Date Presented 03/31/2022

This scoping review identified various nonphysical factors that affect return to work (RTW) after an upper extremity injury. Themes that were identified included self-efficacy, social determinants of health, and a need for holistic intervention approaches. Clinicians should remain cognizant of addressing psychosocial well-being and social determinants of health that can affect RTW to foster improved engagement in and resumption of work. Outcome measures that identify these factors are defined.

Primary Author and Speaker: Michael J. Gerg

Additional Authors and Speakers: Kristin Hazak

Contributing Authors: Vanessa Jewell, Naomi Melendez, Brittany Hoffman

PURPOSE: Upper extremity injuries may prevent adults from returning to work, impacting productivity, and engagement in meaningful employment. According to the U.S. Bureau of Labor Statistics, there were 286,810 working age adults who experienced upper extremity injuries that resulted in lost working days in 2018 (, 2018). There is a growing body of research that supports the premise that there are non-physical as well as physical factors that can have an effect on return to work (RTW). As many as 42 different factors may impact RTW after an upper extremity injury (Buchanan, Niekirk, & Grimmer, 2020). While many of these factors are related to the physical impact of the injury itself, some are related to factors that are non-physical in nature (i.e., education level, coping) (Marom, Ratzon, Carel & Sharabi, 2019). The purpose of this project was to complete a scoping review that identified the various non-physical factors that impact RTW after sustaining an upper extremity injury in order to inform occupational therapy practitioners in making best practice decisions when working with this client population.

DESIGN: Scoping review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews methodology.

METHOD: A comprehensive electronic literature search was conducted of four databases: CINAHL, PsycINFO, PubMed, and the Cochrane Database of Systematic Reviews. The authors further hand searched the journals Work and The Journal of Hand Therapy. Inclusion criteria included articles published in English, published from 2000-2020, and addressed the following topics: upper extremity injury, the client’s psychosocial perceptions of the injury, and return to work.

RESULTS: The initial search of the literature yielded 40 articles that met the inclusion criteria. After duplicate titles were removed, 31 articles remained. The researchers reviewed the remaining titles and abstracts and 10 additional articles were excluded as a result. The final 21 articles were read in full and matrixed by the researchers, and 12 additional articles were excluded based on consensus. After title and abstract review, 9 studies were identified for full-text review that examined various patterns related to non-physical factors that impact RTW. Although the articles were published in eight different countries, three themes emerged from the full-text reviews including client self-efficacy, social determinants of health, and the need for holistic intervention approaches. There was some commonality noted in the use of outcome measures to determine client levels of self-efficacy [i.e., Disabilities of Arm, Shoulder, and Hand (DASH/QuickDASH), Short Form Health Survey (SF-36)].

CONCLUSIONS: Based on the findings of this scoping review, it is highly recommended that occupational therapists providing care to working age clients with upper extremity injuries incorporate holistic intervention approaches into their practice. Holistic approaches consider not only the physical, but also the psychological and social aspects of the client that are affected by the injury. Additional research is required to further explore the themes found in this scoping review and how upper extremity rehabilitation practitioners can address them in practice. Due to the paucity of evidence to support the efficacy and effectiveness of RTW interventions in the United States, more research is recommended.

IMPACT STATEMENT: This scoping review demonstrates the necessity to remain conscious of non-physical factors such as psychosocial issues and the social determinants of health when treating individuals with upper extremity injuries as they can influence injury perception, recovery, and motivation to return to work.


Buchanan, H., Van Niekerk, L., & Grimmer, K. (2020). Work transition after hand injury: A scoping review. Journal of hand therapy : official journal of the American Society of Hand Therapists, S0894-1130(20)30186-1. Advance online publication.

Marom, B. S., Ratzon, N. Z., Carel, R. S., & Sharabi, M. (2019). Return-to-Work Barriers Among Manual Workers After Hand Injuries: 1-Year Follow-up Cohort Study. Archives of physical medicine and rehabilitation, 100(3), 422–432.

United States Bureau of Labor Statistics. (2018). Non fatal injury database (Table R31) [Data set].