However, a post hoc exploratory analysis revealed that patients with an affected dominant hand reported substantially reduced ability to perform 2 activities in the DASH questionnaire: "write" and "turn a key." Conclusions: Following unilateral upper-extremity peripheral nerve disorder, impairment of the dominant hand (compared with impairment of the nondominant hand) is associated with reduced ability to perform specific activities, but this reduced ability is not reflected in standardized measures of disability and health status. To adequately identify disability following unilateral impairment of the dominant hand with the DASH, individual items must be used instead of the total score. New or alternative measures are also recommended.
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Affiliation(s)
- Benjamin A. Philip
- Washington University School of Medicine, St. Louis, MO, USA,Benjamin A. Philip, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8505, St. Louis, MO 63108, USA.
| | - Vicki Kaskutas
- Washington University School of Medicine, St. Louis, MO, USA
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Pomares G, Coudane H, Dap F, Dautel G. Psychological effects of traumatic upper-limb amputations. Orthop Traumatol Surg Res 2020; 106:297-300. [PMID: 32179019 DOI: 10.1016/j.otsr.2019.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/10/2019] [Accepted: 12/02/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The main aim of the present study was to determine the existence of pathological grief in victims of traumatic upper-limb amputation. The secondary objective was to determine risk factors for onset of pathological grief. METHOD A retrospective clinical study was conducted for an 11-year period, including all cases of traumatic upper-limb amputation in adults. Patients were assessed on a questionnaire including an adaptation of the Inventory of Complicated Grief (ICG). Risk factors were assessed on surgical, personal occupational and subjective criteria. Statistical analysis on StatView software used matched Chi2 tests for comparisons, with the significance threshold set at p<0.001. RESULTS With 1058 questionnaires sent out, the response rate was 52%; 3% of returned questionnaires were non-interpretable. Thirty-nine percent showed a state of pathological grief. Risk factors comprised lack of attempted replantation (p<0.001), isolated thumb amputation (p<0.001), and multi-digit or macro-amputation (p<0.001). Subjective esthetic blemish or the feeling of being mutilated was significantly associated with pathological grief (both p<0.001). DISCUSSION Traumatic upper-limb amputation victims incurred a risk of pathological grief (main endpoint), with identifiable risk factors (secondary endpoint). Victim accompaniment and screening for risk of pathological grief are essential to limit the psychological impact of trauma and promote social and occupational reintegration.
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Affiliation(s)
- Germain Pomares
- Institut européen de la main, hôpital Kirchberg, 9, rue Edward-Steichen, 2540 Luxembourg city, Luxembourg.
| | - Henry Coudane
- EA 7299, ETHOS, faculté de médecine, université de Lorraine, 9, avenue de la Forêt-de-Haye 54505 Vandoeuvre-lès-Nancy, France
| | - François Dap
- Service de chirurgie de la main, centre chirurgical Émile-Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
| | - Gilles Dautel
- Service de chirurgie de la main, centre chirurgical Émile-Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France
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Zink PJ, Philip BA. Cortical Plasticity in Rehabilitation for Upper Extremity Peripheral Nerve Injury: A Scoping Review. Am J Occup Ther 2020; 74:7401205030p1-7401205030p15. [PMID: 32078514 PMCID: PMC7018455 DOI: 10.5014/ajot.2020.036665] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE Poor outcomes after upper extremity peripheral nerve injury (PNI) may arise, in part, from the challenges and complexities of cortical plasticity. Occupational therapy practitioners need to understand how the brain changes after peripheral injury and how principles of cortical plasticity can be applied to improve rehabilitation for clients with PNI. OBJECTIVE To identify the mechanisms of cortical plasticity after PNI and describe how cortical plasticity can contribute to rehabilitation. DATA SOURCES PubMed and Embase (1900-2017) were searched for articles that addressed either (1) the relationship between PNI and cortical plasticity or (2) rehabilitative interventions based on cortical plastic changes after PNI. STUDY SELECTION AND DATA COLLECTIO : PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Articles were selected if they addressed all of the following concepts: human PNI, cortical plasticity, and rehabilitation. Phantom limb pain and sensation were excluded. FINDINGS Sixty-three articles met the study criteria. The most common evidence level was Level V (46%). We identified four commonly studied mechanisms of cortical plasticity after PNI and the functional implications for each. We found seven rehabilitative interventions based on cortical plasticity: traditional sensory reeducation, activity-based sensory reeducation, selective deafferentation, cross-modal sensory substitution, mirror therapy, mental motor imagery, and action observation with simultaneous peripheral nerve stimulation. CONCLUSION AND RELEVANCE The seven interventions ranged from theoretically well justified (traditional and activity-based sensory reeducation) to unjustified (selective deafferentation). Overall, articles were heterogeneous and of low quality, and future research should prioritize randomized controlled trials for specific neuropathies, interventions, or cortical plasticity mechanisms. WHAT THIS ARTICLE ADDS This article reviews current knowledge about how the brain changes after PNI and how occupational therapy practitioners can take advantage of those changes for rehabilitation.
