title: Determinants of return to work after carpal tunnel release.
abstract: OBJECTIVE
  The determinants of time to return to work-a common measure of treatment effectiveness-are incompletely defined. Our primary hypothesis was that employment circumstances are the strongest determinant of earlier return to work. Our secondary hypothesis was that return to work in patients with desk-based jobs is predicted by patient expectations and other psychosocial factors.
  
  
  METHODS
  We enrolled 65 employed patients with limited incision open carpal tunnel release in a prospective cohort study. Patients completed validated measures of depression, coping strategies, pain anxiety, and job burnout. Heavy lifting was not allowed for 1 month after surgery. Return to modified and full work duty was recorded in days. Although not specifically an exclusion criterion, none of the patients had a workers' compensation claim or other source of secondary gain.
  
  
  RESULTS
  Patients returned to modified duty an average of 11.8 days and full duty at an average of 18.9 days after surgery. Predictors of earlier return to modified duty in multivariate analyses included desk-based work and both the number of days patients expected to take off and the numbers of days they wanted to take off for the entire cohort, with an additional influence from catastrophic thinking in desk-based workers. Predictors of earlier return to full duty in multivariate analyses included desk-based work and number of days patients expected to take off before for the entire cohort, fewer days off desired in non-desk-based workers, fewer days off desired and change in work role in desk-based workers, and lower pain anxiety in part-time workers.
  
  
  CONCLUSIONS
  The most important determinant of return to full duty work after limited incision open carpal tunnel release is job type, but psychological factors such as patient expectations, catastrophic thinking, and anxiety in response to pain also have a role.
  
  
  METHODS
  Prognostic II.
authors.affiliation: Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: James
authors.initials: J
authors.lastname: Cowan
authors.forename: Heeren
authors.initials: H
authors.lastname: Makanji
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Mudgal
authors.forename: Jesse
authors.initials: J
authors.lastname: Jupiter
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D003289:Convalescence; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009790:Occupations; D010147:Pain Measurement; D011446:Prospective Studies; D018582:Sick Leave / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014942:Workers' Compensation / Q000706:statistics & numerical data; D014945:Wound Healing / Q000502:physiology