Fatores associados ao retorno ao trabalho após um trauma de mão: uma abordagem qualiquantitativa

Abstract

The aims of the present study were to converse with workers that had returned to work after a hand injury and analyze the factors associated to this outcome three years after release from a specialized health center. An observational, cross-sectional cohort study was carried out with quantitative and qualitative approaches. The quantitative analysis employed a databank with information on 35 individuals classified into two groups (returned/did not return to work). The sample was described with regard to gender, age, marital status, schooling, work status, type of accident, occupation, affected side, dominant side, injury-causing agent, diagnosis, duration of professional activity, duration of rehabilitation, grip strength and occupational performance (COPM). A descriptive analysis was initially carried out on the sample. Central tendency and dispersion measurements of the quantitative variables were described in relation to returning to work (RW). The Levene test was employed to determine the equality of variances in grip strength on both the affected and non-affected sides. The T test for independent samples was employed in the association of grip strength and RW. The non-parametric Mann-Whitney test was used in the comparison of the groups regarding the quantitative variables and Fisher's exact test was used for the nominal variables (=0.05). Multivariate analysis was conducted using the CART algorithm to assess the predictive relevance of the four models, thereby identifying workers that had either returned or not returned to work. The SPSS 12.0 and Answertree 2.0 statistical packages were employed. The qualitative analysis was carried out after conducting semi-structured interviews with seven workers from the sample. Among the overall sample studied, 85.7% were male, married (57.1%), with an average age of 37 years and a low level of schooling (54.3%). The most frequent occupations were production of goods/industrial services (65.7%) and commerce/services (20%). Typical work accidents totaled 94.3%. The most frequent diagnoses were: tendon injuries (37.1%) and fractures (22.9%). Machines (54.3%) and perforation/cutting materials (22.9%) were the main injury-causing agents. The non-dominant side was the more affected side (54.3%). Grip strength and occupation category presented a positive association to RW. The multivariate analysis indicated that the variables with greater predictive power were grip strength, COPM scores, occupation category and age. The qualitative analysis confirmed the multi-factor nature of RJ and demonstrated that the importance of work in the lives of workers and the significance of incapacity can assist in the understanding of this process. The present study evidenced the complexity of RW among workers with hand injuries, highlighting a number of factors associated with this outcome and the importance of an individualized assessment centered on the worker.