McIntosh G, Frank J, Hogg-Johnson S, Bombardier C, Hall H
Department of Public Health Sciences, University of Toronto, Canada.
Spine (Phila Pa 1976). 2000 Jan 15;25(2):147-57. doi: 10.1097/00007632-200001150-00003.
Prospective inception cohort study.
To develop a prognostic model that predicts time receiving workers' compensation benefits for low back pain claimants.
As the cost and difficulty of managing low back pain escalate, any predictor of outcome is advantageous.
To obtain the outcome and predictor variables, patient data from two separate databases were linked: a clinical database and an administrative (Ontario workers' compensation) database. Claimants injured between January 1 and December 31, 1994, were included and observed for 1 year from the date of accident. The outcome variable was cumulative number of calendar days receiving benefits.
Multivariable Cox proportional hazards regression (forward stepwise) showed eight significant predictors; five were associated with increased time receiving benefits compared with their reference groups: 1) working in the construction industry, 2) older age, 3) lag time from injury to treatment, 4) pain referred into the leg, and 5) three or more positive Waddell nonorganic signs. Three predictors were associated with reduced time receiving benefits: 1) higher values of questionnaire score, 2) intermittent pain, and 3) a previous episode of back pain. A predictive score was calculated to categorize claimants as at high or low risk for chronicity. When an arbitrary cutoff point was set at the 75th percentile of predictive score, negative predictive value was 94%.
This research identified eight factors for time receiving workers' compensation benefits among claimants with low back pain. This model discriminates between high- and low-risk claimants. Few low-risk claimants continued to receive benefits for more than 3 months.
前瞻性起始队列研究。
建立一个预测模型，用于预测腰痛索赔者领取工伤赔偿福利的时间。
随着管理腰痛的成本和难度不断增加，任何结果预测指标都具有重要意义。
为获取结果变量和预测变量，将来自两个独立数据库的患者数据进行了关联：一个临床数据库和一个行政（安大略省工伤赔偿）数据库。纳入了1994年1月1日至12月31日期间受伤的索赔者，并从事故发生之日起观察1年。结果变量是领取福利的累计日历天数。
多变量Cox比例风险回归（向前逐步法）显示了8个显著的预测因素；与参照组相比，有5个因素与领取福利时间增加相关：1）从事建筑业，2）年龄较大，3）受伤至治疗的间隔时间，4）腿部牵涉痛，5）三个或更多阳性的瓦德尔非器质性体征。有3个预测因素与领取福利时间减少相关：1）问卷得分较高，2）间歇性疼痛，3）既往有腰痛发作史。计算了一个预测分数，以将索赔者分为慢性风险高或低两类。当将预测分数的任意截断点设定在第75百分位数时，阴性预测值为94%。
本研究确定了腰痛索赔者领取工伤赔偿福利时间的8个因素。该模型能够区分高风险和低风险索赔者。很少有低风险索赔者领取福利超过3个月。
