Health-care providers' perspectives on factors influencing return-to-work after surgery for nontraumatic conditions of the upper extremity

Study Design: This study is a descriptive survey. Introduction: 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. Purpose of the Study: 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. Methods: 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. Results: 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. Discussion: 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. Conclusion: Interventions facilitating RTW and future research should consider the factors identified by HCPs in this study.