Background
Methods
Study design and research team
Participants and recruitment
Data collection
Analysis
Results
Participants
Pseudonym | Sex | Age category (years) | Healthcare setting | Type of work contracta | Work role | Available sick pay | Dominant hand | Side of CTR | Post-operative work absence (days) | Interview timing (days after surgery) | |
---|---|---|---|---|---|---|---|---|---|---|---|
Expected | Actual | ||||||||||
Jill | F | 51–60 | NHS 2 | Employed | Sales assistant | Unsure | Right | Right | 14 | 21 | 119 |
Debbie | F | 51–60 | NHS 1 | Employed | Nurse | > 6 months | Right | Right | 21 | 21 | 152 |
Alan | M | 51–60 | NHS 1 | Self-employed | Maintenance | < 1 week | Right | Right | 7 | 7 | 151 |
Sarah | F | 61–70 | NHS 1 | Self-employed | Stable owner | > 6 months | Right | Right | NR | 0 | 123 |
Peter | M | 51–60 | NHS 2 | Employed | Mechanic | < 1 week | Right | Left | 21 | 16 | 130 |
Emma | F | 51–60 | NHS 2 | Employed | Optician | 1–6 months | Both | Left | 42 | 42 | 115 |
George | M | 61–70 | NHS 2 | Self-employed | Gardener | < 1 week | Left | Right | 21 | 14 | 155 |
Helen | F | 51–60 | NHS 1 | Employed | Nurse | > 6 months | Right | Right | 21 | 8 | 149 |
Fiona | F | 21–30 | NHS 1 | Employed | Animal technician | 1–6 months | Right | Right | 21 | 21 | 160 |
Donna | F | 31–40 | NHS 2 | Employed | Police officer | 1–6 months | Right | Left | 14 | 42 | 118 |
Charlotte | F | 41–50 | NHS 2 | Employed | Postal worker | 1–6 months | Right | Right | 21 | 98 | 119 |
Vicky | F | 41–50 | Private | Employed | Secretary | 1–6 months | Right | Right | 7 | 4 | 114 |
Amanda | F | 41–50 | Private | Employed | Administrator | > 6 months | Right | Right | 14 | 6 | 155 |
Alison | F | 41–50 | NHS 2 | Zero hours contract | Carer | < 1 week | Right | Right | 21 | 28 | 94 |
Key themes
Theme 1: CTR is not a ‘minor’ procedure | ||
“I suppose actually just mentally preparing myself, because obviously, I’d never had any surgery done on a hand or a foot, or anything like that before. Obviously, you don’t realise beforehand how frustrating it’s going to be to not be able to use it, if that makes sense? I even struggled with going for a shower, trying to wash your hair and things like that. I had to get my partner, bless him, to wash my hair. It’s just mentally preparing yourself- To not be able to do as much as you would normally, but I suppose that’s the same for any surgery. I suppose I just didn’t prepare myself for what I could and couldn’t do.”
Fiona, animal technician (employed) | ||
“A lot of people don’t realise, do they, how much is involved with carpal tunnel [surgery]. They think, “Oh, it’s just your hand. It’s just a minor op[eration].” But actually, it does affect you a lot in your working areas, wherever you are, whatever you do. They don’t realise how much it is going to affect the daily activities of living afterwards.”
Debbie, nurse (employed) | ||
Theme 2: Validation of the time taken off work | ||
i. Is the sick note a barrier for earlier return to work? | ii. It held more weight coming from the surgeon | iii. The patient role in the prescription of sick leave |
“Not really [I don’t recall any advice about returning to work]. Not that I remember. Only more about how much time to take off”
Amanda, administrator (employed) |
“At least I could give them fair warning, which was fine. And the fact that I had a doctor’s certificate. I had the surgery, and the surgeon said, “No, I will give a certificate straight off for 2 weeks anyway.” So I had warned the employers that 2 weeks [would be the] minimum.”
Alison, carer (zero hours contract) |
“Probably just be more steadfast in our own opinion because I felt, not intimidated, that’s the wrong word, I just thought, “Well, because they’re an expert, they know better than me.” I could see myself and I could feel myself that I wasn’t ready to use my hand and it didn’t feel as if I should have had the stitches out.”
Emma, optician (employed) |
“I just… Obviously took in my sick note that the hospital gave me and I just said I’ll keep in touch and see how we go.”
Peter, Mechanic (employed) | ||
Theme 3: Handling the return | ||
i. Making a graded return to work duties | ii. Travelling to work | |
“I was a bit anxious about coming back to work. I knew I still had trouble using my hand. I would have like a phased return to work. I don’t think they would have been supportive... I needed someone to sit down and say, ‘Look, [Emma] can’t come back full time. She needs to come in at 2:00 pm and go home at 4:00 pm’.” Whatever.
Emma, optician (employed) |
“I had it done over the weekend, and within a couple of days I was back driving, because I had absolutely nil pain from the wound. The pain that I used to get when driving was totally gone.”
Sarah, stable owner (self-employed) | |
“Like, getting in the car, I didn’t drive for over 2 weeks... I didn’t feel happy to because my wrist felt, I don’t know, just not quite strong enough. I was worried. It’s alright if the roads aren’t busy and you could just go along, but if I had to react to something quickly, I didn’t feel comfortable with that. Yes. I was told, advised for 2 weeks not to [drive] and then to see how I felt after that.”
Amanda, administrator (employed) | ||
“I was never forced into anything. It was always my decision as to whether I was happy or not. Certainly, my sergeants and inspectors have been very good and were just keen to do whatever is necessary to get me back out on the frontline again.”
