Vocational rehabilitation for helping workers return to work after injuring their fingers, hand, or arm

What is the aim of this review?

We wanted to find out if vocational rehabilitation can help workers return to work after injuring their fingers, hand or arm.

Key messages

There is no evidence provided by randomised controlled trials (RCTs) to say if vocational rehabilitation can help workers with upper limb injuries return to work. These studies are needed, and they should be conducted and reported according to agreed standards for high-quality research. They should describe the content of vocational rehabilitation in detail. They should also report the number of workers that have returned to work at the end of follow-up or the time it took for them to return to work.

What was studied in the review?

Workers who injure their fingers, hand, or arm often cannot continue working normally. In many countries law compels employers to help workers when injuries affect their work ability. This help is often referred to as vocational rehabilitation. Vocational rehabilitation refers to ways to help disabled workers return to work or to find a new job. Return-to-work can be supported by helping the injured worker cope better, by workplace adjustments, or by physical exercises. Although all these strategies are used in practice, it is still unclear which approach is best and in which circumstances. This is an update of a Cochrane review previously published in 2013.

What are the main results of the review?

We examined all the research published up to 30 August 2017. We wanted to include only studies that randomly assigned participants to receive either vocational rehabilitation or some other treatment. This way of conducting research, commonly known as RCT, is the best way to ensure that any measured improvement is really caused by the treatment. We did not find any RCTs that had studied whether vocational rehabilitation can help workers with upper limb injuries return to work.

How up-to-date is this review?

We searched for studies up to 30 August 2017.

Authors' conclusions: 

There is currently no high-quality evidence to support or refute the efficacy of vocational rehabilitation for enhancing RTW in workers with traumatic upper limb injuries. Since injured people in occupational settings frequently receive vocational rehabilitation with the aim of decreasing work disability, enhancing RTW, increasing productivity, and containing the welfare cost, further high-quality RCTs assessing the efficacy of vocational rehabilitation for workers with traumatic upper limb injury are needed to fill this gap in knowledge.

Read the full abstract...
Background: 

Traumatic upper limb injury is a leading cause of work-related disability. After return-to-work (RTW), many survivors of injuries are able to regain a quality of life (QoL) comparable with the normal population. Since RTW plays an important role in economic productivity and regaining health-related QoL, enhancing RTW in workers with traumatic limb injuries is the primary goal of rehabilitation. Vocational rehabilitation has been commonly employed in the field of occupational safety and health to increase the number of injured people returning to the labour market, prevent illness, increase well-being, and reduce disability.

Objectives: 

To assess the effects of vocational rehabilitation programmes for enhancing RTW in workers with traumatic upper limb injuries.

Search strategy: 

This is an update of a Cochrane review previously published in 2013. We updated our searches of the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9), MEDLINE (to 30 August 2017), EMBASE (to 3 September 2017), CINAHL (to 6 September 2017), and PsycINFO (to 6 September 2017), and we handsearched the references lists of relevant review articles.

Selection criteria: 

We aimed to include all randomised controlled trials (RCTs) comparing vocational rehabilitation with an alternative (control) intervention such as standard rehabilitation, a limited form of the vocational rehabilitation intervention (such as advice on RTW, referral information, or liaison with employer), or waiting-list controls.

Data collection and analysis: 

Two authors independently inspected abstracts, and we obtained full papers when necessary. When the two authors disagreed about the inclusion of a study, we resolved disagreements by discussion. A third author arbitrated when necessary.

Main results: 

Our updated search identified 466 citations. Based on assessments of their titles and abstracts, we decided to evaluate the full texts of five records; however, none met our inclusion criteria.

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