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Affiliation(s)
- Patrick J Zink
- Patrick J. Zink, MSOT, is Occupational Therapist, Select Physical Therapy, Kansas City, MO. At the time of the study, he was Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Benjamin A Philip
- Benjamin A. Philip, PhD, is Assistant Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO;
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Izadi N, Jamshidi S, Mehrdad R, Nasibi E. Predictors of return to work in patients with occupational hand injury. HAND SURGERY & REHABILITATION 2020; 39:218-222. [PMID: 32112867 DOI: 10.1016/j.hansur.2020.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 01/19/2023]
Abstract
Work-related hand injuries are the primary cause of disability and prolonged time away from work. This prospective cohort study was conducted to determine the predictors of return to work (RTW) after traumatic work-related hand injuries. Our study included 280 patients who were referred to the Plastic and Reconstructive Center for treatment of their occupational hand injuries from July 2017 to February 2018. Several functional questionnaires were completed, and they were followed up at 1, 3 and 8 weeks. Telephone interviews were done 3 months later. Approximately half the subjects had returned to work during the first 3 months after a median time away of 57 days. No relationship was found between age, gender, marital status, hand dominance and RTW time. Nevertheless, there was correlation between RTW time with cigarette smoking, injury severity and disability. Our study findings suggest that injury severity and higher work disability scores are prognostic factors for RTW. Also, smoking was associated with later RTW, which could be the result of poor circulation and delayed healing. Employers should implement injury prevention programs with appropriate rehabilitation that takes into consideration the severity of the hand injury, and health strategies to improve unhealthy lifestyle factors such as smoking.
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Affiliation(s)
- N Izadi
- Center for Research on Occupational Disease, Tehran University of Medical Sciences, No. 226, Qods Street, Keshavarz Boulevard, 1416753955 Tehran, Iran.
| | - S Jamshidi
- Plastic and reconstructive surgery, Iran University of Medical Sciences, Tehran Hemat Highway next to Milad Tower 14496, 14535 Tehran, Iran.
| | - R Mehrdad
- Center for Research on Occupational Disease, Tehran University of Medical Sciences, No. 226, Qods Street, Keshavarz Boulevard, 1416753955 Tehran, Iran.
| | - E Nasibi
- Center for Research on Occupational Disease, Tehran University of Medical Sciences, No. 226, Qods Street, Keshavarz Boulevard, 1416753955 Tehran, Iran.
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Dębski T, Noszczyk BH. Epidemiology of complex hand injuries treated in the Plastic Surgery Department of a tertiary referral hospital in Warsaw. Eur J Trauma Emerg Surg 2020; 47:1607-1612. [PMID: 32025767 PMCID: PMC8476384 DOI: 10.1007/s00068-020-01312-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Abstract
Background Trauma to the hand is common and potentially serious, impairing daily living and general quality of life. Patients are often unable to work for several months, with hand function improving only gradually. Here, we review the epidemiology of hand injuries treated at a tertiary referral hospital in Warsaw, Poland. Material and methods In this single-centre, retrospective study, we reviewed medical records of patients presenting to the A&E Unit of the Plastic Surgery Department, Centre of Postgraduate Medical Education in Warsaw, Poland, between January 2001 and December 2005. We assessed a number of patient and injury characteristics, including severity, scored with the Hand Injury Severity Scoring System (HISS), and time off work. Results Of 1091 patients with a hand injury, 84% were male and over half were under the age of 40 years. Hand injury commonly resulted in tendon damage (56.1%), especially to finger flexors (79%), and in skin loss (37.8%). Amputations occurred in 24.1% of cases, while fractures (9.6%) and nerve (6.1%) or joint (5.5%) damage were less common. HISS-graded injury severity was moderate in 28.6% of cases, over half of the patients suffered severe (25.5%) or major (26.5%) injuries, and minor injuries were relatively uncommon (19.4%). Conclusions Amongst patients admitted to our Department, the most common injuries were tendon damage, skin loss, and amputations. Over half of the patients presented with severe or major injuries and took six months or longer to return to work, suggesting they were likely to face substantial social and economic consequences of their injury. Level of evidence IV: retrospective series.
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Affiliation(s)
- Tomasz Dębski
- Department of Plastic Surgery, Medical Center of Postgraduate Education, Orlowski Memorial Hospital, Czerniakowska 231 Street, 00-416, Warsaw, Poland.
