Original research| Volume 100, ISSUE 3, P422-432, March 2019

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

Published:August 18, 2018DOI:



      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.


      A cohort study with baseline medical information, functional evaluation, and 3-, 6-, 9-, and 12-month follow-up telephone interviews.


      Seven physical rehabilitation community occupational therapy clinics.


      Participants (N=178) with acute HI aged 22-65. Two participants were lost to follow-up.


      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.


      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.


      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.


      List of abbreviations:

      95% CI (95% confidence interval), HI (hand injury), ICF (International Classification of Functioning, Disability and Health), NII (National Insurance Institute of Israel), RTW (return to work), TRTW (time of return to work)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rosberg H.-E.
        • Carlsson K.S.
        • Cederlund R.I.
        • Ramel E.
        • Dahlin L.B.
        Costs and outcome for serious hand and arm injuries during the first year after trauma—a prospective study.
        BMC Public Health. 2013; 13: 501
        • Sorock G.S.
        • Lombardi D.A.
        • Courtney T.K.
        • Cotnam J.P.
        • Mittleman M.A.
        Epidemiology of occupational acute traumatic hand injuries: a literature review.
        Safety Sci. 2001; 38: 241-256
        • Ramel E.
        • Rosberg H.-E.
        • Dahlin L.B.
        • Cederlund R.I.
        Return to work after a serious hand injury.
        Work. 2013; 44: 459-469
        • de Jong J.P.
        • Nguyen J.T.
        • Sonnema A.J.M.
        • Nguyen E.C.
        • Amadio P.C.
        • Moran S.L.
        The incidence of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study.
        Clin Orthop Surg. 2014; 6: 196-202
        • Shi Q.
        • Sinden K.
        • MacDermid J.C.
        • Walton D.
        • Grewal R.
        A systematic review of prognostic factors for return to work following work-related traumatic hand injury.
        J Hand Ther. 2014; 27: 55-62
        • Cancelliere C.
        • Donovan J.
        • Stochkendahl M.J.
        • et al.
        Factors affecting return to work after injury or illness: best evidence synthesis of systematic reviews.
        Chiropr Man Therap. 2016; 24: 32
        • National Safety Council
        Injury facts: the source for injury stats.
        (Available at:)
        • Laaksonen M.
        • Gould R.J.
        Return to work after temporary disability pension in Finland.
        J Occup Rehabil. 2015; 25: 471-480
      1. Üstün T. Kostanjsek N. Chatterji S. Rehm J. Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0). World Health Organization, Geneva, Switzerland2010 (Available at:)
        Date accessed: October 1, 2018
      2. Rehabilitation of the hand and upper extremity. Vol. 1-2. Elsevier, Philadelphia2011
        • Sharon A.
        Relationship between psychosocial variables, function and return to work after work injury (in Hebrew) [thesis].
        Tel Aviv University, 2002
        • Nathan P.A.
        • Keniston R.C.
        • Meadows K.D.
        • Lockwood R.S.
        Validation of occupational hand use categories.
        J Occup Med. 1993; 35: 1034-1042
        • Karasek R.
        • Theorell T.
        Healthy work: stress productivity and the reconstruction of working life.
        Basic Books, New York1990
        • Urso-Baiarda F.
        • Lyons R.A.
        • Laing J.H.
        • Brophy S.
        • Wareham K.
        • Camp D.
        A prospective evaluation of the modified hand injury severity score in predicting return to work.
        Int J Surg. 2008; 6: 45-50
        • MacDermid J.C.
        • Roth J.H.
        • McMurtry R.
        Predictors of time lost from work following a distal radius fracture.
        J Occup Rehabil. 2007; 17: 47-62
        • MacDermid J.C.
        Baseline predictors of pain and disability six month following distal radius fractures.
        ([dissertation]) University of Western Ontario, London, Ontario1999
        • Katz J.
        • Melzack R.
        Measurement of pain.
        Surg Clin North Am. 1999; 79: 231-252
        • Schwarzwald J.
        • Solomon Z.
        • Weisenberg M.
        • Mikulincer M.
        Validation of the impact of event scale for psychological sequelae of combat.
        J Consult Clin Psychol. 1987; 55: 251-256
        • Kennedy C.A.
        • Beaton D.E.
        • Solway S.
        • McConnell S.
        • Bombardier C.
        Disabilities of the Arm, Shoulder and Hand (DASH). The DASH and QuickDASH Outcome Measure User’s Manual.
        Third Edition. Institute for Work & Health, Toronto, Ontario2011
        • Marom B.S.
        • Carel R.S.
        • Sharabi M.
        • Ratzon N.Z.
        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.
        Disabil Rehabil. 2017; 39: 1155-1161
        • Seftchick J.L.
        • DeTullio L.M.
        • Fedorczyk J.M.
        • Aulicino P.L.
        Clinical examination of the hand.
        in: Rehabilitation of the hand and upper extremity. Vol. 1. Elsevier, Philadelphia, PA2011: 55-71
        • Fess E.E.
        Functional tests.
        in: Rehabilitation of the hand and upper extremity. Vol. 1. Elsevier, Philadelphia2011: 152-162
        • Jebsen R.H.
        • Taylor N.
        • Trieschmann R.B.
        • Trotter M.J.
        • Howard L.A.
        An objective and standardized test of hand function.
        Arch Phys Med Rehabil. 1969; 50: 311-319
