Expert consensus on facilitators and barriers to return-to-work following surgery for non-traumatic upper extremity conditions: a Delphi study

J Hand Surg Eur Vol. 2017 Feb;42(2):127-136. doi: 10.1177/1753193416669263. Epub 2016 Sep 28.

Abstract

This Delphi study aimed to reach consensus on important facilitators and barriers for return-to-work following surgery for non-traumatic upper extremity conditions. In Round 1, experts ( n = 42) listed 134 factors, which were appraised in Rounds 2 and 3. Consensus (⩾85% agreement) was achieved for 13 facilitators (high motivation to return-to-work; high self-efficacy for return-to-work and recovery; availability of modified/alternative duties; flexible return-to-work arrangements; positive coping skills; limited heavy work exertion; supportive return-to-work policies; supportive supervisor/management; no catastrophic thinking; no fear avoidance to return-to-work; no fear avoidance to pain/activity; return to meaningful work duties; high job satisfaction) and six barriers (mood disorder diagnosis; pain/symptoms at more than one musculoskeletal site; heavy upper extremity exertions at work; lack of flexible return-to-work arrangements; lack of support from supervisor/management; high level of pain catastrophizing). Future prognostic studies are required to validate these biopsychosocial factors to further improve return-to-work outcomes.

Level of evidence: V.

Keywords: Hand; prognostic factors; shoulder; sickness absence; work disability; wrist.

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Consensus*
  • Delphi Technique
  • Fear
  • Female
  • Humans
  • Job Satisfaction
  • Male
  • Middle Aged
  • Motivation
  • Musculoskeletal Diseases / physiopathology*
  • Musculoskeletal Diseases / psychology*
  • Musculoskeletal Diseases / surgery
  • Outcome Assessment, Health Care
  • Return to Work*
  • Upper Extremity*
  • Young Adult