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

• Published in: BMJ open Vol. 11; no. 2; p. e041656
• Main Authors: Newington, Lisa, Ntani, Georgia, Warwick, David, Adams, Jo, Walker-Bone, Karen
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 10-02-2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Carpal tunnel syndrome; Carpal Tunnel Syndrome - surgery; Clinical outcomes; Cohort analysis; Collaboration; Female; hand & wrist; Hand surgery; Humans; Mental health; occupational & industrial medicine; Patients; Primary care; Prospective Studies; Questionnaires; Sick Leave; Surgery; Systematic review; United Kingdom > UK; hand & wrist; occupational & industrial medicine; primary care
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-041656

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.