| | - Bartłomiej Henryk Noszczyk
- Department of Plastic Surgery, Medical Center of Postgraduate Education, Orlowski Memorial Hospital, Czerniakowska 231 Street, 00-416, Warsaw, Poland
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Functional outcomes after flexor tendon repair of the hand. Turk J Phys Med Rehabil 2019; 65:318-326. [PMID: 31893268 DOI: 10.5606/tftrd.2019.2137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 09/30/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate the hand function after flexor tendon repair (FTR) and to investigate factors associated with functional outcomes. Patients and methods Between January 2013 and September 2015, a total of 126 patients (84 males, 42 females; mean age 31 years; range, 15 to 62 years) who underwent FTR due to flexor tendon injuries (FTIs) were included. The hand function was assessed using the Jebsen Hand Function Test (JHFT) and Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) at three and six months following FTR. Results Of the patients, 94 (75%) and 72 (56%) completed the three-month and six-month assessment visits, respectively. A total of 65 patients (51.1%) had both three and six-month follow-up data. The patients regained a fair amount of power grip strength and more than half of their pinch grip strength compared to the unaffected hand. The results of assessment of hand function at activity and participation levels (JHFT and Quick DASH) showed slightly higher levels of disability. Of 41 patients who were employed prior to injury, 29 (71%) returned to work at six months after surgery. Zone IV injury and language barrier were associated with poor functional outcomes at six months. Conclusion Our study results showed that the JHFT and Quick DASH scores of the patients were less than the established norms, although functional outcomes improved over time. Based on these results, we suggest that the presence of zone IV FTI and language barrier are associated with poor functional outcomes.
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Uys ME, Buchanan H, Van Niekerk L. Strategies occupational therapists employ to facilitate work-related transitions for persons with hand injuries: a study protocol for a scoping review. BMJ Open 2019; 9:e027402. [PMID: 30975685 PMCID: PMC6500360 DOI: 10.1136/bmjopen-2018-027402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Hands make it possible to be employable and productive, to communicate non-verbally and to perform fine motor tasks required in day-to-day activities. Sustaining a hand injury can be detrimental to function including the ability to work. As the literature on work-related transitions is scattered across a range of journals, it is difficult to get a sense of how much literature there is, what is known and where the gaps lie. This scoping study will provide a single source of up-to-date evidence to inform health professionals about the strategies occupational therapists employ to facilitate work-related transitions for people with hand injuries. METHODS AND ANALYSIS The methodological framework by Arksey and O'Malley (2005) will form the structure of the scoping review. The search strategy has been developed in collaboration with a subject librarian. The following databases will be searched: EBSCOhost including only Medline, CINAHL and Health Source: Nursing/Academic Edition; PubMed, Scopus, The Cochrane library and Web of Science. Reference lists will be examined, and grey literature sources will be searched to ensure that literature missed in the database searches is included. Covidence will be used to manage the project. Full-texts will be uploaded for literature that meets the inclusion criteria. A process of blind review will be used to ensure that consistency and rigour is upheld. ETHICS AND DISSEMINATION The findings of the scoping review will be disseminated in an article, within 2019, to be published in a peer-reviewed journal. The findings will be presented at conferences to ensure the optimal dissemination of the scoping review's conclusions.
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Affiliation(s)
- Michelle Elizabeth Uys
- Occupational Therapy, Stellenbosch University Department of Medicine, Cape Town, South Africa
- Occupational Therapy, University of Cape Town Department of Health and Rehabilitation, Cape Town, Western Cape, South Africa
| | - Helen Buchanan
- Health & Rehabilitation Sciences, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
| | - Lana Van Niekerk
- Occupational Therapy, Stellenbosch University Department of Medicine, Cape Town, South Africa
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Return-to-Work Barriers Among Manual Workers After Hand Injuries: 1-Year Follow-up Cohort Study. Arch Phys Med Rehabil 2019; 100:422-432. [DOI: 10.1016/j.apmr.2018.07.429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/15/2018] [Accepted: 07/06/2018] [Indexed: 11/23/2022]
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Neutel N, Houpt P, Schuurman AH. Prognostic factors for return to work and resumption of other daily activities after traumatic hand injury. J Hand Surg Eur Vol 2019; 44:203-207. [PMID: 30466378 PMCID: PMC6344984 DOI: 10.1177/1753193418812645] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to investigate prognostic factors for the time off work, the time to resumption of activities of daily living and hobbies, and duration of complaints in patients with a traumatic hand or wrist injury. In a 10-month longitudinal prospective cohort study, 383 patients were included and interviewed in person every 2 to 3 months. Several sociodemographic, psychological and work-related prognostic factors were investigated. For the time off work, job type, diagnosis, complication, blaming someone else for the trauma and gender were all found to be individual prognostic factors in Cox regression. For the time to resumption of activities of daily living and hobbies, and duration of complaints, gender, diagnosis, treatment and complications were found to be prognostic factors in univariate analysis. Age was solely correlated with resumption of activities of daily living and the duration of complaints. Considering these prognostic factors can help predict a patient's recovery more accurately. Level of evidence: II.
