Disability and return to work after MRI on suspicion of scaphoid fracture: Influence of MRI pathology and occupational mechanical exposures

Abstract

ObjectivesWe aimed to determine the prognosis after early MRI on clinical suspicion of scaphoid fracture, hypothesising that MRI pathology is associated with more disability and that MRI pathology and high occupational mechanical hand-arm exposures are associated with slower return to work (RTW).MethodsWe conducted a follow-up study of a cohort of 469 patients, who were scanned in the period 2006 to 2010. The respondents constituted our cohort for disability analysis and the subset that was in the labour market at the time of the trauma constituted our sub-cohort for RTW analysis. Questionnaires included disability scores, job title, and lifestyle factors. Job titles were linked with a job exposure matrix to estimate occupational exposures. Register information was obtained on time until RTW. We used logistic regression analysis of disability and Cox regression analysis of time until RTW.ResultsThe proportion that responded was 53% (249/469) for the disability analysis and 59% (125/212) for the RTW analysis. The mean age at follow up was 43.5 years, the mean time since trauma was 4.8 years, 53% had injury of the dominant hand, and 54% had MRI pathology. Men constituted 43% of the cohort and 56% of the sub-cohort. MRI pathology was not associated with more disability [e.g., for a 'Disabilities of the Arm Shoulder and Hand'-score ≥20 the odds ratio was 0.58 (95% confidence interval 0.26–1.17)]. Patients without MRI pathology and with low occupational exposures were off work for an average of four weeks. Patients with MRI pathology or high occupational exposures were off work for twice as long time.ConclusionMRI pathology was not associated with more disability. For patients, who were in the labour market at the time of the trauma, MRI pathology and high occupational mechanical hand-arm exposures were associated with slower RTW.

Systematic Review of Biopsychosocial Prognostic Factors for Return to Work After Acute Orthopedic Trauma: A 2020 Update

“…There was moderate evidence for age ( 37 , 39 , 45 ), gender ( 23 , 33 , 37 , 39 , 45 ), and education ( 39 , 42 ) as non-significant factors for RTW in the late phase. These factors were identified in one study with a low risk of bias and at least one study with a moderate risk of bias.…”

“…Another difference was that we assessed both the significant and non-significant effects of all reported predictors. For example, increasing age showed no relationship with RTW in three studies (37,39,45), but it significantly predicted RTW in the other six studies (23,27,30,32,33,42). The difference might be due to selection bias.…”

“…Compensation status has been reported in two studies with a low risk of bias and high quality ( 27 , 43 ) and one study with a moderate risk of bias ( 30 ). There was moderate evidence for physical workload, as this factor was reported in one study with a low risk of bias and high quality ( 43 ) and three studies with a moderate risk of bias ( 22 , 29 , 39 ). Other factors were supported by limited evidence ( Table 4 ).…”

“…Return to work was defined as a completion of a period of four consecutive weeks on the labor market in one study ( 39 ), as a sustained outcome for 3 months in one study ( 40 ), as a return to any form of work (the same or modified work, full time or part time) in 18 studies ( 21 , 22 , 24 – 27 , 30 , 32 , 33 , 37 , 41 – 46 , 48 , 49 ), or as not being prevented from working for any days in the last 4 weeks in one study ( 36 ). Nine studies did not provide the definition ( 23 , 28 , 29 , 31 , 34 , 35 , 38 , 47 , 50 ).…”

“…Nine studies did not provide the definition ( 23 , 28 , 29 , 31 , 34 , 35 , 38 , 47 , 50 ). Concerning its measurement, RTW was reported as a binary outcome (yes/no status) in 23 studies ( 21 – 26 , 28 , 30 – 34 , 36 – 38 , 40 – 44 , 47 , 48 , 50 ), as time from injury to RTW in 6 studies ( 27 , 29 , 35 , 39 , 45 , 46 ), or as the number of days paid for work disability in one study ( 49 ).…”