Lancourt J, Kettelhut M
North Dallas Orthopedics and Rehabilitation, Texas.
Spine (Phila Pa 1976). 1992 Jun;17(6):629-40. doi: 10.1097/00007632-199206000-00002.
The results of a prospective study of 134 patients with lower back pain suggest that nonorganic factors are better predictors of return to work than organic findings. Patients who returned to work had fewer job, personal, or family related problems. There were no significant differences between patients who returned to work and those who did not when comparing myelograms, computed tomographic scans, or roentgenographs. The only significant difference in physical organic findings was for muscle atrophy. Patients who did not return to work had a statistically higher incidence rate of muscle atrophy. Length of time off from work was significantly related to outcome, but when patients were categorized according to time off the job, different factors predicted failure to return for patients off work for less than 6 months and patients off for more than 6 months. For patients off for less than 6 months, important predictors were a high Oswestry score, history of leg pain, family relocation, short tenure on the job, verbal magnification of pain, reports of moderate to severe pain on superficial palpation, and positive reaction to a "sham" sciatic tension test. None of these was a significant predictor for the group off for more than 6 months. For the group off work for more than 6 months, previous injuries, and stability of family living arrangements were among the significant predictors not significant for the group off less than 6 months. Using 21 factors selected from a larger group of 92 factors, three statistically significant (P less than or equal to 0.001) predictive measures were developed. These measures predicted return to work for the total sample, and for the two subgroups (off more than, or less than 6 months) more accurately than did the total set of 92 factors.
一项针对134例下背痛患者的前瞻性研究结果表明，与器质性病变相比，非器质性因素能更好地预测患者能否重返工作岗位。重返工作岗位的患者在工作、个人或家庭方面的问题较少。在比较脊髓造影、计算机断层扫描或X光片时，重返工作岗位的患者与未重返工作岗位的患者之间没有显著差异。身体器质性病变方面唯一的显著差异在于肌肉萎缩。未重返工作岗位的患者肌肉萎缩的发生率在统计学上更高。休假时间长短与结果显著相关，但当根据休假时间对患者进行分类时，对于休假少于6个月和休假超过6个月的患者，预测未能重返工作岗位的因素有所不同。对于休假少于6个月的患者，重要的预测因素包括奥斯维斯特里评分高、腿痛病史、家庭搬迁、工作任期短、疼痛言语夸大、浅触诊时有中度至重度疼痛报告以及对“假”坐骨神经张力试验呈阳性反应。这些因素对休假超过6个月的患者组均不是显著的预测因素。对于休假超过6个月的患者组，既往受伤以及家庭生活安排的稳定性是显著的预测因素，但对休假少于6个月的患者组并不显著。从92个因素的较大组中选取21个因素，开发出了三种具有统计学显著性（P≤0.001）的预测指标。这些指标对整个样本以及两个亚组（休假超过或少于6个月）能否重返工作岗位的预测比全部92个因素更准确。
