Impact of Patient-Surgeon Relationship on Patient’s Return to Work

Abstract

Background: Upper-limb injuries and musculoskeletal disorders represent a major economic burden for both patients and society, largely due to limitations in returning to work. We hypothesized that a positive patient-surgeon relationship may facilitate patients’ recovery and lead to a faster return to work. Methods: This longitudinal observational study comprised 219 patients, from 8 French hand trauma centers, who were 18 to 55 years of age and were on sick leave from work because of an injury or musculoskeletal disorder of the upper limb. In addition to instruments measuring patients’ functional scores and quality of life, the quality of the patient-surgeon relationship was assessed at enrollment using a specific questionnaire (Q-PASREL [Quality of PAtient-Surgeon RELationship]). Six months after enrollment, the return-to-work status was assessed. Logistic and Cox regression models were developed to identify predictors of return to work (yes/no) and the time off from work in days. Results: Overall, 74% of the patients who returned to work within 6 months after enrollment had a high or medium-high Q-PASREL score, whereas 64% of the patients who were still on sick leave had a low or medium-low Q-PASREL score. The odds of patients with a low or medium-low Q-PASREL score returning to work were, respectively, 95% and 71% lower than the odds of patients with a high score doing so, with a percent difference of 56% (95% confidence interval [CI] = 40% to 71%) for low versus high (odds ratio [OR] = 0.05 [95% CI = 0.02 to 0.13]) and 25% (95% CI = 6% to 44%) for medium-low versus high (OR = 0.29 [95% CI = 0.11 to 0.76]). All Q-PASREL items and scores were significantly associated with return to work. Conclusions: Patients with a lower Q-PASREL score and more severe disability were less likely to return to work within 6 months and had a longer time off from work. Efforts to improve the quality of patient-surgeon relationships may minimize the duration of sick leaves and accelerate patient recovery. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

ICF-based prediction of return to work after trauma rehabilitation: Results of the icfPROreha study in patients with severe musculoskeletal injuries

“…Our results regarding predictors for RTW related to functioning, i.e., sensation of pain and level of disability, are in line with scientific research on RTW following a traumatic injury ( 4 , 8 , 10 , 15 , 35 ). Whereas a direct comparison of the results is limited, as time points of assessment (i.e., predictors and outcome measured) do not exactly match the time points used in our study.…”

Association of Patient-Surgeon and Patient–Physical Therapist Relationships With Return to Sports After ACL Reconstruction: The Untested Dimension in Outcome Assessments

“…The RTS group had a higher mean PSR QPASREL score (35.7 ± 5.1) than the no-RTS group (33.8 ± 5.9; P = .01, P adj = .027). When scores were categorized according to the Dubert et al 7 categories, no significant difference was observed ( P = .11, P adj = .113). However, significance emerged when the scores were segmented using our data quartile categories ( P = .03, P adj = .039) with the RTS group being more likely to have high quality of PSR (>38; 32.3% vs 21.2%, respectively).…”

“…This questionnaire has been shown to have good psychometric properties, including reliability and validity. 6 In 2019, Dubert et al 7 demonstrated that a positive PSR as measured by the QPASREL was associated with shortened sick leave after surgery for upper limb injuries or musculoskeletal disorders. This can result in reduced time off from work and reduced lost productivity for both patients and payers.…”

“…The authors concluded that the positive impact of a good PSR on surgical outcomes may not be limited to upper limb surgery but can extend to other types of surgeries. 7 Studying the influence of PSR and PPR on RTS after ACLR is a dimension of the cluster that has not been tested before. These relationships have been found to intervene with factors affecting psychological readiness to RTS, such as kinesiophobia and ACL-RSI.…”

Return to work after sick leave due to musculoskeletal disorder or injury: a longitudinal study conducted in Brazil

“…Previous studies have shown that factors such as diffuse muscle pain [ 7 , 11 ], pain intensity levels [ 8 ], and the presence or persistence of pain after surgical treatment [ 22 ] can influence the rate of RTW. Psychological aspects, including distress, somatization, and catastrophizing, have also been identified as negative factors for RTW in the Netherlands, with a group of workers with low back pain [ 11 ].…”