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Affiliation(s)
- Niels Neutel
- UMC Utrecht, Department of Plastic Surgery, Utrecht, The Netherlands,Niels Neutel, Department of Plastic Surgery, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Peter Houpt
- Isala Zwolle, Department of Plastic Surgery, Zwolle, The Netherlands
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Eisele A, Dereskewitz C, Kus S, Oberhauser C, Rudolf KD, Coenen M. Factors affecting time off work in patients with traumatic hand injuries-A bio-psycho-social perspective. Injury 2018; 49:1822-1829. [PMID: 30054047 DOI: 10.1016/j.injury.2018.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
Hand injuries are common and can result in a long time off work. To analyse and identify factors affecting time of work, a holistic view on patients is needed. World Health Organization's International Classification of Functioning, Disability and Health (ICF) with its bio-psycho-social perspective provides such a holistic view. The purpose of this study is to analyse time off work in patients with traumatic hand injuries and to identify factors affecting time off work from a bio-psycho-social perspective. We used factors derived from the ICF Core Set for Hand Conditions to predict time off work by applying Cox regression analyses and Kaplan-Meier method using data of a multicentre prospective study in nine German Level 1 hand trauma centres. In total, 231 study participants with a broad range of hand injuries were included. From these, 178 patients (77%) returned to work within 200 days. Impairments in mobility of joint functions and sensory functions related to temperature and other stimuli as well as higher hand strain at work led to extended time off work. Gender, fine hand use and employment status additionally influenced time off work in sub-models. Our results demonstrate that a bio-psycho-social perspective is recommended when investigating time off work.
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Affiliation(s)
- A Eisele
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health und Health Services Research, Research Unit for Biopsychosocial Health, Pettenkofer School of Public Health, Ludwig-Maximilians-Universität (LMU) München, Germany
| | - C Dereskewitz
- Department of Hand Surgery, Plastic and Microsurgery, BG Trauma Hospital, Hamburg, Germany
| | - S Kus
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health und Health Services Research, Research Unit for Biopsychosocial Health, Pettenkofer School of Public Health, Ludwig-Maximilians-Universität (LMU) München, Germany; ICF Research Branch - a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Germany
| | - C Oberhauser
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health und Health Services Research, Research Unit for Biopsychosocial Health, Pettenkofer School of Public Health, Ludwig-Maximilians-Universität (LMU) München, Germany; ICF Research Branch - a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Germany
| | - K-D Rudolf
- Department of Hand Surgery, Plastic and Microsurgery, BG Trauma Hospital, Hamburg, Germany
| | - M Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair for Public Health und Health Services Research, Research Unit for Biopsychosocial Health, Pettenkofer School of Public Health, Ludwig-Maximilians-Universität (LMU) München, Germany; ICF Research Branch - a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Germany.
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Chown G, Beckwold M, Chernosky H, Lozoskie J, Yerkes A. The Use of Psychosocial Services Post Hand and Upper Limb Injury and Trauma: A Pilot Study. Hand (N Y) 2018; 13:529-537. [PMID: 28877603 PMCID: PMC6109901 DOI: 10.1177/1558944717725373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research demonstrates that hand injuries may cause psychological difficulties. To enhance recovery, therapists must provide appropriate referrals. The purpose of this study was to explore the use of psychosocial services by occupational therapists (OTs) and certified hand therapists (CHTs) post hand and upper limb injury or trauma. METHODS A quantitative survey design was implemented using a self-made questionnaire, which consisted of questions regarding demographic information, types and frequency of hand and upper limb injuries, psychiatric diagnoses, frequency of psychosocial service referrals, frames of references used, types of psychosocial assessments and interventions employed, and barriers to psychosocial services. The questionnaire was randomly distributed to 29 therapists. RESULTS The most frequently recorded frame of reference was the Biomechanical. Only 17.2% participants implemented psychosocial assessments. Sixteen of the 29 participants referred to 9 possible psychosocial services; however, majority of referrals were "occasionally." OTs specialized in mental health, behavioral specialists, and social workers were recorded with the least amount of referrals. A Spearman rank correlation found a weak, but significant inverse relationship between referrals by therapists and years of experience as an OT or CHT (-0.322 and -0.351, P < .05, respectively). CONCLUSIONS Therapists appear to be biomechanically oriented which may impact outcomes. An inverse correlation was found where the less experience participants had, the more likely they were to refer to psychosocial services. The results emphasized the lack of psychosocial assessments, interventions, and referral services being used by therapists. Further education to therapists, third parties, and other health professionals is warranted.
