Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia; Harvard Center for Work, Health and Well-being, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia.
The Hopkins Centre, Menzies Health Institute, Griffith University, Gold Coast, Australia; Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia; Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
J Hand Ther. 2020 Jan-Mar;33(1):87-95.e1. doi: 10.1016/j.jht.2018.09.011. Epub 2019 Mar 8.
This study is a descriptive survey.
Health care providers (HCPs) are key stakeholders who facilitate workers' return to work (RTW) following upper extremity surgery. Hand therapists play a major role in this process, yet we do not know if and/or how their perspectives differ from other HCPs.
This study examined HCPs' opinion on factors that influence RTW after surgery for nontraumatic upper extremity conditions and whether HCPs from different disciplines differed in their opinion.
HCPs (occupational therapists, physiotherapists, hand therapists, exercise physiologists, psychologists, surgeons, and general practitioners) completed a survey rating 50 factors on a worker's ability to RTW. Each factor was scored using a 5-point Likert scale from "not" to "extremely" influential, which was later dichotomised. Agreement was indicated at 75%. The level of disagreement between disciplines was examined.
Respondents (n = 787) identified 20 factors being influential on RTW. They are (in order from highest to lowest) poor pain coping (the highest, >85% of respondents), postoperative psychological state, RTW self-efficacy, employer/supervisor's support, employer's unwillingness for job modification, recovery expectations, job satisfaction, suitable duties availability, whether the job can be modified, and mood disorder diagnosis. There was agreement that two factors do not influence RTW, gender, and preemployment medical assessment. There was disagreement (P < .05) between HCP disciplines on six factors (obesity, comorbidities, doctors' RTW recommendation, diagnosis, fitness, income). There were no consistent patterns with respect to which professions disagreed across all six factors. Hand therapists differed from the other disciplines for three of the factors including diagnosis, comorbidities, and doctor's recommendation for RTW.
The factors that stakeholders agreed as having the greatest influence were mainly related to the worker (pain and psychological factors) and the workplace and are amenable to RTW interventions.
Interventions facilitating RTW and future research should consider the factors identified by HCPs in this study.
本研究为描述性调查。
医疗保健提供者（HCPs）是促进上肢手术后工人重返工作岗位（RTW）的关键利益相关者。手部治疗师在这一过程中发挥着重要作用，但我们不知道他们的观点是否以及/或者如何与其他 HCPs 不同。
本研究调查了 HCPs 对影响非创伤性上肢疾病手术后 RTW 的因素的看法，以及来自不同学科的 HCPs 在观点上是否存在差异。
HCPs（职业治疗师、物理治疗师、手部治疗师、运动生理学家、心理学家、外科医生和全科医生）完成了一项调查，对 50 个影响工人 RTW 能力的因素进行了评分。每个因素都使用 5 分制（从“无”到“非常”）进行评分，然后进行二分法处理。意见一致的比例为 75%。检查了学科之间的分歧程度。
受访者（n = 787）确定了 20 个对 RTW 有影响的因素。按影响力从高到低排列依次为：较差的疼痛应对能力（最高，>85%的受访者）、术后心理状态、RTW 自我效能感、雇主/主管的支持、雇主不愿意进行工作修改、康复预期、工作满意度、合适职责的可用性、工作是否可修改以及情绪障碍诊断。有 2 个因素被认为不会影响 RTW，即性别和就业前医疗评估，这两个因素得到了一致的认同。HCP 学科之间在 6 个因素（肥胖、合并症、医生的 RTW 建议、诊断、健康状况、收入）上存在分歧（P<.05）。在所有 6 个因素中，没有一个职业一致地不同意其他职业。手部治疗师与其他学科在诊断、合并症和医生推荐 RTW 这三个因素上存在分歧。
利益相关者一致认为影响最大的因素主要与工人（疼痛和心理因素）和工作场所有关，并且可以通过 RTW 干预来改善。
促进 RTW 的干预措施和未来的研究应考虑本研究中 HCPs 确定的因素。