Donna, police officer (employed) |
Theme 1: CTR is not a ‘minor’ procedure
“You don’t realise how much you depend on your hands until you can’t use them. I managed to adapt with having a shower and sticking my hand out behind the curtain (laughter). But washing hair and drying hair was an absolute nightmare. It didn’t happen properly. Cooking, yes, was a nightmare. I found I couldn’t lift a saucepan properly with my left hand. It wasn’t as strong as my dominant hand. And even cutting up your dinner, you really don’t realise. You do find ways to adapt in the end, but you just don’t realise how you rely on your dominant hand all the time. It was a good fortnight to be able to even grip a knife to cut anything properly. I just couldn’t grip it. It was too painful across the palm of the hand where the cut was, to grip the knife… But I think I would have prepared for it a bit more. Yes. Or even roped a friend in more to come and do things for me.”Debbie, nurse (employed).
“I was just told to keep it dry. No washing up. I was just told what I couldn’t do, rather than anything that might help me do day-to-day tasks… I think the exercises could have been given in a different way. I was just given a sheet of paper. It was in my pack, it wasn’t even pointed out to me. I found it in my pack. The trouble is in hospital, they give you lots of information, but it’s in a pack”.Emma, optician (employed).
Theme 2: validation of the time taken off work
“He did sign me off for 3 weeks. He said, “Because of my work,” but obviously, after the 2 weeks, I went to see him and I had the stitches out… Yes. He said then, “You can return to work but on lighter duties.” He said he’s done the sick note for 3 weeks, so it was up to me really… I was thinking about going back to work after 2 weeks, but that’s just because you get a bit bored at home when you’ve got nothing to do. I’m glad I took the 3 weeks, because if I went back after 2 weeks, I would have done more than what I should have done… If your surgeon signs you off for a certain amount of time, I would take that, all of that time, to recover properly.”Fiona, animal technician (employed).
“I went back to work as soon as I possibly could, you know, because no one’s going to pay me if I don’t earn money…. Probably a little bit too early, I did jump the gun a little bit, but now I’m okay, so it’s all good”.Alan, maintenance worker (self-employed).
“[The fit/sick note] was given to me straight away, so I didn’t have to ask for it. It did. That lasted the whole period. That was one of the most helpful things. Having the six-week note from the surgeon, rather than having to go to my GP. It held more weight, coming from the surgeon.”Emma, optician (employed).
“I think, on reflection, had I had an interview before returning to work, or had I had some sort of occupational health check, I think that would have guided me. Had they said to me at that check then, “Well, [Alison], let’s give it another week,” I would have said, “Alright then.” Because I was being told officially, if you like. I’ve always been a little bit like that. I’m not the sort of person that will go off sick… You sort of get on with it, but then you realise that perhaps you should have given yourself another couple of weeks, I think. So that was it. There was no return to work interview or anything, which possibly in my previous employment I may well have had.”Alison, carer (zero hours contract).
“I mean, to be fair, he tried to sign me off for 4 weeks, and I said, “How about one?” He said, “Well, let’s just say on light duties,” and gave me a sick note, do you see what I mean?... I said to him- because he laughed and he went, “Well, that’s what I would do,” So I said to him, “We’re both singing on the same hymn sheet, then.” I know some people would have been more than happy to go, “Yes, great, I have a month off.” But like he said to me, if you like your job, what’s the point? Do you see what I mean?”Vicky, secretary (employed).
“Well, you’ve just got to play it by ear really. When it was all strapped up it was a bit awkward. I was advised not to work, but of course I did. I mean sod that. [I don’t care about that]. I mean it’s rather like accountants or anything else, you take the advice on board that they give you and adapt it to your own use.”George, gardener (self-employed).
Theme 3: handling the return
“I had to do a risk assessment with the health and safety officer, my supervisor there. I wasn’t allowed to do any cleaning for at least 3 to 4 weeks, I think it was… Yes, because of the heaviness, because of the actual manual work involved, they didn’t want me to go back to that. Even when I did the feeding, they said, “Oh, you can try feeding,” because sometimes, you’re still lifting heavy things. I wasn’t allowed to lift panels. I could only lift feed buckets that I felt I was comfortable to”.Fiona, animal technical (employed).
“I was planning just to go back and go on the computer and do the invoices and things, but that didn’t work out, so I just did light stuff that I could do with my right hand. If there was anything that I needed to move or lift then someone else moved or lifted it for me.”Peter, mechanic (employed).
“I mean, I was there in body and useful to do some things, but I couldn’t do the full job for a start. I couldn’t grip, to be quite honest. I couldn’t do the things like taking out stitches and things like that at work. I couldn’t grip the scissors properly.”Debbie, nurse (employed).
"I didn’t have any advice on what to do when I went back…. None of them talked about work, unless I asked. I said to my surgeon, “What should I be doing?” He said, “Just treat it as normal now. Just use your hand as normal, but take it slowly.” I thought, “What does that mean?”Emma, optician (employed).
“[It was] a little bit of a struggle when I get- I use the public transport, because- I mean you’ve got only one hand and then when you want to get on and get off, it’s quite difficult.” Charlotte, postal worker (employed).
“I mean, he said to me, a week before I drive, and I drove home. But I had an automatic at the time, so it didn’t bother me”.Alan, maintenance worker (self-employed).
“But the left was worse than the right, because of course I’ve got a manual car, so the gear change was particularly- I wouldn’t say difficult. I wouldn’t say I would have gone on a long journey, I wouldn’t like to have done an emergency stop. Yes, so gear changing was probably challenging, I think the word is (laughter). I had to use two hands to pull the handbrake on when I had the left done, but the right, because - you don’t use your right, you only use it on the steering wheel.”Vicky, secretary (employed).