MacKenzie Ellen J, Bosse Michael J, Kellam James F, Pollak Andrew N, Webb Lawrence X, Swiontkowski Marc F, Smith Douglas G, Sanders Roy W, Jones Alan L, Starr Adam J, McAndrew Mark P, Patterson Brendan M, Burgess Andrew R, Travison Thomas, Castillo Renan C
Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
J Trauma. 2006 Sep;61(3):688-94. doi: 10.1097/01.ta.0000195985.56153.68.
A better understanding of the factors influencing return to work (RTW) after major limb trauma is essential in reducing the high costs associated with these injuries.
Patients (n = 423) who underwent amputation or reconstruction after limb threatening lower extremity trauma and who were working before the injury were prospectively evaluated at 3, 6, 12, 24, and 84 months. Time to first RTW was assessed. For individuals working at 84 months, the percentage of time limited in performance at work was estimated using the Work Limitations Questionnaire.
Estimates of the cumulative proportion returning to work at 3, 6, 12, 24, and 84 months were 0.12, 0.28, 0.42, 0.51, and 0.58. Patients working at 84 months were, on average, limited in their ability to perform the demands of their job 20 to 25% of the time. In the context of a Cox proportional hazards model, differences in RTW outcomes by treatment (amputation versus reconstruction) were not statistically significant. Factors that were significantly associated (p < 0.05) with higher rates of RTW include younger age, being White, higher education, being a nonsmoker, average to high self efficacy, preinjury job tenure, higher job involvement, and no litigation. Early (3 month) assessments of pain and physical functioning were significant predictors of RTW.
Return to work after severe lower extremity trauma remains a challenge. Although the causal pathway from injury to impairment and work disability is complex, this study points to several factors that influence RTW that suggest strategies for intervention.
更好地了解影响严重肢体创伤后重返工作岗位（RTW）的因素对于降低与这些损伤相关的高昂成本至关重要。
对423例在下肢受到威胁性创伤后接受截肢或重建手术且受伤前有工作的患者进行前瞻性评估，评估时间为伤后3、6、12、24和84个月。评估首次重返工作岗位的时间。对于在84个月时仍在工作的个体，使用工作限制问卷估计其工作表现受限的时间百分比。
在3、6、12、24和84个月时重返工作岗位的累积比例估计分别为0.12、0.28、0.42、0.51和0.58。在84个月时仍在工作的患者，平均而言，其工作能力受限的时间占20%至25%。在Cox比例风险模型中，不同治疗方式（截肢与重建）导致的重返工作岗位结果差异无统计学意义。与较高重返工作岗位率显著相关（p<0.05）的因素包括年龄较小、白人、受教育程度较高、不吸烟、自我效能一般至较高、受伤前工作年限、工作投入度较高以及未提起诉讼。早期（3个月）对疼痛和身体功能的评估是重返工作岗位的重要预测因素。
严重下肢创伤后重返工作岗位仍然是一项挑战。尽管从损伤到功能障碍和工作残疾的因果路径很复杂，但本研究指出了几个影响重返工作岗位的因素，并提出了干预策略。
