Further development and validation of the Hamburger Prognosescores HandAF und HandDAU: Prediction of return to work and time off work in patients with hand injuries in the rehabilitation management provided by the German Social Accident Insurance

Status:

completed 02/2021

Aims:

The aim of the project was to review and further develop the Hamburger Prognosescore HandAF and Hamburger Prognosescore HandDAU developed in a pilot study (2012 to 2016) to predict the recovery of work ability or the duration of work disability from the start of rehabilitation management of patients with hand injuries. Specifically, the database for calculating the two prognosis scores was expanded by merging the data from the pilot study into a common data pool, both prognosis scores were recalculated and refined based on the combined data pool, and the goodness and predictive power of both prognosis scores were examined using the combined data pool. Furthermore, a protocol for the synchronization of the data of the project with the ICF(International Classification of Functioning Disability and Health)-based assessment ICF HandA from the former project Leuchtturmprojekt Hand (FR0189) was created and a manual as well as Excel applications for the calculation of the Hamburger Prognosescore HandAF and the Hamburger Prognosescore HandDAU were provided.

Activities/Methods:

The project was conducted as a monocentric, prospective longitudinal study (referred to below as the main study) at BG Clinic Hamburg. Standardized procedures and measuring instruments were used to record aspects of functioning and contextual factors, as well as data on disease-specific aspects at the beginning, during the course, and at the end of rehabilitation management. All patients with hand injuries who were treated in the rehabilitation management of the accident insurance institutions at the BG Clinic Hamburg were included. Inclusion criteria for the study were: age ≥ 18 years, diagnosis of single or multiple hand injuries, and presentation to at least one rehabilitation management session at BG Clinic Hamburg. The project was accompanied by an advisory board consisting of representatives of the participating accident insurance institutions, patient representatives and health professionals. The data of the study were analyzed descriptively, bivariately and multivariately.

A total of 346 patients with hand injuries (mean age 45.1 years, 80.4% male) were included in the main study. The patients participated in a mean of 2.9 rehabilitation management sessions (1 to 14 sessions). 87.6% of patients (n=303) achieved the ability to work with the completion of rehabilitation management.

A total of 870 patients were included in the combined data pool for validation and refinement of the two scores (pilot study: n=524; main study: n=346). Patients from both studies were largely homogeneous in terms of age, sex, marital status, education and occupation. In the combined data pool, a total of 88.7% of the patients reached work capacity. Among the work-eligible patients, work ability occurred on average 105.3 days after the start of rehabilitation management.

The Hamburger Prognosescore HandAF is calculated using 10 independent variables; these range from children living in the household, general health and the extent of physical stress at work to wrist mobility. The score has a good sensitivity of 70.5% and a specificity of 78.6%. The Hamburger Prognosescore HandDAU takes into account 21 independent variables such as injury to the long fingers, injury to the back of the hand, maximum muscle strength and sensitivity to cold. The score has a good quality.

Results:

The two scores provide control tools for rehabilitation management that can be used on admission to rehabilitation management to identify patients who have a high probability of continued inability to work or a delayed onset of work ability after completion of rehabilitation management. For patients at such risk, further rehabilitative or other work-related interventions can thus be assessed and initiated at an early stage. Thus, both scores can contribute to personalized care and rehabilitation and thus to a sustainable improvement of the social participation of patients with hand injuries.

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