Sickness absence after carpal tunnel release: a systematic review of the literature.

Lisa Newington,Martin Stevens,David Warwick,Karen Walker-Bone,Jo Adams

doi:10.5271/sjweh.3762

Abstract

Objectives The aim of this systematic review was to provide an overview of time to return to work (RTW) after carpal tunnel release (CTR), including return to different occupations and working patterns. Methods A systematic search from inception to 2016 was conducted using nine electronic databases, trial registries and grey literature repositories. Randomized controlled trials and observational studies reporting RTW times after CTR were included. Study risk of bias was assessed using Cochrane risk of bias assessment tools. Time to RTW was summarized using median and range. Results A total of 56 relevant studies were identified: 18 randomized controlled trials and 38 observational studies. Only 4 studies were rated as having a low risk of bias. Reported RTW times ranged from 4-168 days. Few studies reported occupational information. Among 6 studies, median time to return to non-manual work was 21 days (range 7-41), compared with 39 days for manual work (range 18-101). Median time to return to modified or full duties was 23 days (ranges 12-50 and 17-64, respectively), as reported by 3 studies. There was no common method of defining, collecting or reporting RTW data. Conclusions This review highlights wide variation in reported RTW times after CTR. Whilst occupational factors may play a role, these were poorly reported, and there is currently limited evidence to inform individual patients of their expected duration of work absence after CTR. A standardized definition of RTW is needed, as well as an agreed method of collecting and reporting related data.

Highlights

Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder [1] and recommended treatment includes carpal tunnel release surgery (CTR) [2, 3]
Key terms Return to work; Elective hand surgery
Whilst there have been previous systematic reviews which included return to work (RTW) time after CTR as a measure of the effectiveness of different CTR interventions [5,6,7,8,9], these reviews have not explored the variation caused by occupational factors, such as the type of work, work pattern or whether participants were employed or self-employed

Summary

Introduction

Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disorder [1] and recommended treatment includes carpal tunnel release surgery (CTR) [2, 3]. Despite CTR being such a frequently performed procedure, there is currently no evidence-based guidance to inform patients and clinicians about when it is safe to return to work, or other activities, after their surgery. Whilst there have been previous systematic reviews which included return to work (RTW) time after CTR as a measure of the effectiveness of different CTR interventions [5,6,7,8,9], these reviews have not explored the variation caused by occupational factors, such as the type of work, work pattern or whether participants were employed or self-employed. We undertook a systematic review of the literature to address the following question: when do patients return to work after CTR, and how do occupational factors influence this timing?

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Conclusion