Turner J A, Franklin G, Turk D C
Departments of Psychiatry and Behavioral Sciences and Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA.
Am J Ind Med. 2000 Dec;38(6):707-22. doi: 10.1002/1097-0274(200012)38:6<707::aid-ajim10>3.0.co;2-9.
Loss of productive life among injured workers potentially could be prevented by clearer knowledge of disability risk factors. Despite the number of studies that have examined predictors of disability, there have been no systematic literature reviews integrating multiple risk factor domains. Such a synthesis could help to define important gaps in knowledge, inform future study designs most likely to successfully address these gaps, and highlight the importance of secondary (disability) prevention to public health policy. A systematic synthesis of the literature on risk factors for chronic or recurrent disability in injured workers was performed to meet this need.
Articles were identified through a MEDLINE search, personal file searches, and requests to experts. Information concerning study methods and results was abstracted from 20 articles that met the inclusion criteria (population-based or prospective cohort studies).
The most frequently identified predictors of prolonged disability were older age and greater baseline pain and functional disability. Lumbar symptoms, smaller company size, and construction work were significant predictors in several, but not all, studies. Risk factors did not appear to differ for back versus mixed injuries.
Several risk factors for prolonged disability were identified. Research is needed to develop and test multivariate models of worker, workplace, health care, and administrative risk factors for prolonged and recurrent disability in order to refine and target interventions.
通过更清晰地了解残疾风险因素，有可能预防受伤工人生产性生活的丧失。尽管已有多项研究对残疾预测因素进行了考察，但尚无整合多个风险因素领域的系统性文献综述。这样的综合分析有助于明确知识上的重要空白，为最有可能成功填补这些空白的未来研究设计提供信息，并突出二级（残疾）预防对公共卫生政策的重要性。为满足这一需求，我们对受伤工人慢性或复发性残疾风险因素的文献进行了系统性综合分析。
通过医学文献数据库（MEDLINE）检索、个人文件检索以及向专家咨询来确定文章。从20篇符合纳入标准（基于人群或前瞻性队列研究）的文章中提取有关研究方法和结果的信息。
最常被确定的长期残疾预测因素是年龄较大以及基线疼痛和功能残疾程度较高。在一些但并非所有研究中，腰部症状、公司规模较小和建筑工作是显著的预测因素。背部损伤与混合性损伤的风险因素似乎并无差异。
确定了几个导致长期残疾的风险因素。需要开展研究来开发和测试关于工人、工作场所、医疗保健及行政风险因素对长期和复发性残疾影响的多变量模型，以便优化和针对性地进行干预。
