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

Review question

Can vocational rehabilitation help workers return to work after having injured their fingers, hand or arm?

Background

Injuries sustained to fingers, hand, or arm can seriously limit a person's ability to continue working normally. In many countries law compels employers to help injured workers when the injury affects their work ability. This help is often referred to as vocational rehabilitation.

What is vocational rehabilitation?

Vocational rehabilitation consists of a range of ways to help disabled workers return to work or to find a new job. Return-to-work (RTW) 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, there is no evidence in the form of systematic reviews on which approach is best and in which circumstances.

What does the research show?

We examined all the published research up to 5 May 2013. We wanted to include studies only if getting vocational rehabilitation or some other treatment was determined by chance. This way of conducting research, known as a randomised controlled trial (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 if vocational rehabilitation can help workers with upper limb injuries return to work.

Conclusion

There is no evidence from RCTs to say if vocational rehabilitation can help workers with upper limb injuries return to work. We need RCTs conducted with workers with upper limb injuries to see if vocational rehabilitation can improve their RTW. These studies 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.

Authors' conclusions: 

There is currently no high-level evidence to support or refute the efficacy of vocational rehabilitationin enhancing RTW in workers with traumatic upper limb injuries. Since vocational rehabilitation has frequently been provided to injured people in occupational settings 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 adapted in the field of occupational safety and health to enhance 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 programs in enhancing RTW of workers with traumatic upper limb injuries.

Search strategy: 

We searched OSH UPDATE databases (CISDOC, HSELINE, International Bibliographic, NIOSHTIC, NIOSHTIC-2, RILOSH) (up to 10 December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 11), MEDLINE through PubMed (up to 15 November 2012), EMBASE (up to 28 November 2012), CINAHL (up to 5 May 2013), PsycINFO (up to 7 December 2012), and handsearched the reference 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, an incomplete form of the vocational rehabilitation intervention (such as with limited 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 search identified 332 citations. Based on assessments of their titles and abstracts, we decided to evaluate the full texts of 15 citations. In the end, none of these 15 citations met our inclusion criteria.

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