Returning to work after a hand injury: Does ethnicity matter?

BACKGROUND: Hand injuries (HI) are common and may limit participation in work. The objective of this study is to examine the effect of ethnicity and other prognostic variables on return-to-work (RTW) among male manual workers after acute HI. METHODS: A cohort of 178 subjects (90 Arabs, 88 Jews) aged 22 to 65 was studied. Trained bilingual occupational therapists evaluated and interviewed the subjects, using structured validated questionnaires for evaluating personal and environmental factors, body function and structure, and activity limitation and participation restrictions. Employment status 3 months post injury was assessed by a telephone interview. To establish a predictive model for RTW, ethnicity and certain variables of the four domains mentioned above were analyzed using logistic regression analysis. RESULTS: A significant difference in the rate of RTW between Jews and Arabs was found (45.5% for Jews, 28.9% for Arabs, p = 0.03) three months post HI. In the univariate regression analysis, ethnicity was associated with RTW (OR = 2.05; CI: 1.10-3.81) for Jews vs. Arabs. Using a multivariate analysis, only legal counseling, educational attainment, and the severity of disability were significantly associated with RTW. CONCLUSION: RTW three months post HI among manual workers is directly related to variables such as education and legal counseling and only indirectly related to ethnicity. Patients with a lower level of education and those who were engaged in legal counseling need special attention and close guidance in the process of RTW.

Return-to-Work Barriers Among Manual Workers After Hand Injuries: 1-Year Follow-up Cohort Study.

OBJECTIVE: To determine time of return to work (TRTW) in relation to multivariable predictors among male manual workers after hand injury (HI) over a 12-month follow-up. DESIGN: A cohort study with baseline medical information, functional evaluation, and 3-, 6-, 9-, and 12-month follow-up telephone interviews. SETTING: Seven physical rehabilitation community occupational therapy clinics. PARTICIPANTS: Participants (N=178) with acute HI aged 22-65. Two participants were lost to follow-up. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: The dependent variable was TRTW. The independent variables originated from 4 domains: personal factors, environmental factors, body function and structure, and activity limitation and participation restriction. The proportion of return to work (RTW) at each time point was calculated. Multiple Cox regressions established a predictive model for TRTW. RESULTS: At the end of the study, 75.3% participants returned to work. The median TRTW was 94 days. In the final model, only compensation factors and education contributed significantly to overall RTW, but when separate analyses were performed, decreased level of self-efficacy, higher workplace demands, level of pain, level of emotional response to trauma, reduced physical capability of the hand, and higher level of disability were significantly associated with delayed TRTW. CONCLUSIONS: TRTW was determined by the physical capability of the hand, pain, and psychosocial factors, but it was also affected by legal factors. Participants who did not return to work during the first 9 months are at risk for long-term disability. Developing treatment programs for those who are at risk for not returning to work, taking into consideration these factors, is recommended.

Cross-cultural adaptation of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for Hebrew-speaking subjects with and without hand injury.

PURPOSE: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire is used internationally to assess function and disability. The instrument has been translated into several languages, but no Hebrew version exists. The objective of this study was to evaluate the use of the 12-item WHODAS 2.0 questionnaire among Hebrew speakers with and without hand injuries (HI). METHODS: The translated questionnaire was conducted among 155 uninjured subjects (UI) and 77 male workers with HI. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was assessed in UI subjects and calculated using the intraclass correlation coefficient (ICCagreement). Validity was evaluated by correlating the 12-item WHODAS 2.0 to the short-form of health survey (SF-12) in UI subjects and comparing the 12-item WHODAS 2.0 scores and the Quick Disability of Arm, Shoulder, and Hand (QDASH) Outcome Measure in the HI group. RESULTS: The Cronbach's alpha of the WHODAS 2.0 for the entire sample was α = 0.83. The ICCagreement for test-retest reliability was 0.88. A positive significant correlation was found between the 12-item WHODAS 2.0 and the QDASH (rs = 0.53, p < .005). CONCLUSIONS: The results support the reliability and validity of this Hebrew translation of the 12-item WHODAS 2.0. IMPLICATIONS FOR REHABILITATION Measurement tools that assess activities and participation after HI are an essential part of the rehabilitation process. The 12-item WHODAS 2.0 is a useful tool, since it addresses a broader range of activity and participation domains compared to the DASH and enables better implementation of the ICF model. Since the WHODAS 2.0 does not target a specific disease (as oppose to the DASH), it can be used to compare disabilities caused by different diseases or traumas. The WHODAS 2.0 measures both the function and disability in general populations as well as clinical situations; therefore, the instrument is useful for assessing both health and disability.