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Ladds E, Redgrave N, Hotton M, Lamyman M. Systematic review: Predicting adverse psychological outcomes after hand trauma. J Hand Ther 2018; 30:407-419. [PMID: 28237074 DOI: 10.1016/j.jht.2016.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION AND PURPOSE OF THE STUDY After traumatic hand injury, extensive physical and psychological adaptation is required following surgical reconstruction. Recovery from injury can understandably be emotionally challenging, which may result in impaired quality of life and delayed physical recovery. However, the evidence base for identifying high-risk patients is limited. METHODS A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present), PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting psychological outcomes after acute hand trauma. Subsequent review and selection by 2 independent reviewers identified 19 studies for inclusion. These were poor quality level 2 prognostic studies, cross sectional or cohort in design, and varied widely in methodology, sample sizes, diagnostic methods, and cutoff values used to identify psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires used to identify them were extracted and analyzed. RESULTS Patients with amputations or a tendency to catastrophize suffered highest pain ratings. Persisting symptom presence at 3 months was the best predictor of chronicity. Many different questionnaires were used for symptom detection, but none had been specifically validated in a hand trauma population of patients. Few studies assessed the ability of selection tools to predict patients at high risk of developing adverse psychological outcomes. DISCUSSION AND CONCLUSION Despite a limited evidence base, screening at 3 months may detect post-traumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Emma Ladds
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| | - Nathalie Redgrave
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Matthew Hotton
- Department of Psychological Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Michael Lamyman
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Bai Z, Song D, Deng H, Li-Tsang CWP. Predictors for return to work after physical injury in China: A one-year review. Work 2018; 60:319-327. [PMID: 29865101 DOI: 10.3233/wor-182735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several studies have explored the factors influencing patients' return to work (RTW) status. However, only few studies have tried to explore the predictors for RTW in subpopulations in terms of different levels of disability, particularly in the Chinese population. OBJECTIVE This study describes the trends in patient's RTW and explores the predictors associated with RTW for patients with work-related injury in Mainland China. METHODS A total of 457 patients with different types of injury were followed up for one year. Patients were stratified into three groups according to the grade of disability as follows: mild, moderate, and severe. Variables affecting RTW were then compared between the three groups, and multiple logistic regression was performed to identify the predictors for RTW. RESULTS The RTW rates during the study period were significantly different among the three groups. RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. For the mild disability group, educational level, expectation to RTW, and other types of injury (e.g., spinal cord injury, traumatic brain injury, and burn) were significant predictors for RTW. White-collar work and better employer satisfaction were positive predictors for RTW for the moderate group. Meanwhile, no significant predictor for RTW was determined for the severe disability group. CONCLUSIONS RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. The predictors for RTW also varied among the patients with different levels of disability. These predictors may help vocational rehabilitation service providers provide more accurate intervention.
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Affiliation(s)
- Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.,Department of Occupational Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), China
| | - Danyang Song
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Huan Deng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Cecilia W P Li-Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
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Gyer G, Michael J, Inklebarger J. Occupational hand injuries: a current review of the prevalence and proposed prevention strategies for physical therapists and similar healthcare professionals. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018. [DOI: 10.1016/j.joim.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pélissier C, Fort E, Fontana L, Charbotel B, Hours M. Factors associated with non-return to work in the severely injured victims 3 years after a road accident: A prospective study. ACCIDENT; ANALYSIS AND PREVENTION 2017; 106:411-419. [PMID: 28728063 DOI: 10.1016/j.aap.2017.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/07/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Road accidents may impact victims' physical and/or mental health and socio-occupational life, particularly the capacity to return to work. The purpose of our study is to assess modifiable medical and socio-occupational factors of non-return to work in the severely injured 3 years after a road accident. Among1,168 road accidents casualties in the Rhône administrative Département of France followed for five years, 141 of the 222 severely injured (Maximal Abbreviated Injury Scale ≥ 3) aged more than 16 years who were in work at the time of the accident, reported whether they had returned to work in the 3 years following the accident. The subgroups of those who had (n=113) and had not returned to work (n=28) were compared for socio-occupational (gender, age, educational level, marital status, socio-occupational group) accident-related medical factors (type of road user, type of journey, responsibility in the accident, initial care) and post-accident medical factors (pain intensity, post-traumatic stress disorder, physical sequelae, quality of life) by using standardized tools. Severity of initial head, face and lower-limb injury, intense persistent pain, post-traumatic stress disorder, poor self-assessed quality of life and health status at 3 years were associated with non-return to work on univariate analysis. On multivariate analysis, severity of initial head and lower-limb injury, intense persistent pain at 3 years and post-traumatic stress disorder were significantly associated with non-return to work 3 years following severe road-accident injury. Post-traumatic stress disorder and chronic pain were essential modifiable medical determinants of non-return to work in the severely injured after a road accident: early adapted management could promote return to work in the severely injured. Improve early adapted treatment of pain and PTSD in the rehabilitation team should help the severely injured return to work following a road accident.
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Affiliation(s)
- C Pélissier
- Université de Lyon, Université Lyon 1, Université de St Etienne, IFSTTAR, UMRESTTE, UMR_T9405, 42005 Saint Etienne, France; Service de Santé au Travail, CHU de Saint-Etienne, France.
