[为因肌肉骨骼疾病导致工作残疾的工人提供多学科医学康复：随机对照试验结果]

[Offering multidisciplinary medical rehabilitation to workers with work disability due to musculoskeletal disorders: results of randomized controlled trial].

作者信息

Hüppe A, Glaser-Möller N, Raspe H

机构信息

Institut für Sozialmedizin der Universität zu Lübeck.

出版信息

Gesundheitswesen. 2006 Jun;68(6):347-56. doi: 10.1055/s-2006-926870.

DOI:10.1055/s-2006-926870

PMID:16826467

Abstract

AIMS

In Germany medical rehabilitation has to be initiated by members of statutory pension fund and health insurances. This often leads to delays in the application for and provision of rehabilitation services. Since January 2000 a regional statutory pension fund for blue collar workers (LVA Schleswig-Holstein), 4 statutory health insurances and their medical service MDK have been evaluating a pro-active system to offer rehabilitation to certain member groups. Its acceptance, performance and outcomes were evaluated within a randomized controlled study.

METHODS

Over one year actively insured (i. e. working) members of the a. m. institutions were screened for longer work disability due to musculoskeletal disorders (ICD-10: M05 - 25, M40 - 54, M60 - 99). Based on further inclusion criteria eligible persons were randomized either to an intervention (invitation, counselling, application support) or control (usual care) group. At baseline and six and 12 months all participants completed a postal questionnaire enquiring about various health status aspects (secondary outcomes). Information on sick leave (cases, days), hospital treatment and disability pension was based on administrative data (primary outcomes). Analyses were run on an intention to treat-, per protocol-, as actual-, and matched pairs-basis.

RESULTS

230 persons gave written informed consent (IG: n = 134, KG: n = 96). Within 6 months after study entry 69% of the IG- and 20 % of the KG-members participated in a 3 week in-patient multidisciplinary rehabilitation program. Compared to 6 months prior to the study the occurrence of sick leave due to musculoskeletal disorders was clearly reduced during follow-up between month 6 and 12, however with no significant difference between the two groups. Additionally, IG and CG did not differ in any other primary and secondary outcomes.

CONCLUSION

Contrary to our expectations the IG-members do not seem to benefit from the PETRA-programme including inpatient rehabilitation.

摘要

目的

在德国，医疗康复必须由法定养老金基金和健康保险的成员发起。这往往导致康复服务申请和提供的延迟。自2000年1月以来，一个针对蓝领工人的地区性法定养老金基金（石勒苏益格 - 荷尔斯泰因州劳动保护协会）、4家法定健康保险机构及其医疗服务机构MDK一直在评估一种主动为特定成员群体提供康复服务的系统。在一项随机对照研究中对其接受度、表现和结果进行了评估。

方法

在一年多的时间里，对上述机构的在职参保成员进行筛查，以确定是否因肌肉骨骼疾病（国际疾病分类第十版：M05 - 25、M40 - 54、M60 - 99）导致长期工作残疾。根据进一步的纳入标准，符合条件的人员被随机分为干预组（邀请、咨询、申请支持）或对照组（常规护理）。在基线、6个月和12个月时，所有参与者都完成了一份邮寄问卷，询问各种健康状况方面的问题（次要结果）。病假（病例数、天数）、住院治疗和残疾抚恤金的信息基于行政数据（主要结果）。分析是基于意向性分析、符合方案分析、实际分析和配对分析进行的。

结果

230人给予了书面知情同意（干预组：n = 134，对照组：n = 96）。在研究入组后的6个月内，干预组69%的成员和对照组20%的成员参加了为期3周的住院多学科康复项目。与研究前6个月相比，在第6个月至第12个月的随访期间，因肌肉骨骼疾病导致的病假发生率明显降低，但两组之间没有显著差异。此外，干预组和对照组在任何其他主要和次要结果方面也没有差异。