Article

Factors affecting return to work after carpal tunnel syndrome surgery in a large French cohort.

Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, France.
Archives of physical medicine and rehabilitation (Impact Factor: 2.18). 11/2011; 92(11):1863-9. DOI: 10.1016/j.apmr.2011.06.001
Source: PubMed

ABSTRACT To evaluate occupational outcomes after surgical release of the median nerve in carpal tunnel syndrome (CTS).
Retrospective study 12 to 24 months after surgery.
Hand centers (N=3) in 2 different areas.
Patients who had undergone surgical release of the median nerve in 2002 to 2003.
Not applicable.
Duration of sick leave after surgery and associated factors were analyzed by using bivariate (log rank) and multivariate analyses of survival (Cox model).
Questionnaires mailed in 2004 regarding medical condition (history and surgery), employment (occupational category codes in 1 digit), and compensation were returned (N=1248; 62%), with 253 men and 682 women stating they were employed at the time of surgery (N=935). Most were working at the time of the study (n=851; 91.0%). Median duration of sick leave before returning to work was 60 days. The main factors associated with adverse occupational outcome (long duration of sick leave) were simultaneous intervention for another upper-extremity musculoskeletal disorder, belief (by the patient) in an occupational cause, and "blue-collar worker" occupational category (the strongest determinant).
This study emphasizes the multifactorial nature of the occupational outcome of CTS after surgery, including occupational category. The probability of return to work for each risk factor provides a fair description of prognosis for physicians and patients.

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    ABSTRACT: BACKGROUND: The assessment of post-surgical outcomes among patients with Workers' Compensation is challenging as their results are typically worse compared to those who do not receive this compensation. These patients' time to return to work is a relevant outcome measure as it illustrates the economic and social implications of this phenomenon. In this meta-analysis we aimed to assess the influence of this factor, comparing compensated and non-compensated patients. FINDINGS: Two authors independently searched MEDLINE (Ovid), Embase (Ovid), CINAHL, Google Scholar, LILACS and the Cochrane Library and also searched for references from the retrieved studies. We aimed to find prospective studies that compared carpal tunnel release and elective rotator cuff surgery outcomes for Workers' Compensation patients versus their non-compensated counterparts. We assessed the studies' quality using the Guyatt & Busse Risk of Bias Tool. Data collection was performed to depict included studies characteristics and meta-analysis. Three studies were included in the review. Two of these studies assessed the outcomes following carpal tunnel release while the other focused on rotator cuff repair. The results demonstrated that time to return to work was longer for patients that were compensated and that there was a strong association between this outcome and compensation status - Standard Mean Difference, 1.35 (IC 95%; 0.91-1.80, p < 0.001). CONCLUSIONS: This study demonstrated that compensated patients have a longer return to work time following carpal tunnel release and elective rotator cuff surgery, compared to patients who did not receive compensation. Surgeons and health providers should be mindful of this phenomenon when evaluating the prognosis of a surgery for a patient receiving compensation for their condition.Type of study/level of evidence: Meta-analysis of prospective Studies/ Level III.
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