Evidence for return to work following complex orthopaedic injury - a scoping review

Background: The rates of return to work (RTW) following complex orthopaedic injury are low. No review has summarised current knowledge and prognostic factors for RTW in these patients.Objectives: This scoping review presents the nature and the extent of current research evidence for the prognostic factors of RTW following complex orthopaedic injury.Methods: This review was designed using the PRISMA-ScR checklist. Online databases were searched for articles (1969-2023) which covered: return to work, complex orthopaedic injury, and prognostic factors. Complex orthopaedic injury is defined as multiple fractures, open fractures, high energy pelvic injuries or polytrauma with related orthopaedic injury. Data were extracted and placed into an evidence table.Results: Eleven studies were eligible for inclusion. All but one were prospective cohort in design with small patient numbers. There was a skew for studies of open tibial fractures. There was limited breadth of tested prognostic factors. The only commonly reported statistically significant prognostic factors were age, ISS classification and nature of work. Endpoints for RTW ranged from 3 months to 8 years, preventing the pooling of data for meta-analyses.Conclusion: In summary, there is a limited understanding of prognostic factors for RTW following complex orthopaedic injury. Estimates for RTW following these injuries range from 16-90%. The authors recommend that future studies take a holistic approach, using the biopsychosocial model, when investigating prognostic factors for RTW in these patients. This study offers guidance on qualitative investigation, investigative variables and mechanisms to achieve this.