Barriers and facilitators to return to work post-acute orthopedic trauma in upper limbs: an integrative literature review

Silva, Ana Raquel; Sime, Mariana Midori

doi:10.4322/2526-8910.ctoAR1601

Brasil

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Review Article • Cad. Bras. Ter. Ocup. 27 (2) • Apr-Jun 2019 • https://doi.org/10.4322/2526-8910.ctoAR1601 linkcopy

Barriers and facilitators to return to work post-acute orthopedic trauma in upper limbs: an integrative literature review¹

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction Traumatic upper limb injuries often lead to work disability. Ensuring the maintenance of the worker occupational role is a goal for occupational therapists in occupational health, using prevention and rehabilitation techniques. Therefore, it is important to know the factors that influence return to work.

Objective To document evidence of barriers and facilitators elements of return to work after acute upper limb trauma.

Method A review study using the integrative review approach. The search included Biblioteca Virtual em Saúde (BVS), Scielo, Lilacs, Periódicos Capes and Pubmed databases. Articles that mentioned a return to work and upper limb trauma in their abstract, published between 2005 and 2015 and written in Portuguese, English or Spanish, were also used.

Results The final sample consists of 13 articles, after qualitative analysis the results were grouped into four categories: Patient, Injury, Rehabilitation, and Work. Injury severity, hospitalization time, number of surgical procedures, insertion in a rehabilitation program, work-related rehabilitation, family and workplace support were the main elements identified.

Conclusion The rehabilitation program should be integrated and multidisciplinary with actions aimed at pain management, functional recovery, and preparation for a return to work. Support family member and whenever possible work environment should be considered within the vocational rehabilitation program to ensure the return to work.

Keywords: Hand Injuries; Return to Work; Vocational Rehabilitation

Article	Source	Sample data	Type of Study	Main Objective	Measures of Evaluation/Results Evaluated
A1	Langford, Cheung and Li (2015)	Ten patients with comminuted fracture of the proximal phalanx or metacarpal head treated with wire fixation from 2005 to 2014	Qualitative	To evaluate the effectiveness (defined as a bone union and joint stability) of comminuted fractures fixation involving metacarpophalangeal joint after firearm injury or crush injury	Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire, range of motion in metacarpophalangeal pain, use of the affected hand, return to work.
A2	Loisel et al. (2014)	Seventy-nine patients who suffered an accident during the carpentry activity for 2 years	Qualitative	To describe the demographic characteristics of patients with injuries during carpentry activity	Interview/Subjective Questionnaire to identify the context of the accident, characteristics of the injury, socio-occupational characteristics of the patient, severity of the sequel, and time away from work.
A3	Hu et al. (2014)	There were 246 cases of workers with work-related injuries treated in hospitals in the east region of China	Quantitative and qualitative	To explore the situations and potential determinants of return to work and length of leave after a work-related injury	Interview with a structured questionnaire to identify demographic characteristics, injury severity according to the Hand Injury Severity Scale, return and stay at work for at least 1 month
A4	Roesler, Glendon and O’Callaghan (2013)	There were 192 patients of a hand therapy clinic	Quantitative and qualitative	To develop and test a comprehensive and multivariate biopsychosocial conceptual model to predict a return to work as a result	Instruments used: Interview with socio-demographic data, Pain Rating Scale, Work Satisfaction Scale, General Self-Efficacy Scale, Positive and Negative Affect Scale, Modified Hand Injury Severity Scale, Multi-dimensional Health Locus of Control Scale
A4	Roesler, Glendon and O’Callaghan (2013)	There were 192 patients of a hand therapy clinic	Quantitative and qualitative		Data collected: Predictors factors of return to work related to socio-demographic characteristics, work characteristics, biomedical factors, psychosocial factors, and psychological factors
A5	Ramel et al. (2013)	Forty people aged 19-64 years old who experienced complex hand trauma	Quantitative and qualitative	To explore important factors for the return to work of people who have experienced complex hand trauma	A self-administered questionnaire to identify demographic data, self-perception of hand and body functions, pain, health and disability status, physical and mental quality of life, work environment description, the cause of injury, treatment and rehabilitation.
A6	Hoxie et al. (2009)	There were 134 medical records of patients who suffered a hand injury by an electric saw	Quantitative	To provide detailed information on the costs of hand injury by an electric saw	Data collection by medical records
A6	Hoxie et al. (2009)		Quantitative		Costs with medical treatment and rehabilitation, time away from work and costs with leaving from work
A7	Cheng (2008)	There were 27 respondents with moderate to severe disability due to hand trauma	Qualitative	To examine the experiences of workers who suffered hand trauma in Hong Kong	Open interviews with workers who suffered hand trauma to identify the perception of incapacity resulting from the injury and its consequences for the return to work and family life.
A8	Kadzielski, Bot and Ring (2012)	93 workers with a finger injury	Quantitative and qualitative	To evaluate the separate effects of job satisfaction, burnout and secondary gain in upper limb disability due to finger trauma.	Instruments used: Shirom-Melamed’s Burnout Measure, Job Descriptive Index questionnaire, Disabilities of the Arm, Shoulder, and Hand, Short Form Health Survey (SF-36), Mental Component Summary, Physical Component Summary.
A8	Kadzielski, Bot and Ring (2012)	93 workers with a finger injury	Quantitative and qualitative		Data collected: demographic data, burnout, job satisfaction, upper limb functional condition, and overall health status.
A9	Matsuzaki et al. (2009)	There were 50 patients with total or partial amputation of their finger	Quantitative	To investigate the effects of severity and the cause of the hand trauma injury on functional recovery and return to work	Instruments used: Tamai’s Score, Quick Disabilities of the Arm, Shoulder, and Hand, Hand Injury Severity Scale.
A9	Matsuzaki et al. (2009)		Quantitative		Data collected: sensory recovery, the range of motion of the finger, skin temperature, manual function, return to work condition, duration of treatment, time away from work, the severity of the injury, number of fingers involved and type of injury.
A10	Chen et al. (2012)	There were 120 patients from a reconstructive and plastic rehabilitation center with traumatic upper limb injury	Quantitative and qualitative	To investigate the relationship between injury severity, self-perceived health, demographic characteristics and time away from work, after work-related upper limb trauma and the influence of psychological factors for fitness for return to work	Instruments used: Modified Hand Injury Severity Score, Short Form Health Survey (SF-36)
A10	Chen et al. (2012)		Quantitative and qualitative		Data collected: severity of trauma, self-perceived health, time away from work
A11	Cabral et al. (2010)	Thirty-five hand trauma workers attended at a rehabilitation center	Quantitative and qualitative	To describe the workers who returned to work after a hand trauma and analyze the factors they associated with this outcome after three years of high rehabilitation.	Instruments used: anamnesis, dynamometer, and Canadian Occupational Performance Measure.
A11	Cabral et al. (2010)		Quantitative and qualitative		Data collected: gender, age, marital status, school level, the labor situation, type of accident, occupation, affected side, dominance, causative agent, diagnosis, time of exercise of the professional activity, rehabilitation time, prehension strength, occupational performance, and work situation.
A12	Du, Lai and Wang (2007)	There were 102 hospitalized workers with non-severe upper limb fracture	Qualitative	To study the factors influencing the return to work of individuals with upper limb fracture	Instruments used: an interview with a structured questionnaire, report of the department of labor insurance and labor inspection.
A12	Du, Lai and Wang (2007)		Qualitative		Data collected: severity of the injury, socio-demographic data, information about medical treatment and hospitalization, psychosocial condition, employment conditions.
A13	Lee et al. (2010)	There were 140 patients hospitalized for a hand injury	Qualitative	To examine the relationship between initial anatomic severity and the possibility of a return to work of patients with hand injuries	Instruments used: Hand Injury Severity score and an interview.
A13	Lee et al. (2010)	There were 140 patients hospitalized for a hand injury	Qualitative		Data collected: socio-demographic characteristics, occupational characteristics, the severity of the lesion.

