Determinants of Return to Work in Patients with Hand Disorders and Hand Injuries

Introduction Return to work (RTW) in patients with hand disorders and hand injuries is determined by several determinants not directly related to the physical situation. Besides biomedical determinants, work-related and psychosocial determinants may influence RTW as well. This study is conducted to investigate the influence of these potential determinants on RTW in patients with hand disorders and hand injuries. Methods Included 91 patients who were operatively treated for a hand disorder or a hand injury, and who were employed prior to surgery. Patients answered several questionnaires on the aforementioned categories. Potential determinants significantly related to RTW in a univariate analysis were entered in a logistic regression for the total group and the acutely injured patients separately. Results Pain, accident location, job independence and symptoms of post-traumatic stress disorder (PTSD) were univariately associated with RTW. Pain was a determinant for late RTW in the total group and accident location and symptoms of PTSD in the acutely injured group. Conclusion Pain, accident location and symptoms of PTSD were most important in resuming work in hand injured patients or in patients with a hand disorder. These findings may indicate that attention should be paid to the treatment of pain, and to the development of symptoms of PTSD during rehabilitation. It may be necessary to make extra efforts aimed at RTW in patients who sustained their injury on the job

Validity of the Dictionary of Occupational Titles for Assessing Upper Extremity Work Demands

Objectives: The Dictionary of Occupational Titles (DOT) is used in vocational rehabilitation to guide decisions about the ability of a person with activity limitations to perform activities at work. The DOT has categorized physical work demands in five categories. The validity of this categorization is unknown. Aim of this study was to investigate whether the DOT could be used validly to guide decisions for patients with injuries to the upper extremities. Four hypotheses were tested. Methods: A database including 701 healthy workers was used. All subjects filled out the Dutch Musculoskeletal Questionnaire, from which an Upper Extremity Work Demands score (UEWD) was derived. First, relation between the DOT-categories and UEWD-score was analysed using Spearman correlations. Second, variance of the UEWD-score in occupational groups was tested by visually inspecting boxplots and assessing kurtosis of the distribution. Third, it was investigated whether occupations classified in one DOT-category, could significantly differ on UEWD-scores. Fourth, it was investigated whether occupations in different DOT-categories could have similar UEWD-scores using Mann Whitney U-tests (MWU). Results: Relation between the DOT-categories and the UEWD-score was weak (r(sp) = 0.40; p < .01). Overlap between categories was found. Kurtosis exceeded +/- 1.0 in 3 occupational groups, indicating large variance. UEWD-scores were significantly different within one DOT-category (MWU = 1.500; p < .001). UEWD scores between DOT-categories were not significantly different (MWU = 203.000; p = .49). Conclusion: All four hypotheses could not be rejected. The DOT appears to be invalid for assessing upper extremity work demands

Return to work after hand injury

Handletsels zijn een belangrijke oorzaak voor werkverzuim in Nederland. Niet alleen treden de meeste handletsels op in het werkende deel van de bevolking; ook kunnen de gevolgen van een op het oog klein letsel langdurige gevolgen hebben. Uit vragenlijstonderzoek blijkt dat meer dan de helft van de handletselpatiënten langer dan tien weken over zijn werkhervatting doet. Niet alleen pijn, maar ook symptomen van post-traumatische stress, de plaats waar het letsel ontstaan is en het uiterlijk van de hand , bepalen de tijd die nodig is voor herstel. Verder laat het onderzoek zien dat een gebruikelijke richtlijn – de Dictionary of Occupational Titles – de arbeidsbelasting van de bovenste extremiteiten niet adequaat beoordeelt, waardoor geen koppeling gemaakt kan worden met de belastbaarheid van de patiënt. Werkplekonderzoek en belastbaarheidsonderzoek blijven nodig om deze inschatting te maken. Een goede interventie voor handletselpatiënten moet niet alleen aandacht schenken aan fysieke aspecten van handletsel, maar ook aan psychosociale en werkgerelateerde factoren. Gedurende het onderzoek werd een groepsinterventie gericht op werkhervatting ontwikkeld die aan deze eisen voldoet, en werd deze in een pilotstudie getest. Omdat de onderzoeksgroep klein was, konden geen statistisch verantwoorde conclusies worden getrokken. Echter, de nieuwe interventie lijkt kostenbesparend te zijn ten opzichte van gebruikelijke interventies, en klinisch betere resultaten op te leveren. Verder onderzoek naar de effectiviteit van de nieuwe interventie is gewenst. Hand injuries are an important cause of absenteeism at work. Even the consequences of minor hand injuries can be large. A survey study found more than 50 percent of the patients with hand injuries to take longer than 10 weeks to resume work. Pain, accident location, aesthetics of the hand and symptoms of posttraumatic stress disorder seem to influence the time off work. The Dictionary of Occupational Titles appears not to be valid to make an estimation of work demands with regard to upper extremities, withholding professionals from matching work load and work capacity of patients with hand injuries. So far, the most valid way to make this match is to perform workplace analysis and combine it with results of a capacity test, such as a Funcational Capacity Evaluation. Treatment programs for patients with hand injuries should not only focus on the physical rehabilitation, but also on the psychosocial and work-related aspects that influence return to work. In this thesis a novel group intervention was developed that meets those aspects. The intervention was tested in a pilot study. Because of the limited sample size, no statistically significant results could be found, but outcomes seem to be bot economically and clinically relevant. Therefore, further studies seem justified and desirable.