Predictive Value of Disability Scoring Systems for Return-to-Work Outcomes in Hand and Forearm Injuries

Abstract

BACKGROUND: Predicting return-to-work (RTW) outcomes following upper extremity trauma is crucial for optimizing patient care, guiding rehabilitation, and reducing the socioeconomic burden. Although several disability scoring systems have been proposed to assess injury severity, their ability to estimate RTW status and duration remains underexplored. This study aimed to evaluate the predictive value of the Modified Hand Injury Severity Score (MHISS), Upper Extremity Disability Rate (UEDR), and Total Body Disability Rate (TBDR) for RTW outcomes in patients with hand, wrist, and forearm injuries. METHODS: A retrospective cross-sectional study was conducted on 69 patients who presented to the Forensic Medicine Department of Ondokuz Mayıs University between 2020 and 2024. Eligible participants were adults with documented hand, wrist, or forearm injuries and complete treatment records, including MHISS scoring. Demographic data, injury characteristics, and disability rates (UEDR, TBDR) were collected. Statistical analyses included Spearman correlation, receiver operating characteristic (ROC) analysis, and logistic regression to assess associations between scoring systems and RTW status and duration. RESULTS: The median MHISS score was 20.0, with corresponding UEDR and TBDR values of 3.0% and 2.0%, respectively. Occupational injuries, observed in 37.7% of cases, were associated with significantly higher disability scores (p<0.05). ROC analysis demonstrated strong predictive ability for MHISS (area under the curve [AUC]: 0.886), UEDR (AUC: 0.903), and TBDR (AUC: 0.897) in identifying RTW status. While MHISS effectively predicted RTW status, it did not correlate with RTW duration (p=0.082). In contrast, UEDR and TBDR showed weak but statistically significant correlations with RTW duration (r=0.295 and r=0.296, respectively). Multivariate logistic regression did not identify any independent predictors of RTW. CONCLUSION: Disability scoring systems such as MHISS, UEDR, and TBDR are useful tools for predicting whether patients will return to work following hand and forearm injuries. However, their ability to estimate the duration of work absence is limited. Future research should integrate psychosocial, occupational, and rehabilitation-related variables to develop more comprehensive models for RTW prognosis. © 2025, Turkish Association of Trauma and Emergency Surgery. All rights reserved.