Pain, Disability in Daily Activities and Work Participation in Patients with Traumatic Hand Injury

Abstract

Traumatic hand injuries are represented in a large proportion of the patients treated at the out-patient department of occupational therapy in the VU University Medical Centre, Amsterdam. Most of the patients are referred to occupational therapy by specialists in the hospital. Information about the course of traumatic hand injuries regarding performance of daily activities is still limited. Research, focused on problems experienced by patients with hand injuries, may contribute to a better understanding of the course and rehabilitation of traumatic hand injuries. This article is a report of a cross-sectional observational study with the objective to: 1) describe the impact of traumatic injuries of the hand on daily activities and work participation six months after injury 2) to analyse the impact of demographic characteristics and type and severity of the injury on pain and ability to perform daily activities, and 3) to analyse the impact of demographic characteristics and type and severity of the injury on work participation and time off work (TOW). Fifty-eight patients completed a questionnaire six months after injury. The Disability of Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate disability in daily activities. A Numeric Rating Scale (NRS) was used to evaluate pain. Patients showed a mean DASH score of 22.5 (±19.3). The experience of pain and ethnicity were predictors of disability (p<0.001). The average TOW was 10.3 weeks (± 8.3). There was a significant difference (p=0.005) in TOW between Dutch patients (7.6 ± 5.8) and patients of another ethnicity (20.0 ± 8.9). Despite the reported disabilities in performing daily activities, almost all patients (91%) returned to their occupations within six months after hand injury. It is suggested that, for optimal rehabilitation, it may be necessary to focus more attention on the cultural background of the patients and the problems experienced in daily activities. Integration of evaluative instruments in hand therapy practice is advocated to guide therapy sessions, to measure outcome and to anticipate long-term problems in daily activities in an early stage of treatment.