ORIGINAL ARTICLE

The role of job strain on return to work after carpal tunnel surgery

D Gimeno¹, B C Amick, III^1,2, R V Habeck³, J Ossmann¹, J N Katz⁴

¹ Southwest Center for Occupational and Environmental Health, School of Public Health, University of Texas-Houston Health Science Center, Houston, TX, USA
² Texas Program for Society and Health, Rice University, Houston, Texas, USA and Institute for Work and Health, Toronto, Ontario, Canada
³ WE Upjohn Institute for Employment Research, Kalamazoo, MI, USA
⁴ Division of Rheumatology, Immunology and Allergy, Departments of Medicine and Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

Correspondence to:
Correspondence to:
Dr D Gimeno
Southwest Center for Occupational and Environmental Health, The University of Texas School of Public Health, Health Science Center at Houston, 1200 Herman Pressler Street, RAS W1004D, PO Box 20186, Houston, Texas 77225-0186 USA; David.Gimeno.1{at}uth.tmc.edu

Aims: To examine the impact of job strain (that is, high psychological job demands and low job control) on return to work and work role functioning at two months, six months, or both, following carpal tunnel release surgery.

Methods: A community based cohort of carpal tunnel syndrome (CTS) patients from physician practices was recruited between April 1997 and October 1998 throughout Maine (USA). 128 patients at two months and 122 at six months completed all relevant questions. A three level outcome variable indicated whether patients had: (1) returned to work functioning successfully, (2) returned to work functioning with limitations, or (3) not returned to work for health reasons. Two job strain measures were created: one, by combining psychological job demands and job control; and two, by dividing demands by control. Ordinal logistic regression was used to identify predictors of the three level work outcome variable.

Results: After adjustment, workers with high demands and high control (active work) were less likely to successfully return to work (OR = 0.22; p = 0.014) at two months. Having a job with higher demands than job control (high strain) predicted not returning to work or returning to work but not successfully meeting job demands (OR = 0.14; p = 0.001), at six months.

Conclusions: The findings underscore the role of psychosocial work conditions, as defined by the Karasek demand-control model, in explaining a worker’s return to work. Clinicians, researchers, and employers should consider a multidimensional and integrative model of successful work role functioning upon return to work. Moreover, since the evidence of the effects of work process changes on the reduction of CTS is very scarce, these findings point to the opportunity for collaborative workplace interventions to facilitate successful return to work.

Abbreviations: CTS, carpal tunnel syndrome; JCQ, Job Content Questionnaire

Keywords: work organisation; carpal tunnel syndrome; job strain; prospective design; work role functioning

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