Beaton Dorcas E, Bombardier Claire, Cole Donald C, Hogg-Johnson Sheilah, Van Eerd Dwayne
Institute for Work & Health, 481 University Avenue, Toronto, Ontario, Canada.
Scand J Work Environ Health. 2007 Apr;33(2):131-39. doi: 10.5271/sjweh.1116.
Workers' musculoskeletal disorders are often pain-based and elude specific diagnoses; yet diagnosis or classification is the cornerstone to researching and managing these disorders. Clinicians are skilled in pattern recognition and use it in their daily practice. The purpose of this study was to use the clinical reasoning of experienced clinicians to recognize patterns of signs and symptoms and thus create a classification system.
Two hundred and forty-two workers consented to a standardized physical assessment and to completing a questionnaire. Each physical assessment finding was dichotomized (normal versus abnormal), and the results were graphically displayed on body diagrams. At two different workshops, groups of experienced researchers or clinicians were led through an exercise of pattern recognition (clustering and naming of clusters) to arrive at a classification system. Interobserver reliability was assessed (8 observers, 40 workers), and the classification system was revised to improve reliability.
The initial classification system had good face validity but low interobserver reliability (kappa <0.3). Revisions were made that resulted in a proposed triaxial classification system. The signs and symptoms axes quantified the areas in the involved upper limbs. The proposed third axis described the likelihood of a specific clinical diagnosis being made and the degree of certainty. The interobserver reliability improved to approximately 0.70.
This triaxial classification system for musculoskeletal disorders is based on clinically observable findings. Further testing and application in other populations is required. This classification system could be useful for both clinicians and epidemiologists.
工人的肌肉骨骼疾病通常基于疼痛，难以进行明确诊断；然而，诊断或分类是研究和管理这些疾病的基石。临床医生擅长模式识别并在日常实践中加以运用。本研究的目的是利用经验丰富的临床医生的临床推理来识别体征和症状模式，从而创建一个分类系统。
242名工人同意接受标准化体格检查并填写问卷。每项体格检查结果分为两类（正常与异常），结果以图表形式展示在人体图上。在两个不同的研讨会上，经验丰富的研究人员或临床医生小组通过模式识别练习（聚类和为聚类命名）得出一个分类系统。评估了观察者间的可靠性（8名观察者，40名工人），并对分类系统进行了修订以提高可靠性。
最初的分类系统具有良好的表面效度，但观察者间可靠性较低（kappa<0.3）。经过修订，提出了一个三轴分类系统。体征和症状轴量化了受累上肢的区域。提议的第三轴描述了做出特定临床诊断的可能性和确定程度。观察者间可靠性提高到约0.70。
这个肌肉骨骼疾病的三轴分类系统基于临床可观察到的发现。需要在其他人群中进行进一步测试和应用。这个分类系统对临床医生和流行病学家可能都有用。
