[Psychosocial repercussions of hand injuries and support for patients]. / Répercussions psychosociales des accidents de la main et accompagnement des patients.

PSYCHOSOCIAL REPERCUSSIONS OF HAND INJURIES AND SUPUPORT FOR PATIENTS. There are many nonmedical factors influencing a patient's return to work. To optimize care, the practitioner must be aware of the need to go beyond the scope of their own specialty. In particular, they must be able to identify patients with psychological comorbidity and/or chronic pain, in order to direct them as early as possible towards appropriate care. They must also pay particular attention to administrative requests whether these come from the patient themselves or from their insurers. Last but not least, the decompartmentalization of professional practices and the improvement of communication between the stakeholders are essential, although very complex to implement. In the Île-de-France and Centre regions of France, two associations offer support that meets all these best practices.

RÉPERCUSSIONS PSYCHOSOCIALES DES ACCIDENTS DE LA MAIN ET ACCOMPAGNEMENT DES PATIENTS. Il existe de nombreux facteurs autres que médicaux influençant le retour à l'emploi des patients. Afin d'optimiser la prise en charge, le soignant doit avoir en tête qu'il est nécessaire de sortir du champ de sa spécialité. Il doit notamment être capable d'identifier les patients présentant une comorbidité psychique et/ou des douleurs chroniques afin de les orienter au plus tôt vers une prise en charge adaptée. Il doit également porter une attention toute particulière aux demandes administratives, qu'elles émanent du patient lui-même ou de ses assurances. Enfin, il est primordial, bien que très complexe à mettre en oeuvre, de décloisonner les pratiques professionnelles et d'améliorer la communication entre les acteurs. En Île-de-France et en région Centre, deux associations proposent un accompagnement répondant à l'ensemble de ces bonnes pratiques.

Impact of Patient-Surgeon Relationship on Patient's Return to Work.

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.

Development of an instrument evaluating the impact of surgeon-patient relationship in patients on sick leave.

Background: To date, no specific instruments exist to measure the quality of the patient-surgeon relationship despite its potential to influence clinical and economic outcomes in patients undergoing surgery for musculoskeletal disorders (MSDs). Objective: The objective was to develop and validate an instrument to assess the quality of the patient-surgeon relationship, taking into account the return to work after functional restoration surgery. Methods: The instrument development was based on literature review, cognitive interviews and expert examinations. The instrument's psychometric properties were explored in a sample of 50 French patients on sick leave with musculoskeletal disorders or hand injuries. Face validity, internal consistency and test-retest reliability were evaluated. The dimensionality of the instrument was studied using an exploratory principal component analysis. Results: The 11-item instrument showed good psychometric properties. The cognitive interviews allowed enhancing the validity of the instrument content by capturing patients' point of view. The exploratory principal component analysis demonstrated the uni-dimensionality of the instrument with the first factor accounting for 83% of the total explained variance. Conclusion:This study has developed the first instrument capable of the specific assessment of the impact of the surgeon-patient relationship on recovery, in patients with hand traumas and MSDs.