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

Affiliation

Newington L(1)(2), Ntani G(3), Warwick D(4), Adams J(5)(6), Walker-Bone K(3).
Author information:
(1)MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK [Email]
(2)Hand Therapy, Guy's and St Thomas' NHS Foundation Trust, London, UK.
(3)MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
(4)Hand Surgery, University Hospital Southampton NHS Foundation Trust and Faculty of Medicine, University of Southampton, Southampton, UK.
(5)Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, UK.
(6)Centre for Innovation and Leadership in Health Sciences, School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK.

Abstract

OBJECTIVES: To 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. DESIGN: Multicentre prospective observational cohort study. SETTING AND PARTICIPANTS: Participants 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. OUTCOMES: The main outcome was duration of work absence from date of surgery to date of first return to work. RESULTS: 254 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. CONCLUSIONS: There 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.