Review of Time Off Needed for Patients with Hand Injuries
Occupational hand injuries in Hong Kong are high, estimated to represent about 40 percent of visits to emergency departments. In contrast, in Denmark, the rate is only about 26 percent. The issue of hand injuries is an important one because such injuries affect no only the social aspects of life, but the ability to work and earn an income, as well.

The length of time a patient remains off work due to a hand injury varies quite a bit. Deciding factors as to whether to stay home or go to work include issues like what type of job the patient does, the severity of the injury and the rehabilitation, if the patient receives compensation, and even the social and economic environment. The author of this study wanted to evaluate the average time of work lost due to hand injuries, as based on an injury severity score, as well as other factors.

Researchers recruited 124 subjects with hand injuries and they were followed for two weeks. Over half of the subjects worked in non-skilled labor. According to law in Hong Kong, if a person is injured on the job, he or she is entitled to compensation for up to two years, during which the patients undergo rehabilitation in preparation for the return to work. In a previous study, researchers found that those subjects who were off for long periods had a lower chance of returning to work. In other words, the longer people were off, the less likely they were to return to their job. They also found that women came back in higher numbers than did men.

In defining "time off work," researchers used the length of time between the initial hand injury and the return to work. The researchers then assessed the severity of the injuries by using the Hand Injury Severity Scale, HISS, which looks at the integument, skeletal, motor, and neural for each hand. This means if the hand was intact (integument), the condition of the hand's bones (skeletal), how the hand moved (motor), and if the nerves were affected (neural).

To assess the work the subjects did, their jobs were classified from one to five, according to their physical demand, from sedentary to very heavy. The researchers also looked to see if the injured hand was the dominant hand. The main injuries were: finger fracture (34 patients), tendon injury (28), simple laceration (tear or cut in the skin) (19), hand fracture (16), and crushing injury to the hand (7).

When analyzing the findings, the researchers found that of the 124 subjects, 109 returned to work, 10 were no longer working, two had changed jobs, and three were lost to follow-up. What made this group particularly interesting is that not all patients were compliant (went along with) treatment. In fact, 43 patients did not follow the complete treatment. They also found that half of the subjects performed sedentary jobs, making return to work easier. This was in comparison with those in the very heavy jobs, among whom only nine returned to work and four were unemployed after the treatment ended.

Among the subjects who returned to work, the average length of time off work was about eight weeks and the average length of rehabilitation was nine weeks. The severity of the injury and presence of complications did affect the length of time a subject would be off work. There did not seem to be any differences between subjects who did or did not go to work in terms of age, gender, or if the injured hand was dominant. There also did not appear to be any differences between the subjects regarding if the injury occurred while at work, if there was posttraumatic stress, or if there was adequate social support. There was, however, a difference between those who had complications and those who had physically demanding jobs. Those who were unemployed after the injury had a higher rate of complications and were more likely to have a demanding job. Education also appeared to play a role; those who had less education were more likely to be unemployed.

The author concluded that the severity of injury, number of operations, and whether a subject received compensation while off work all played a role in how long they stayed off work. She wrote that these findings should help physicians understand the effects of the injury on work.
Joyce Y.P. Wong, MMed.Sc. Time Off Work in Hand Injury Patients. In Journal of Hand Surgery. June 2008. Volume 33. No. 5. Pp. 718-725.