Hagberg M, Violante F S
Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital, Göteborg University, Göteborg, Sweden.
Med Lav. 2007 Mar-Apr;98(2):89-93.
Several reviews and attempts at meta-analysis have pointed out that comparisons between studies on work-related musculoskeletal disorders are problematic, since different studies use different case definitions. In a clinical setting, the case definition involves a detailed history, a physical examination, and laboratory testing.
When determining which tests should be included in a clinical examination, it is necessary to take into consideration the characteristics of clinical tests in terms of likelihood ratio for confirming and ruling out disease in addition to the pre-test probability of disease. If the different musculoskeletal symptoms and signs do not completely comply with the criteria for a disease, we recommend the choice of an ICD label (International Classification of Diseases - WHO) that focuses on the symptoms rather than the pathology. We suggest that the process for a new feasible case definition system for the neck and upper extremities should start with the creation of a consensus of criteria for diagnosis of common musculoskeletal disorders in primary care, developed by a panel consisting of researchers in the key disciplines. Furthermore, we suggest that in workers whose musculoskeletal function is crucial for employment, use of the International Classification of Function (ICF) may be one way to improve classification of health problems.
多项综述及荟萃分析尝试指出，由于不同研究采用不同的病例定义，与工作相关的肌肉骨骼疾病研究之间的比较存在问题。在临床环境中，病例定义涉及详细病史、体格检查及实验室检测。
在确定临床检查应纳入哪些检测时，除疾病的预检概率外，还需考虑临床检测在确诊和排除疾病方面的似然比特征。如果不同的肌肉骨骼症状和体征不完全符合某种疾病的标准，我们建议选择侧重于症状而非病理的国际疾病分类（ICD - 世界卫生组织）标签。我们建议，针对颈部和上肢的新的可行病例定义系统的制定过程，应首先由关键学科的研究人员组成的小组制定基层医疗中常见肌肉骨骼疾病诊断标准的共识。此外，我们建议，对于肌肉骨骼功能对就业至关重要的工人，使用国际功能分类（ICF）可能是改善健康问题分类的一种方法。
