我國約一半職業傷病之發生部位為肘、前臂、腕、手和指部外傷，不但造成手功能損傷，同時造成工作障礙。早期復工對勞工生、心理功能，家庭經濟、雇主的負擔和社會的勞動力都是正向助力，勞工可以參與社會活動和貢獻，同時增加自我價值和生活滿意度。本研究目的期以實證的角度，探討職業傷害造成前臂或手外傷之勞工，在醫療穩定準備復工前，自覺健康之看法，並且以生物心理社會模式預測自行復工之重要因素。本研究採橫斷式研究法，研究樣本分成二組各60人，分別為醫療穩定可以自行復工之勞工，以及無法自行復工需要職業重建服務之勞工，透過「台灣簡短36」量表（SF-36台灣版）調查受試者之自覺健康，以「修訂的手外傷嚴重指數」分析手外傷嚴重程度，以獨立樣本t檢定和卡方檢定分析二組在社會人口變項、自覺健康、手外傷嚴重程度和工作障礙期間的差異，以Pearson積差相關分析進行自覺健康與自行復工、社會人口變項、手外傷嚴重程度和工作障礙期間相關檢定，並以二元邏輯斯迴歸分析預測自行復工之重要因素。
研究結果顯示可以自行復工或需要職業重建之勞工在社會人口變項、手外傷嚴重程度都沒有顯著不同，但二組在工作障礙期間達顯著水準（p=0.001），可以自行復工的勞工平均工作障礙期間151天，需要職業重建勞工平均工作障礙期間251天，自覺健康分量表在身體生理功能（p=0.020）、活力（p=0.045）及心理健康（p=0.042）三個分量表分數達顯著差異。本研究樣本以SF-36台灣版調查職業傷害致前臂或手外傷勞工自覺健康之分數都較我國一般國民差，性別和自覺身體生理功能 （r=.271, p<0.01）、身體疼痛（r=.180, p<0.05）、一般健康（r=.217, p<0.05）、活力（r=.338, p<0.01）和心理健康（r=.243, p<0.01）有關。年長者自覺因生理功能角色受限（r=-.257, p<0.01）、因情緒角色受限（r=-.415, p<0.01）和身體疼痛（r=-.277, p<0.01）較差；身心障礙者只感到身體生理功能較非障礙者差（r=-.236, p<0.01）；工作障礙期間（r=-.339, p<0.01）和修訂的手外傷嚴重指數（r=-.196, p<0.05）與身體生理功能有關；低教育程度者感到因情緒角色受限（rs=.257, p<0.01）明顯比高教育者差；薪資補償與心理健康有關（rs=.196, p<0.01）；而已婚勞工自覺因生理功能角色受限、身體疼痛、活力、因情緒角色受限和心理健康都比未婚勞工差。經過二元邏輯斯迴歸分析，職業傷害致前臂或手外傷勞工，工作障礙期間和自覺心理健康是準備復工階段預測自行復工的重要因素，每增加工作障礙期間一天，自行復工之可能性即減少0.5％，以SF-36台灣版自評心理健康的分數每增加１分，可以自行復工的機會增加5％，手外傷嚴重程度、性別、婚姻狀況、薪資補償狀況可能經由工作障礙期間及自覺心理健康間接與自行復工產生相關。
本研究建議協助職業傷害致前臂或手外傷勞工早期準備復工，並關注勞工自覺心理健康，尤其是女性、已婚和薪資補償較受傷前少的勞工，自覺健康是一項調查自行復工的有效工具。建議可以從醫療系統、職場及社會政策等重要關係人介入，策略包括職務再設計、職業傷害諮商、輔導、協調勞雇或職場關係等，協助職業傷害致前臂或手外傷勞工提早復工。

Forearm, wrist and hand injuries were the most common work-related injuries, and resulted in different severities of hand function impairments. This cross-sectional study aimed to investigate work-related forearm or hand injured workers’ self-perceived health before return-to-work, and predict factors of early return-to-work. A total of 120 clients were recruited and divided into 2 groups depending on the ability to return-to-work (RTW). One group could self-RTW after medical rehabilitation (SR group), and the other was recruited from Vocational Evaluation Programs for Work-Related Injury (VR group). All clients were medical stable and motivated to return to work before exploration. Modified Hand Injury Severity Score (MHISS) was measured to quantify hand, wrist and forearm injuries. SF-36 Taiwan version was self-administered as health perception. The groups were compared with each other regard to sociodemographic factors, hand injury severity, health perception, and time off work. Independent t tests were used for continuous variables, and Chi-square tests were used to compare categorical variables. Pearson correlation coefficient was used to analysis the correlation between SF-36 and sociodemographic factors, MHISS, and time off work. Binary logistic regression was used to predict the factors of early return-to-work.
The results indicated that there were no any significant differences in sociodemographic factors and the severity of hand injury between both groups. Self-perceived physical functioning (p=0.020), vital (p=0.045), mental health (p=0.042) and time off work (p=0.001) were significantly different between SR group and VR group. Besides, gender was associated with physical functioning (r=.271, p<0.01), bodily pain (r=.180, p<0.05), general health (r=.217, p<0.05), vital (r=.338, p<0.01), and mental health (r=.243, p<0.01). Elderly had poorer self-perceived health in role limitation due to physical problems (r=-.257, p<0.01), bodily pain (r=-.277, p<0.01), and role limitation due to emotional problems (r=-.415, p<0.01). Disabled clients only reported poorer physical functioning (r=-.236, p<0.01) than non-disabled. Time-off-work (r=-.339, p<0.01) and MHISS (r=-.196, p<0.05) were associated with physical functioning. Higher education reported better role limitation due to emotional problems (rs=.257, p<0.01). Finanal support was related to mental health perception (rs=.196, p<0.01). Married workers rated poorer self-perceived role limitation due to physical problems, bodily pain, vital, role limitation due to emotional problems, and mental health. After binary logistic regression analysis, time-off-work and self-perceived mental health were strongly predictive of self-RTW. Increase one day of time-off-work would reduce 0.5% to self-RTW. Increase one score of self-rated mental health in SF-36 would increase 5% to self-RTW.
This evidence-based study showed that shorter time-off-work and better self-perceived mental health could predict self return-to-work for work-related forearm, wrist or hand injury. Health perception was a validated tool to investigate the thoughts that lead to return to work. Physician advices for readiness for return-to-work, work accommodation, supportive workplace disability management, and workers’ compensation for financial incentive policy were return-to-work strategies.

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