Cole Donald C, Mondloch Michael V, Hogg-Johnson Sheilah
Institute for Work & Health, Toronto, Ont.
CMAJ. 2002 Mar 19;166(6):749-54.
Rigorous evidence on factors affecting the prognosis of work-related soft-tissue injuries remains limited. Although shown to be important for a wide variety of clinical conditions, recovery expectations have rarely been assessed as prognostic factors for workers with soft-tissue injuries. We examined the predictive role of various measures of recovery expectations among workers with injuries resulting in time off work.
We identified a prospective cohort of 1566 injured workers shortly after they filed a claim for their injury with the Ontario Workers' Compensation Board (OWCB). They had soft-tissue injuries to the back or upper or lower extremities, had new, lost-time claims from May to November 1993 and were still off work at the time of the first interview. We interviewed participants by telephone within 3 weeks after the injury and measured their recovery expectations (perceptions regarding progress, expected change in condition, expected time until return to usual activities and expectations regarding return to usual job) along with other, potentially important prognostic factors. The primary outcome was total time receiving 100% wage-replacement benefits during the year following injury, obtained from OWCB administrative files. Self-reported measures of pain, health-related quality of life and functional status, obtained up to 4 times during the year following injury, were both independent predictors and secondary outcomes.
The 4 measures of recovery expectations together explained one-sixth of the variation in time receiving benefits. All but expectations regarding return to usual job were individually predictive of time receiving benefits. Judging one's recovery as much better than expected resulted in a 30% (95% confidence interval [CI] 9%-46%) faster rate of stopping receiving benefits (and likely returning to work) compared with judging one's recovery as much worse than expected. Similarly, participants who expected to return to usual activities within 3 weeks had a 37% (95% CI 26%-47%) faster rate of stopping receiving benefits than those who responded "Don't know" to this question, and participants who stated that they were fully recovered or would get better soon had a 25% (CI 5%-40%) faster rate than those who thought they would never get or stay better. Positive recovery expectations were also associated with reductions in pain grade and improvement in functional status outcomes.
Expectations regarding recovery may provide useful information on the complex process of recovering from work-related soft-tissue injuries. For clinicians, patients' negative or uncertain expectations may indicate the need for further probing and intervention on psychosocial factors to facilitate recovery.
关于影响工作相关软组织损伤预后因素的确切证据仍然有限。尽管恢复期望已被证明对多种临床状况很重要，但很少被评估为软组织损伤工人的预后因素。我们研究了各种恢复期望指标对因伤休假工人的预测作用。
我们确定了一个前瞻性队列，其中1566名受伤工人在向安大略省工人赔偿委员会（OWCB）提出工伤索赔后不久被纳入研究。他们的背部、上肢或下肢有软组织损伤，于1993年5月至11月提出新的误工索赔，且在首次访谈时仍未复工。我们在受伤后3周内通过电话采访了参与者，测量了他们的恢复期望（对进展的看法、病情预期变化、恢复正常活动的预期时间以及恢复正常工作的期望）以及其他可能重要的预后因素。主要结局是受伤后一年内领取100%工资替代福利的总时长，数据来自OWCB行政档案。在受伤后一年内最多4次获得的自我报告的疼痛、健康相关生活质量和功能状态指标，既是独立预测因素，也是次要结局。
恢复期望的4项指标共同解释了领取福利时间差异的六分之一。除恢复正常工作的期望外，其他各项指标均能单独预测领取福利的时间。与认为自己恢复情况比预期差得多的人相比，认为自己恢复情况比预期好得多的人停止领取福利（并可能复工）的速度快30%（95%置信区间[CI]9%-46%）。同样，预计在3周内恢复正常活动的参与者停止领取福利的速度比回答“不知道”的参与者快37%（95%CI 26%-47%），表示自己已完全康复或很快会好转的参与者比认为自己永远不会好转或保持好转的参与者快25%（CI 5%-40%）。积极的恢复期望还与疼痛等级降低和功能状态改善相关。
恢复期望可能为从工作相关软组织损伤中恢复的复杂过程提供有用信息。对于临床医生来说，患者的消极或不确定期望可能表明需要进一步探究和干预心理社会因素以促进恢复。
