Outcomes Following Carpal Tunnel Release in Patients Receiving Workers’ Compensation: A Systematic Review

Dunn, John C.; Kusnezov, Nicholas; Koehler, Logan R.; Berge, Dennis Vanden; Mitchell, Justin; Orr, Justin D.; Pallis, Mark

doi:10.1177/1558944717701240

Cited by 13 publications

(10 citation statements)

References 47 publications

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“…Mean RTW times ranged from 4-168 days in 41 studies; median RTW times ranged from 14-60 days in 17 studies. Earlier return to work was reported following endoscopic CTR and in populations without workers’ compensation, findings that are consistent with those of previous systematic reviews (5–9, 70). We also found that return to modified duties occurred sooner than return to full duties and return to non-manual occupations were generally faster than return to manual roles.…”

Section: Discussionsupporting

confidence: 91%

Sickness absence after carpal tunnel release: a systematic review of the literature

Newington¹,

Stevens²,

Warwick³

et al. 2018

Scand J Work Environ Health

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Objectives The aim of this systematic review was to provide an overview of time to return to work (RTW) after carpal tunnel release (CTR), including return to different occupations and working patterns. Methods A systematic search from inception to 2016 was conducted using nine electronic databases, trial registries and grey literature repositories. Randomized controlled trials and observational studies reporting RTW times after CTR were included. Study risk of bias was assessed using Cochrane risk of bias assessment tools. Time to RTW was summarized using median and range. Results A total of 56 relevant studies were identified: 18 randomized controlled trials and 38 observational studies. Only 4 studies were rated as having a low risk of bias. Reported RTW times ranged from 4-168 days. Few studies reported occupational information. Among 6 studies, median time to return to non-manual work was 21 days (range 7-41), compared with 39 days for manual work (range 18-101). Median time to return to modified or full duties was 23 days (ranges 12-50 and 17-64, respectively), as reported by 3 studies. There was no common method of defining, collecting or reporting RTW data. Conclusions This review highlights wide variation in reported RTW times after CTR. Whilst occupational factors may play a role, these were poorly reported, and there is currently limited evidence to inform individual patients of their expected duration of work absence after CTR. A standardized definition of RTW is needed, as well as an agreed method of collecting and reporting related data.

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Section: Discussionsupporting

confidence: 91%

Sickness absence after carpal tunnel release: a systematic review of the literature

Newington¹,

Stevens²,

Warwick³

et al. 2018

Scand J Work Environ Health

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show abstract

“… 6 The relationship between longer duration of work absence and availability of sick pay has also be reported previously for those with and without worker’s compensation. 9 21 It is plausible that financial necessity is driving earlier return to work for those with limited sick pay. Alternatively, those with access to paid leave might choose to take the maximum available duration.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review of the prognostic factors associated with return to work after CTR identified 11 studies which evaluated more than 90 potential prognostic factors. 8 Longer durations of work absence after CTR were found to be associated with: receipt of workers' compensation 9 ; manual work [10][11][12] ; longer expected durations of work absence 10 ; being on sick leave before CTR surgery 13 ; selfblame for the hand problem 13 and beliefs that the symptoms were caused by work. 12 Much of the existing research has been conducted at single sites and involved small numbers of participants.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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ObjectivesTo describe when patients return to different types of work after elective carpal tunnel release (CTR) surgery and identify the factors associated with the duration of sickness absence.DesignMulticentre prospective observational cohort study.Setting and participantsParticipants were recruited preoperatively from 16 UK centres and clinical, occupational and demographic information were collected. Participants completed a weekly diary and questionnaires at four and 12 weeks postoperatively.OutcomesThe main outcome was duration of work absence from date of surgery to date of first return to work.Results254 participants were enrolled in the study and 201 provided the follow-up data. Median duration of sickness absence was 20 days (range 1–99). Earlier return to work was associated with having surgery in primary care and a self-reported work role involving more than 4 hours of daily computer use. Being female and entitlement to more than a month of paid sick leave were both associated with longer work absences. The duration of work absence was strongly associated with the expected duration of leave, as reported by participants before surgery. Earlier return to work was not associated with poorer clinical outcomes reported 12 weeks after CTR.ConclusionsThere was wide variation in the duration of work absence after CTR across all occupational categories. A combination of occupational, demographic and clinical factors was associated with the duration of work absence, illustrating the complexity of return to work decision making. However, preoperative expectations were strongly associated with the actual duration of leave. We found no evidence that earlier return to work was harmful. Clear, consistent advice from clinicians preoperatively setting expectations of a prompt return to work could reduce unnecessary sickness absence after CTR. To enable this, clinicians need evidence-informed guidance about appropriate timescales for the safe return to different types of work.

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“…15 Moreover, patients with workers' compensation have higher rates of postoperative pain after CTR with delayed return to work, which may contribute to specific insurance requirements of EDS prior to surgery. 16 Moreover, 14 respondents typed in that insurance authorization or requirement was a reason behind obtaining EDS. Additionally, 47% of respondents stated concerns regarding malpractice as a reason for obtaining EDS.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Diagnostic Testing for Carpal Tunnel Syndrome: A Survey of the American Society for Surgery of the Hand

Billig

Sears

2022

The Journal of Hand Surgery

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Purpose In 2016, the American Academy of Orthopaedic Surgeons (AAOS) changed the clinical practice guidelines (CPGs) for the diagnosis of carpal tunnel syndrome, relaxing the recommendation for electrodiagnostic studies (EDS) prior to offering surgery. However, it is unknown how the updated guidelines changed the practice patterns of hand surgeons.Methods A web-based multiple-choice survey was sent to the members of the American Society for Surgery of the Hand. We assessed the current diagnostic practice patterns of hand surgeons. The survey was pretested using expert review with content and survey methodology experts and cognitively tested to ensure readability and understandability. ResultsThe final cohort consisted of 770 hand surgeons. Approximately 26% of respondents required EDS prior to seeing a patient in consultation, and 56% of members routinely ordered EDS after evaluating a patient with carpal tunnel syndrome if testing was not performed prior to evaluation. The top reasons for obtaining EDS were to provide additional information for unclear diagnoses (97% selected), for patients with worker's compensation (82% selected), for grading the severity (73% selected), and to provide a baseline examination in the event of persistent symptoms (72% selected). However, only 38% of respondents believed that the current AAOS CPGs were appropriate, and 43% of respondents did not know what the guidelines recommended.Conclusions Despite the change in AAOS CPGs, EDS continues to be ubiquitously used for the diagnosis of carpal tunnel syndrome. Nevertheless, a substantial proportion of hand surgeons are unaware of the recommendations for EDS within the AAOS CPGs.Clinical relevance These findings highlight the importance of explicitly defining which patients and which clinical scenarios would benefit from additional diagnostic testing and identifying strategies for more widespread dissemination of guidelines.

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Outcomes Following Carpal Tunnel Release in Patients Receiving Workers’ Compensation: A Systematic Review

Cited by 13 publications

References 47 publications

Sickness absence after carpal tunnel release: a systematic review of the literature

Sickness absence after carpal tunnel release: a systematic review of the literature

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

Utilization of Diagnostic Testing for Carpal Tunnel Syndrome: A Survey of the American Society for Surgery of the Hand

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