| | - E Fort
- Université de Lyon, Université Lyon 1, IFSTTAR, UMRESTTE, UMR_T9405, F-69373 Lyon, France
| | - L Fontana
- Université de Lyon, Université Lyon 1, Université de St Etienne, IFSTTAR, UMRESTTE, UMR_T9405, 42005 Saint Etienne, France; Service de Santé au Travail, CHU de Saint-Etienne, France
| | - B Charbotel
- Université de Lyon, Université Lyon 1, IFSTTAR, UMRESTTE, UMR_T9405, F-69373 Lyon, France; Hospices Civils de Lyon, Service de Santé au Travail, France
| | - M Hours
- Univ Lyon, IFSTTAR, Univ Lyon 1, UMRESTTE, UMR_T9405, F-69675 Bron, France
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Kendrick D, Dhiman P, Kellezi B, Coupland C, Whitehead J, Beckett K, Christie N, Sleney J, Barnes J, Joseph S, Morriss R. Psychological morbidity and return to work after injury: multicentre cohort study. Br J Gen Pract 2017; 67:e555-e564. [PMID: 28630058 PMCID: PMC5519127 DOI: 10.3399/bjgp17x691673] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/22/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The benefits of work for physical, psychological, and financial wellbeing are well documented. Return to work (RTW) after unintentional injury is often delayed, and psychological morbidity may contribute to this delay. The impact of psychological morbidity on RTW after a wide range of unintentional injuries in the UK has not been adequately quantified. AIM To quantify the role of psychological factors, including anxiety, depression, and post-traumatic distress, on RTW following unintentional injuries. DESIGN AND SETTING A longitudinal multicentre prospective study was undertaken in Nottingham, Bristol, Leicester, and Guildford, UK. METHOD Participants (n = 273) were 16-69-year-olds admitted to hospital following unintentional injury, who were in paid employment prior to injury. They were surveyed at baseline, then at 1, 2, 4, and 12 months following injury; demographic data were collected along with injury characteristics, psychological morbidity, and RTW status. Associations between demographic, injury and psychological factors, and RTW between 2 and 12 months after injury were quantified using random effects logistic regression. RESULTS The odds of RTW between 2 and 12 months after injury reduced as depression scores early in the recovery period (1 month after injury) increased (odds ratio [OR] 0.87, 95% confidence interval [CI] = 0.79 to 0.95) and as length of hospital stay increased (OR 0.91, 95% CI] = 0.86 to 0.96). For those experiencing threatening life events following injury (OR 0.27, 95% CI = 0.10 to 0.72) and with higher scores on the Crisis Support Scale (OR 0.93, 95% CI] = 0.88 to 0.99), the odds of RTW between 2 and 12 months after injury were lower. Multiple imputation analysis found similar results, but those relating to crisis support did not remain statistically significant. CONCLUSION Primary care professionals can identify patients at risk of delayed RTW who may benefit from management of psychological morbidity and support to RTW.
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Affiliation(s)
- Denise Kendrick
- School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham
| | - Paula Dhiman
- Research Design Service East Midlands, Queen's Medical Centre, Nottingham
| | - Blerina Kellezi
- Department of Psychology, Nottingham Trent University, Nottingham
| | - Carol Coupland
- School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham
| | - Jessica Whitehead
- School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham
| | | | - Nicola Christie
- Centre for Transport Studies, University College London, London
| | | | - Jo Barnes
- Loughborough Design School, Loughborough University, Loughborough
| | - Stephen Joseph
- School of Education, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham
| | - Richard Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham
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khodadadi-hassankiadeh N, Dehghan-Nayeri N, Shahsavari H, Yousefzadeh-Chabok S, Haghani H. Psycho-social and Mental Variables and Post-Traumatic Stress Disorder in Traffic Accident Survivors in Northern Iran. Bull Emerg Trauma 2017; 5:197-205. [PMID: 28795065 PMCID: PMC5547208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/08/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE To assess the psycho-social and mental variables associated with post-traumatic stress disorder (PTSD) in a series of Iranian patients. METHODS A total of 528 eligible accident survivors in pre-sampling of a randomized controlled trial targeting PTSD were included in this cross-sectional study. Psycho-social characteristics associated to PTSD were explored in these survivors in an outpatient clinic. They completed the questionnaires via interview between six weeks to six months after accident. Data collection tools were PSS (DSM-V version) for PTSD and BDI-II for depression and a researcher-made questionnaire for psycho-social variables. RESULTS There was a significant association between PTSD and the following variables; family communication, current depression, return to work, history of death of relatives, witnessed the death, length of amnesia, hospitalization, injured situation, and accident severity. Multivariate logistic regression indicated that some variables were associated with PTSD such as accident severity, (p<0.001), injured situation, (p<0.001), current depression, (p<0.001), RTW (p<0.001), and family communication (p=0.01). CONCLUSION Psychiatric nursing prevention efforts is best directed toward motorcycle depressed drivers with severe accident and poor family communication who do not return to work. Thus, routine assessment of PTSD, depression and psycho-social variables after traffic accidents must be taken into account.
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Affiliation(s)
| | - Nahid Dehghan-Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Shahsavari
- School of Nursing and Midwifery. Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Yousefzadeh-Chabok
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran.
