Abásolo Lydia, Carmona Loreto, Hernández-García César, Lajas Cristina, Loza Estíbaliz, Blanco Margarita, Candelas Gloria, Fernández-Gutiérrez Benjamín, Jover Juan A
Hospital Clínico San Carlos, Madrid, Spain.
Arthritis Rheum. 2007 Mar 15;57(2):335-42. doi: 10.1002/art.22529.
To evaluate how an intervention program modifies the clinical course of work disability in musculoskeletal diagnoses.
All patients with temporary work disability related to musculoskeletal disorders (MSDs) in 3 health districts of Madrid, Spain were randomized into standard care (control group) or the intervention group. Intervention consisted of a specific program, run by rheumatologists, following detailed proceedings. Inclusion and followup lasted 12 months each. According to the cause, every temporary work disability episode was classified into 11 syndrome categories. For each we calculated efficacy, as the difference between groups in the number of days on sick leave per temporary work disability episode; relative efficacy, or the percentage of days saved in the intervention group; and time of maximum program effect. Analyses were performed on an intent-to-treat basis. Survival techniques were run and results were expressed as the hazard ratio (HR) in the intervention versus control group.
A total of 13,077 patients were included, generating 16,297 temporary work disability episodes. The most frequent cause was back pain. Temporary work disability episodes were significantly shorter in the intervention group than in the controls in all syndrome categories except knee pain (excluding osteoarthritis). Program relative efficacy varied from 28-72%. The program was highly efficacious in carpal tunnel syndrome (HR 2.09, 95% confidence interval [95% CI] 1.17-3.75), peripheral osteoarthritis (HR 1.58, 95% CI 1.14-2.19), and inflammatory diseases (HR 1.52, 95% CI 1.09-2.12). The maximum effect of the program always took place within the first 2 months.
The implementation of this type of specialist-run, protocol-based early intervention program would be very beneficial in the treatment of patients with work disability related to MSDs, except for those with knee pain (excluding osteoarthritis).
评估一项干预计划如何改变肌肉骨骼疾病诊断中工作残疾的临床进程。
西班牙马德里3个卫生区所有与肌肉骨骼疾病（MSD）相关的临时工作残疾患者被随机分为标准护理组（对照组）或干预组。干预由风湿病学家按照详细程序实施特定计划组成。纳入和随访各持续12个月。根据病因，每例临时工作残疾发作被分为11种综合征类别。对于每种综合征，我们计算疗效，即每组每次临时工作残疾发作病假天数的差异；相对疗效，即干预组节省天数的百分比；以及计划最大效果时间。分析基于意向性治疗原则进行。采用生存技术，结果以干预组与对照组的风险比（HR）表示。
共纳入13077例患者，产生16297次临时工作残疾发作。最常见的病因是背痛。除膝关节疼痛（不包括骨关节炎）外，干预组所有综合征类别的临时工作残疾发作时间均显著短于对照组。计划相对疗效在28%-72%之间。该计划在腕管综合征（HR 2.09，95%置信区间[95%CI]1.17-3.75）、外周骨关节炎（HR 1.58，95%CI 1.14-2.19）和炎症性疾病（HR 1.52，95%CI 1.09-2.12）中疗效显著。该计划的最大效果总是在头两个月内出现。
实施这种由专科医生主导、基于方案的早期干预计划对治疗与MSD相关的工作残疾患者非常有益，但膝关节疼痛（不包括骨关节炎）患者除外。
