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					Return to work with upper limb impairments: combined
effort to recognize negative outcomes in advance
Moshe S.1, Izhaki R.2, Chodick G.3, Yagev Y.4, Slodownik D.5,
Juven Y.6
Maccabi Healthcare Services - Occupational Medicine Clinics:
1Jerusalem & HaShfela District, 2Occupational Therapy Clinic,
Jerusalem & HaShfela District; 3Medical Informatics Dept.
4HaNegev District; 5Department of Dermatology, Hadassah
University Medical Center, Jerusalem, Israel6Central District

Background: Return to work (RTW) is a key goal in proper
management of Upper limb disorders (ULD). Impairments stem
from diverse medical etiologies, and numerous variables have
some impact on RTW. The abundance of factors, their complex
interactions and the diversity in human behavior has made it
difficult to pinpoint those at risk, and to efficiently intervene.
Objective:       To weigh various clinical, functional and
occupational parameters and identify RTW predictors.
Methods: Retrospective study analyzing data of 52 workers
referred to an occupational clinic to assess their fitness to work
due to ULD. Participants were further examined by an
occupational therapist. Functional assessment included
objective parameter (e.g. grip & pinch strength, FDT) as well as
subjective ones (DASH scores). Quantifying work requirements
was based on a match between job title and an “on line” data
base scale – Dictionary of titles (DOT). RTW status was based
on a follow up telephone questionnaire.
Results: There were no differences between the groups in
distribution of socio demographic or vocational parameters. As
opposed to all other clinical variables, only the DASH score was
different (p<0.001). Patients who did not RTW valued their
disability as substantially greater (55%) than those who did
Conclusions: Physicians and Rehabilitation staff should regard
a high Dash Score as a warning sign when assessing RTW
prospects. It is advisable to focus on workers with large
discrepancy between a high DASH score and low objective
disability and concentrate efforts to guide RTW.

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