- Neuroscience Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Haghani
- Department of Biostatistics, School of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
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Miller C, Peek AL, Power D, Heneghan NR. Psychological consequences of traumatic upper limb peripheral nerve injury: A systematic review. HAND THERAPY 2016. [DOI: 10.1177/1758998316679387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction Traumatic upper limb peripheral nerve injuries significantly impact individuals’ function and ability to return to work. Patients with peripheral nerve injury experience ongoing psychological impairments for which they are not routinely treated. The aim of this review was to investigate the psychological consequences of traumatic upper limb peripheral nerve injury. Methods A systematic review of MEDLINE, Embase, PsycINFO, CINAHL, AMED, BNI, the Cochrane libraries and grey literature up to October 2015 was undertaken. Two reviewers independently assessed methodological quality in accordance with Cochrane Collaboration recommendations. Eligibility criteria comprised: adults or adolescents with traumatic upper limb peripheral nerve injury using any measurement of psychological well-being. Results Six studies ( n = 245) met the inclusion criteria. Methodological quality varied widely. Evidence of post-traumatic stress disorder at one month, which decreased over time, was reported in three studies. Two studies found a statistically significant correlation between the early presence of post-traumatic stress disorder and reduction in function at 12 or more months. Limited information was available on anxiety, depression and mental quality of life. Combined nerve injuries (in two studies) had significantly higher levels of post-traumatic stress disorder, at one month, compared to those with an isolated nerve injury. Conclusion There is some evidence of early post-traumatic stress disorder following traumatic upper limb peripheral nerve injury, which may have an impact on functional outcome. However, high-quality studies using prospective cohorts are required to further evaluate the psychological aspects associated with this traumatic injury.
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Affiliation(s)
- Caroline Miller
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Dominic Power
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Liu H, Regmi S, He Y, Hou R. Thumb Tip Defect Reconstruction Using Neurovascular Island Pedicle Flap Obtained From Long Finger. Aesthetic Plast Surg 2016; 40:755-60. [PMID: 27357635 DOI: 10.1007/s00266-016-0674-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/15/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Thumb tip reconstruction has been a very challenging issue for hand surgeons. Varieties of reconstructive options have been described or modified to obtain satisfactory sensory recovery. However, none has yielded entirely satisfactory results. This study reports a retrospective review of clinical data records of patients treated with a neurovascular island pedicle flap obtained from the medial aspect of the long finger. METHODS We enrolled 15 patients (9 men and 6 women), who received neurovascular island pedicle flaps for thumb tip amputations between December 2011 and December 2015. The average size of the flap was 2.8 × 2.2 cm(2) (range 2.5 × 1.8 cm(2) to 3.5 × 2.5 cm(2)). At the final follow-up visits, static two-point discrimination, visual analogue scale, Michigan hand outcome questionnaire and return-to-work time were used to evaluate surgical outcomes. RESULTS All flaps survived well. The follow-up period was 18 months. The mean static 2PD values at the reconstructed thumb tip and donor finger pulp (medial side) were 5.3 mm (range 4-8 mm) and 3.2 mm (range 3-4 mm), respectively. The average VAS scores for the aesthetic appearance of the donor site and recipient site were 9.1 (range 8-10) and 9.0 (range 8-9.5), respectively. The average Michigan Hand Outcome Questionnaire (MHOQ) score for hand function (reconstructed hand) was 8.2 (range 6-16). The average RTW time was 8.4 weeks (range 7-12 weeks). CONCLUSIONS Neurovascular island pedicle flap obtained from the medial aspect of long finger is a very reliable alternative technique for thumb tip defect reconstruction. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Hongjun Liu
- Department of Hand and Foot Surgery, Rui Hua Hospital, Affiliated hospital of Suzhou University, 5 Tayun Road, Yuexi Town, Wuzhong District, Suzhou, 215104, Jiangsu, People's Republic of China
- Department of Hand and Foot surgery, Subei People's Hospital, Affiliated hospital of Yangzhou University, Yangzhou, Jiangsu, People's Republic of China
| | - Subhash Regmi
- College of Medicine, Yangzhou University, Yangzhou, Jiangsu, People's Republic of China
| | - Yanyan He
- Department of Hand and Foot surgery, Subei People's Hospital, Affiliated hospital of Yangzhou University, Yangzhou, Jiangsu, People's Republic of China
| | - Ruixing Hou
- Department of Hand and Foot Surgery, Rui Hua Hospital, Affiliated hospital of Suzhou University, 5 Tayun Road, Yuexi Town, Wuzhong District, Suzhou, 215104, Jiangsu, People's Republic of China.
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Peters SE, Johnston V. Methods and tools used by healthcare professionals to identify barriers to return-to-work for workers with upper extremity conditions in Australia. HAND THERAPY 2016. [DOI: 10.1177/1758998316665058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Healthcare professionals, including hand therapists, are frequently called upon to identify barriers to return-to-work for workers with upper extremity injuries. However, the methods and tools used to assess barriers to return-to-work remain unknown. Results from these assessments can be used to direct appropriate interventions for those who may be at risk of a prolonged work absence. Methods The purpose of this study was to identify the tools and methods used by healthcare professionals to assess barriers to return-to-work for workers with upper extremity conditions. A total of 596 Australian healthcare professionals responded to an open-ended question regarding the tools/methods they use to identify barriers to return-to-work. All responses were coded and analysed descriptively. Differences between professional disciplines were recorded. Results Healthcare professionals nominated 59 types of tools and methods that they use to identify barriers to return-to-work for workers with upper extremity conditions in their clinical practice. The most favoured method was clinical interviewing. Other commonly used tools were clinical measures, e.g., strength, and a return-to-work risk-factor screening tool validated on musculoskeletal diagnoses, the Orebro Musculoskeletal Screening Questionnaire. Discussion Healthcare professionals use a variety of methods and tools to identify barriers to return-to-work for workers with upper extremity conditions. Generally, they favoured subjective methods. Future research is needed to develop or validate assessment tools designed to identify barriers to return-to-work for workers with upper extremity conditions. In the absence of upper extremity specific screening tools, hand therapists should consider the biopsychosocial framework when evaluating barriers to return-to-work.