        • Clay F.J.
        • Fitzharris M.
        • Kerr E.
        • McClure R.J.
        • Watson W.L.
        The association of social functioning, social relationships and the receipt of compensation with time to return to work following unintentional injuries to Victorian workers.
        J Occup Rehabil. 2012; 22: 363-375
        • National Insurance Institute of Israel
        Work disability benefit.
        (Available at:)
        • Casey P.P.
        • Feyer A.M.
        • Cameron I.D.
        Associations with legal representation in a compensation setting 12 months after injury.
        Injury. 2015; 46: 918-925
        • Harris I.A.
        • Young J.M.
        • Jalaludin B.B.
        • Solomon M.J.
        The effect of compensation on general health in patients sustaining fractures in motor vehicle trauma.
        J Orthop Trauma. 2008; 22: 216-220
        • Franche R.L.
        • Krause N.
        Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors.
        J Occup Rehabil. 2002; 12: 233-256
        • Norrefalk J.R.
        • Ekholm J.
        • Borg K.
        Ethnic background does not influence outcome for return-to-work in work-related interdisciplinary rehabilitation for long-term pain: 1- and 3-year follow-up.
        J Rehabil Med. 2006; 38: 87-92
        • Gary K.W.
        • Arango-Lasprilla J.C.
        • Ketchum J.M.
        • et al.
        Racial differences in employment outcome after traumatic brain injury at 1, 2, and 5 years postinjury.
        Arch Phys Med Rehabil. 2009; 90: 1699-1707
        • Poerbodipoero S.J.
        • Steultjens M.P.
        • Van Der Beek A.J.
        • Dekker J.
        Pain, disability in daily activities and work participation in patients with traumatic hand injury.
        Hand Ther. 2007; 12: 40-47
        • Asher A.L.
        • Devin C.J.
        • Archer K.R.
        • et al.
        An analysis from the Quality Outcomes Database, Part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease.
        J Neurosurg Spine. 2017; 27: 370-381
        • Campbell C.M.
        • Edwards R.R.
        Ethnic differences in pain and pain management.
        Pain Manag. 2012; 2: 219-230
        • Black R.M.
        Culture, race, and ethnicity and the impact on occupation and occupational performance.
        in: Schell B.A. Gillen G. Scaffa M.E. Willard and Spackman’s occupational therapy. 12th ed. Lippincott Williams & Williams, Baltimore, MD2014: 173-187
        • Sharabi M.
        The relative centrality of life domains among Jews and Arabs in Israel: the effect of culture, ethnicity, and demographic variables.
        Community Work Fam. 2014; 17: 219-236
        • Clarfield A.M.
        • Manor O.
        • Bin Nun G.
        • et al.
        Health and health care in Israel: an introduction.
        Lancet. 2017; 389: 2503-2513
        • Chiang M.
        • Carlson G.
        Occupational therapy in multicultural contexts: issues and strategies.
        Br J Occupat Ther. 2003; 66: 559-567
        • Arango-Lasprilla J.C.
        • Ketchum J.M.
        • Stevens L.F.
        • et al.
        Ethnicity/racial differences in employment outcomes following spinal cord injury.
        NeuroRehabilitation. 2009; 24: 37-46
        • Arango-Lasprilla J.C.
        • Ketchum J.M.
        • Lewis A.N.
        • Krch D.
        • Gary K.W.
        • Dodd Jr., B.A.
        Racial and ethnic disparities in employment outcomes for persons with traumatic brain injury: a longitudinal investigation 1-5 years after injury.
        PM R. 2011; 3: 1083-1091
        • Dean S.G.
        • Hudson S.
        • Hay-Smith E.J.
        • Milosavljevic S.
        Rural workers’ experience of low back pain: exploring why they continue to work.
        J Occup Rehabil. 2011; 21: 395-409
        • Katz J.N.
        • Amick 3rd, B.C.
        • Keller R.
        • et al.
        Determinants of work absence following surgery for carpal tunnel syndrome.
        Am J Ind Med. 2005; 47: 120-130
        • Labriola M.
        • Lund T.
        • Christensen K.B.
        • et al.
        Does self-efficacy predict return-to-work after sickness absence? A prospective study among 930 employees with sickness absence for three weeks or more.
        Work. 2007; 29: 233-238
        • Arnstein P.
        The mediation of disability by self efficacy in different samples of chronic pain patients.
        Disabil Rehabil. 2000; 22: 794-801
        • Roessler R.T.
        Improving job tenure outcomes for people with disabilities.
        Rehabil Couns Bull. 2002; 45: 207-212
        • Opsteegh L.
        • Reinders-Messelink H.A.
        • Schollier D.
        • et al.
        Determinants of return to work in patients with hand disorders and hand injuries.
        J Occup Rehabil. 2009; 19: 245-255
        • Cederlund R.
        • Thorén-Jönsson A.L.
        • Dahlin L.B.
        Coping strategies in daily occupations 3 months after a severe or major hand injury.
        Occup Ther Int. 2010; 17: 1-9
        • Sahin F.
        • Akca H.
        • Akkaya N.
        • Zincir Ö.D.
        • Işik A.
        Cost analysis and related factors in patients with traumatic hand injury.
        J Hand Surg Eur Vol. 2013; 38: 673-679
        • Skov O.
        • Jeune B.
        • Lauritsen J.M.
        • Barfred T.
        Time off work after occupational hand injuries.
        J Hand Surg Br. 1999; 24: 187-189
        • Whelan L.R.
        Assessing abilities and capacities: range of motion, strength, and endurance.
        in: Radomski M.W. Trombly C.A. Occupational therapy for physical dysfunction. 7th ed. Wolters Kluwer Health, Philadelphia2014: 144-241