Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98104, USA.
Am J Ind Med. 2012 Sep;55(9):816-32. doi: 10.1002/ajim.22029. Epub 2012 Mar 5.
We sought to identify early risk factors for work disability compensation prior to and after carpal tunnel syndrome (CTS) surgery, and to determine whether pre-surgery disability compensation is associated with long-term disability.
Washington State workers' compensation administrative data and data from interviews with workers 18 days (median) after submitting new workers' compensation claims for CTS were examined. Baseline risk factors for pre-surgery disability compensation and for long-term disability (>365 days of work disability compensation prior to 2 years after claim filing) were evaluated for workers who underwent CTS surgery and had at least 1 day of disability compensation (N = 670).
After adjustment for baseline long-term disability risk factors, workers with pre-surgery disability compensation had over five times the odds of long-term disability. Baseline factors in multiple domains, including job, psychosocial, clinical, and worker pain and function, were associated with both pre-surgery disability compensation and long-term disability.
Risk factors for work disability prior to and after CTS surgery are similar, and early work disability is a risk factor for long-term CTS-related disability. An integrated approach to CTS-related disability prevention could include identifying and addressing combined risk factors soon after claim filing, more efficient use of conservative treatments and appropriate work modifications to minimize early work loss, and, when indicated, timely surgical intervention.
我们旨在确定腕管综合征 (CTS) 手术前后导致工作残疾补偿的早期风险因素，并确定术前残疾补偿是否与长期残疾相关。
我们研究了华盛顿州工人赔偿管理数据以及对新提交 CTS 工人赔偿索赔后 18 天（中位数）的工人进行访谈的数据。对接受 CTS 手术且至少有 1 天残疾补偿（索赔提交后 2 年内有>365 天工作残疾补偿）的工人进行了术前残疾补偿和长期残疾（>365 天工作残疾补偿）的基线风险因素评估（N=670）。
在调整了长期残疾的基线风险因素后，有术前残疾补偿的工人发生长期残疾的几率是没有术前残疾补偿的工人的五倍多。多个领域的基线因素，包括工作、心理社会、临床以及工人的疼痛和功能，与术前残疾补偿和长期残疾均相关。
CTS 手术前后工作残疾的风险因素相似，早期工作残疾是 CTS 相关长期残疾的一个风险因素。针对 CTS 相关残疾的预防可以采用综合方法，包括在索赔提交后尽快识别和处理综合风险因素，更有效地利用保守治疗和适当的工作调整，以尽量减少早期工作损失，并在需要时及时进行手术干预。