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Affiliation(s)
- Susan E Peters
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Queensland, Australia
| | - Venerina Johnston
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
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Wu TY, Yu WH, Huang CY, Hou WH, Hsieh CL. Rasch Analysis of the General Self-Efficacy Scale in Workers with Traumatic Limb Injuries. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:332-339. [PMID: 26614307 DOI: 10.1007/s10926-015-9617-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Purpose The purpose of this study was to apply Rasch analysis to examine the unidimensionality and reliability of the General Self-Efficacy Scale (GSE) in workers with traumatic limb injuries. Furthermore, if the items of the GSE fitted the Rasch model's assumptions, we transformed the raw sum ordinal scores of the GSE into Rasch interval scores. Methods A total of 1076 participants completed the GSE at 1 month post injury. Rasch analysis was used to examine the unidimensionality and person reliability of the GSE. The unidimensionality of the GSE was verified by determining whether the items fit the Rasch model's assumptions: (1) item fit indices: infit and outfit mean square (MNSQ) ranged from 0.6 to 1.4; and (2) the eigenvalue of the first factor extracted from principal component analysis (PCA) for residuals was <2. Person reliability was calculated. Results The unidimensionality of the 10-item GSE was supported in terms of good item fit statistics (infit and outfit MNSQ ranging from 0.92 to 1.32) and acceptable eigenvalues (1.6) of the first factor of the PCA, with person reliability = 0.89. Consequently, the raw sum scores of the GSE were transformed into Rasch scores. Conclusions The results indicated that the items of GSE are unidimensional and have acceptable person reliability in workers with traumatic limb injuries. Additionally, the raw sum scores of the GSE can be transformed into Rasch interval scores for prospective users to quantify workers' levels of self-efficacy and to conduct further statistical analyses.
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Affiliation(s)
- Tzu-Yi Wu
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan
| | - Wan-Hui Yu
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan
| | - Chien-Yu Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Shiujou Rd, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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Regmi S, Gu JX, Zhang NC, Liu HJ. A Systematic Review of Outcomes and Complications of Primary Fingertip Reconstruction Using Reverse-Flow Homodigital Island Flaps. Aesthetic Plast Surg 2016; 40:277-83. [PMID: 26913519 DOI: 10.1007/s00266-016-0624-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fingertip reconstruction using reverse-flow homodigital island flaps has been very popular over the years. However, the outcomes of reconstruction have not been clearly understood. In these circumstances, a systematic review of available literature is warranted. OBJECTIVE To assess the outcomes and complications of fingertip reconstruction using reverse-flow homodigital island flaps. To justify the usage of reverse-flow homodigital island flaps for fingertip reconstruction. SEARCH METHODS A PubMed [MEDLINE] electronic database was searched (1985 to 15 April 2015). SELECTION/ELIGIBILITY CRITERIA Retrospective case series that met the following criteria were included: (1) Study reported primary data; (2) Study included at least five cases of fingertip defects treated using reverse-flow homodigital island flaps; (3) Study reported outcomes and complications of fingertip reconstruction, either primary or delayed, using reverse-flow homodigital island flaps; (4) The study presented at least one of the following functional outcomes: Static two-point discrimination, return-to-work time, range of motion of distal interphalangeal joints; (5) The study presented at least one complication. DATA COLLECTION AND ANALYSIS Two review authors independently assessed search results, and two other review authors analyzed the data and resolved disagreements. The following endpoints were analyzed: survival rate of the flap, sensibility, and functional outcomes and complications. MAIN RESULT Eight studies were included in this review. The included studies were published between 1995 and 2014, and a total of 207 patients with 230 fingertip defects were reported. The overall survival rate of the flap was 98 % (including partial survival). The mean static two-point discrimination (2PD) was 7.2 mm. The average range of motion of the DIP joint was 63°. The average return-to-work time was 7 weeks after injury. On average, 2 % of the patient had complete flap necrosis, 5 % had partial flap necrosis, 4 % developed venous congestion, 4 % developed flexion contracture, and 12 % experienced mild-to-moderate cold intolerance. AUTHORS' CONCLUSIONS Survival of reconstructed fingertips (98 %) is better with reverse-flow homodigital island flaps than fingertip replantation (86 %). The sensibility outcome using sensate flaps (mean s2PD = 7.2 mm) is similar to the sensibility outcome following replantation (mean s2PD = 7 mm). The common complications include cold intolerance, venous congestion, and flexion contracture. Therefore, reverse-flow homodigital island flaps may not be the ideal choice but are a very reliable alternative for fingertip reconstruction. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Hebert JS, Burger H. Return to Work Following Major Limb Loss. HANDBOOKS IN HEALTH, WORK, AND DISABILITY 2016. [DOI: 10.1007/978-1-4899-7627-7_28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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