Sickness absence after carpal tunnel release: a multicentre prospective cohort study

Work Participation in Patients With Carpal Tunnel Syndrome Referred to Departments of Occupational Medicine-A Danish Register-Based Cohort Study

BACKGROUND

We describe long-term work participation of patients with carpal tunnel syndrome (CTS) referred to Danish departments of occupational medicine and compare to patients with contact dermatitis.

METHODS

One thousand seven hundred and sixty CTS-patients were included in this register-based nationwide longitudinal follow-up study and compared to 3158 contact dermatitis patients. We extracted register data on public benefits 5 years before and after assessment at a department of occupational medicine between 2000 and 2013. We defined a work participation score (WPS) as weeks where the patient was working divided by number of potential work weeks per year, dichotomized into low and high at the 75th percentile. We analyzed the risk of low WPS and of receiving permanent health-related public benefits during follow-up.

RESULTS

Before assessment, both CTS and contact dermatitis patients had high work participation. In the follow-up period work participation decreased permanently for both patient groups. Comparing women with CTS to women with contact dermatitis, odds ratios (OR) of low WPS were 2.56 (2.11-3.11) and 1.68 (1.38-2.05) one and 5 years after assessment. For men, OR of low WPS were 2.01 (95% CI, 1.67-2.44) and 1.27 (95% CI, 1.04-1.56). ORs of receiving permanent health-related public benefits during follow-up were 2.10 (95% CI, 1.56-2.83) for men and 1.97 (95% CI, 1.54-2.54) for women with CTS compared to those with contact dermatitis.

CONCLUSIONS

Patients referred to Danish departments of occupational medicine due to CTS have increased risk of reduced long-term work participation and of receiving permanent health-related public benefits compared to patients referred due to contact dermatitis.

Occupational and non-occupational risk factors correlating with the severity of clinical manifestations of carpal tunnel syndrome and related work disability among workers who work with a computer

The contribution of certain occupational and personal factors to the development of carpal tunnel syndrome (CTS) is still uncertain. We investigated which specific occupational and non-occupational factors correlate with the level of clinical manifestations and work disability related to CTS. The study included 190 workers who work with a computer and have diagnosed CTS (100 men, 90 women, aged 20-65 years). Subjective experience of CTS-related impairments was assessed with the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). The objective, neural impairments were tested with electrodiagnostics (EDX), whereas CTS-related work disability data were collected from medical records. We found a high inter-correlation between BCTQ, EDX, and work disability data. These also showed high correlations with certain occupational factors (duration of computer-working in months and hours spent daily in computer-working, certain ergonomic, microclimatic, and other occupational conditions) and non-occupational factors (demographic and lifestyle factors: nutritional status, diet, smoking, alcohol consumption, and physical activity). Despite its limitations, our study has identified occupational and non-occupational risk factors that can aggravate CTS and work disability, but which can also be improved with workplace and lifestyle preventive and corrective measures. More research is needed, though, to establish the possible causal relationships and the independent influence of each of those risk factors.

Driving, work, wound care and rehabilitation after carpal tunnel release: Consensus recommendations from a UK Delphi study

Introduction

There is variability in the information available for patients after carpal tunnel release (CTR). We aimed to establish (i) what advice should be provided regarding return to driving after CTR; (ii) how work activities should be categorised and defined in relation to CTR, and when patients should be recommended to return to these activities; (iii) what wound care and rehabilitation advice should be provided after CTR.

Methods

We developed consensus recommendations from an expert panel of hand surgeons, primary care surgeons and hand therapists using an electronic Delphi process. Participants were recruited from clinical organisations using pre-defined criteria. Delphi questionnaires included open text and tick-box responses. Consensus was defined as ≥75% agreement and summary feedback was provided after each round.

Results

There were 33 panellists (21 surgeons and 12 hand therapists), of which 27 (82%) completed all rounds. Expected return to driving was agreed as 5-14 days. Expected timescales were also agreed for return to seven selected occupational activities. Post-operative advice focused on using and moving the hand, rather than specific rehabilitation. While consensus was reached for most items, there were important areas of disagreement, including divergent views on driving with sutures in situ and the need to inform car insurers.

Conclusion

Recommendations from this study expand on existing advice by including functional descriptors for occupational activities and guidance timescales generated through a formal consensus process. Areas where consensus was not reached warrant further exploration to assess whether different practices impact clinical and functional outcomes for patients.

Return to work after medial unicompartmental knee arthroplasty: A systematic review

INTRODUCTION

This study aims to evaluate the current literature with regard to the average time to and overall rate of return to work (RTW) following medial unicompartmental knee arthroplasty (UKA).

METHODS

A systematic search was conducted on MEDLINE (Ovid), Embase, Pubmed, CINAHL, Web of Science, Scopus, and the Cochrane Library to identify studies reporting RTW after UKA. Primary outcomes were the rate and time to RTW after UKA. Secondary outcomes were postoperative changes in work intensity, functional scores, and factors affecting RTW. Methodological quality was evaluated using the the Methodological Index for Non-Randomized Studies (MINORS) criteria.

RESULTS

Seven studies met inclusion criteria. Results were summarized qualitatively. The overall methodological quality of the studies was moderate based on the MINORS score. These studies included 636 patients with 46.5% male. Mean age was 63.1 years. The average rate of RTW was 81.7%. The average time to RTW was 5.4 ± 3.9 weeks (range 1-32 weeks). 81.8% of patients in one study returned to an equally or more physically demanding job, while 83.5% were able to work the same or longer hours postoperatively in another study. Functional scores improved after surgery (n = 6 studies). Factors affecting RTW were postoperative rehabilitation, retirement, and the effects of surgery.

CONCLUSION

Limited evidence from the included studies with moderate quality suggests that UKA allows patients to RTW faster, with a high rate of RTW and improved functional outcomes. However, consensus definitions and methods of work status analysis are needed for future studies.