Category	RT facilitating factors	Articles with evidence	Factors barriers for RT	Articles with evidence
Patients	Higher school level	A3, A13	Living alone	A4
	The lower number of family dependents	A3	Locus of external control	A4
	Self-efficacy	A4	Lower satisfaction with health	A5
	Family member support	A7, A13	The absence of family support	A7
	Higher satisfaction with health and functionality	A10, A1	Abandonment of Rehabilitation	A1
			Burnout anterior a lesão	A8
Injury	Lower surgical procedures	A1, A6	A higher number of surgical procedures	A1, A6
	Injuries that did not require hospitalization	A3	Longer hospitalization time	A2, A3, A5
	Lower severity of the injury	A3, A6, A9	Higher severity of the injury	A3, A6, A9, A10, A12, A13
	Injury not caused by an accident at work	A3	Pain	A8
	Shorter treatment time	A9	Longer treatment time	A9, A10
	Minimal to moderate pain	A1	Injury to the dominant limb	A12
			Permanent disability	A7
			Injuries that demanded greater economic cost	A6
Rehabilitation	ADM recovery	A1	Scar adherence	A1
	Occupational training	A2	Worst manual function, prehension, strength, dexterity, and joint mobility	A5
	Early rehabilitation program	A5	Greater time in rehabilitation	A10
	Higher prehension strength at rehabilitation discharge	A11	Lower prehension strength on rehabilitation discharge	A11
	Early start in work-oriented rehabilitation programs	A10	Less time in rehabilitation	A11
Work	Receive insurance due to work accident	A3, A12, A13	Receive compensation for an accident at work	A8
	Do not have salary change due to leave work	A3	The decrease in salary due to leave work	A3
	Less time away from work	A3, A9	Longer time away from work	A2, A3, A5, A9
	Workplace support	A5, A7	No support in the workplace	A7
	Satisfaction with work	A8
	Stability in employment	A12
	Non-manual workers	A12, A13
	Higher wages	A13

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Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
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[1] Source: The authors (2017).

Barriers and facilitators to return to work post-acute orthopedic trauma in upper limbs: an integrative literature review1

Abstract

Barriers and facilitators to return to work post-acute orthopedic trauma in upper limbs: an integrative literature review¹