title: Expert consensus on facilitators and barriers to return-to-work following surgery for non-traumatic upper extremity conditions: a Delphi study.
abstract: This Delphi study aimed to reach consensus on important facilitators and barriers for return-to-work following surgery for non-traumatic upper extremity conditions. In Round 1, experts ( n = 42) listed 134 factors, which were appraised in Rounds 2 and 3. Consensus (⩾85% agreement) was achieved for 13 facilitators (high motivation to return-to-work; high self-efficacy for return-to-work and recovery; availability of modified/alternative duties; flexible return-to-work arrangements; positive coping skills; limited heavy work exertion; supportive return-to-work policies; supportive supervisor/management; no catastrophic thinking; no fear avoidance to return-to-work; no fear avoidance to pain/activity; return to meaningful work duties; high job satisfaction) and six barriers (mood disorder diagnosis; pain/symptoms at more than one musculoskeletal site; heavy upper extremity exertions at work; lack of flexible return-to-work arrangements; lack of support from supervisor/management; high level of pain catastrophizing). Future prognostic studies are required to validate these biopsychosocial factors to further improve return-to-work outcomes.
  
  
  METHODS
  V.
authors.affiliation: 1 Occupational Therapy, The University of Queensland, St Lucia, Brisbane, Australia.|2 Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia.
authors.forename: S E
authors.initials: SE
authors.lastname: Peters
authors.affiliation: 3 Physiotherapy, The University of Queensland, St Lucia, Brisbane, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Johnston
authors.affiliation: 2 Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia.|4 Department of Orthopaedic Surgery, Princess Alexandra Hospital, Woolloongabba, Australia.|5 Orthopaedic Surgery, The University of Queensland, St Lucia, Brisbane, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Ross
authors.affiliation: 3 Physiotherapy, The University of Queensland, St Lucia, Brisbane, Australia.|6 MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Coppieters
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D032921:Consensus; D003697:Delphi Technique; D005239:Fear; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009140:Musculoskeletal Diseases / Q000503:physiopathology* / Q000523:psychology* / Q000601:surgery; D017063:Outcome Assessment, Health Care; D062707:Return to Work; D034941:Upper Extremity; D055815:Young Adult
keywords: Hand; prognostic factors; shoulder; sickness absence; work disability; wrist