Simple clinical tools improve ability-to-work predictions for individuals 3–24 months after upper limb injury - 12/07/23
, François Luthi a, b, c, 1, Philippe Vuistiner b, Stefan M. Scholz-Odermatt d, Cyrille Burrus b, c, Michel Konzelmann b, c, Bertrand Léger b
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Highlights |
• | Establishing a vocational prognosis after upper-limb injury is difficult. |
• | Taking pain medicine is a red flag for long-term work ability. |
• | Having a grip strength <16 kg is a red flag for long-term work ability. |
Abstract |
Background |
Despite numerous previous studies, predicting the ability to work (ATW) after an upper limb injury (ULI) remains difficult for those still not working 3–24 months after their initial injury.
Objectives |
We aimed to identify simple prognostic characteristics that were associated with the long-term ATW for individuals who remained unable to work several months after the accident that caused their ULI.
Methods |
A single-center prospective observational study in a rehabilitation center in the French-speaking part of Switzerland. We included participants who were 18–60 years old, still unable to work because of persistent pain/disability 3–24 months after an ULI, and who were referred to our rehabilitation center for a 1-month intensive interdisciplinary treatment. Data were collected on personal characteristics, body function/structure variables, activity limitations/participation restrictions, and environmental factors. Participants’ evolution during rehabilitation was assessed using functional tests/questionnaires and the 7-level self-reported Patient's Global Impression of Change (PGIC) assessment at discharge. Participant outcomes after 1 year were categorized as either able (ATW>0%) or unable (ATW=0%) to work. The best prognostic characteristics were selected by logistic regression analysis.
Results |
Among the 317 participants, 202 (64%) had an ATW>0% at 1 year. A grip strength ≥16 kg (Jamar Hand Dynamometer score - affected side) and “(I) do not take pain medicine” were independent predictors. Overall, 96% (26/27) of participants with these 2 characteristics had an ATW>0% at 1 year. The simultaneous absence of these characteristics predicted an unfavorable prognosis in 50% (59/119) of participants. For those who also had a positive PGIC score then 100% (25/25) of participants with these 3 characteristics had an ATW>0%; for those without, only 42% (19/45) had an ATW>0%.
Conclusions |
Grip strength (≥16 kg) and not taking pain medicine are favorable prognostic factors for an ATW after an ULI. Their absence is associated with a poor ATW prognosis for half of people with ULI and should alert caregivers to risk of long-term absenteeism (“red flags”). Including data from a PGIC further improves the ATW prediction. We recommend that these 3 criteria be systematically evaluated.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Work capacity, Predictive value of tests, Prognosis, Upper extremity, Injuries
Abbreviations : AIS, ATW, AUC, BPI, CI, DASH, HADS, HISS, JHD, PCS, PGIC, PILE, ROC, RTW, TSK, ULI
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Vol 66 - N° 5
Articolo 101747- giugno 2023 Ritorno al numero
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Benvenuto su EM|consulte, il riferimento dei professionisti della salute.