Abstract
BackgroundCarpal tunnel syndrome is a common nerve compression disorder which affects hand sensation and function. Carpal tunnel release surgery (CTR) is frequently performed to alleviate these symptoms. For many CTR patients, surgery occurs during their working lifetime, but there is currently no evidence-based guidance to inform clinicians or patients when it might be safe to return to different types of work afterwards. The aim of this qualitative study was to explore the return to work experiences of patients who had recently undergone CTR.MethodsSemi-structured 1:1 interviews were conducted with a subgroup of participants recruited to a multi-centre prospective cohort study. Interviewees were purposely selected to represent a range of demographic, clinical and occupational characteristics. All had recently undergone CTR and had returned to work. Interviews were audio recorded, transcribed verbatim and analysed using the framework method. Participants were recruited until data saturation was achieved.ResultsFourteen participants were interviewed: 11 women (median age 49 years, range 27–61) and 3 men (age range 51–68 years). Three key themes were identified. Theme 1 centred on the level of functional disability experienced immediately after surgery. There was an expectation that CTR would be a ‘minor’ procedure, but this did not match the participants’ experiences. Theme 2 explored the desire for validation for the time away from work, with participants recalling a need to justify their work absence to themselves as well as to their employers. Theme 3 focused on the participants’ reflections of handing their return to work and function, with many reporting uncertainties about what constituted appropriate activity loads and durations. There was a desire for specific information relating to individual work roles.ConclusionIndividual return to work decision-making was largely influenced by the recommendations received. According to the views of participants, clinicians may be able to prepare patients better pre-operatively, especially with respect to function in the immediate post-operative period and by providing return to work guidance that can be tailored for individual work roles.
Highlights
Carpal tunnel syndrome is a common nerve compression disorder which affects hand sensation and function
Interviewees appeared to be seeking specific information from the surgeon regarding when they should return to work and how to make a graded return, yet when a period of work absence was documented on a fit note, no interviewees returned to work before that time point
A similar scenario was observed for return to driving. These findings suggest that there is a need to be mindful of both the potential positives and negatives of any change in return to work strategy after Carpal tunnel release surgery (CTR), and that there is an expectation for surgeons to be able to understand the work demands of many very different work roles
Summary
Carpal tunnel syndrome is a common nerve compression disorder which affects hand sensation and function. For many CTR patients, surgery occurs during their working lifetime, but there is currently no evidence-based guidance to inform clinicians or patients when it might be safe to return to different types of work afterwards. The aim of this qualitative study was to explore the return to work experiences of patients who had recently undergone CTR. More than 90,000 CTR procedures are expected annually by 2020 in the English NHS alone [5], but there is currently no evidence-based guidance advising when it might be safe to return to functional activities, including work, after CTR. Prognostic factors associated with earlier return to work have been reviewed by Peters et al and included an expectation or desire for fewer days off work, lower pain anxiety and a work role that was unaffected by CTS [7]
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