Feldman Jeffrey B
Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC 27103, USA.
J Surg Orthop Adv. 2004 Spring;13(1):1-14.
The findings of recent extensive evidence-based reviews of the literature on occupational low back pain disability (OLBPD) are examined. There is strong evidence that variables other than biomedical or biomechanical factors have more impact on OLBPD. Nevertheless, the multitude of interacting physical, psychological, social, occupational, financial, and legal variables has confounded, and is likely to continue to confound, efforts to develop simple checklists to predict disability. In contrast, a shift toward conceptualizing and differentially treating OLBP according to its duration postinjury provides a promising new direction. Increasing evidence points to the subacute stage postinjury (4-12 weeks) as a critical period in preventing disability. In limited studies to date, interventions implemented in the subacute stage that address maladaptive cognitions and behavior and focus on return to work have demonstrated reductions in lost work time and disability. Collaborative approaches that combine the proactive efforts of the physician, rehabilitation professionals, and the workplace hold the most promise for future prevention of OLBPD.
本文探讨了近期关于职业性下背痛残疾（OLBPD）的大量循证文献综述的结果。有充分证据表明，除生物医学或生物力学因素外，其他变量对OLBPD的影响更大。然而，众多相互作用的身体、心理、社会、职业、财务和法律变量已经造成了混淆，并且可能会继续混淆开发简单清单以预测残疾的努力。相比之下，根据损伤后的持续时间对OLBP进行概念化和差异化治疗的转变提供了一个有前景的新方向。越来越多的证据表明，损伤后的亚急性期（4-12周）是预防残疾的关键时期。在迄今为止的有限研究中，在亚急性期实施的针对适应不良认知和行为并专注于重返工作的干预措施已显示出减少了误工时间和残疾情况。将医生、康复专业人员和工作场所的积极努力结合起来的协作方法对未来预防OLBPD最有前景。
