Frymoyer J W
Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington 05405.
Clin Orthop Relat Res. 1992 Jun(279):101-9.
Since World War II, the incidence of chronic low back disability has increased dramatically, at a rate disproportionate to all other health conditions. The factors that contribute to this disability are reviewed. Psychosocial and work environmental factors are far more accurate predictors of disability than physical factors. A predictive risk model is described that allows an estimate of the patient's risk of becoming chronically disabled early in the course of a low back pain episode. This model demonstrates that work environment, perception of compensability, and the duration of the current episode are significantly predictors. Surprisingly, psychologic factors, as measured by the Minnesota Multiphasic Personality Inventory (MMPI), are not predictive in the cohorts studied to date. Although there are inherent limitations in study design, the results offer additional credence to the hypothesis that low back pain disability is often the result of psychosocial and work environmental factors. The model may also be used to address the hypothesis that patients at risk for future disability are more effectively treated by early, aggressive rehabilitation programs.
自第二次世界大战以来，慢性腰背痛致残的发生率急剧上升，其增长速度与所有其他健康状况不相称。本文对导致这种致残情况的因素进行了综述。心理社会因素和工作环境因素比身体因素更能准确预测致残情况。文中描述了一种预测风险模型，该模型能够在腰背痛发作初期对患者发展为慢性残疾的风险进行估计。该模型表明，工作环境、对可补偿性的认知以及当前发作的持续时间是显著的预测因素。令人惊讶的是，通过明尼苏达多相人格调查表（MMPI）测量的心理因素在迄今为止所研究的队列中并无预测作用。尽管研究设计存在固有局限性，但这些结果为下述假说提供了更多可信证据，即腰背痛致残往往是心理社会因素和工作环境因素所致。该模型还可用于验证下述假说，即对于未来有残疾风险的患者，早期积极的康复计划能更有效地对其进行治疗。
