Busch H, Göransson S, Melin B
Department of Psychology, University of Stockholm, Stockholm, Sweden.
Pain Pract. 2007 Sep;7(3):234-40. doi: 10.1111/j.1533-2500.2007.00134.x.
Recovery beliefs are assumed to predict rehabilitation outcomes and return-to-work in various clinical conditions but are less frequently assessed in musculoskeletal disorders. We tested the hypothesis that recovery beliefs constitute a risk factor for sustained long-term sick absenteeism in men and women suffering from nonspecific chronic musculoskeletal disorders. A total of 233 subjects with a recent or ongoing experience of long-term sick leave were included in a prospective design. Subjects answered a postal baseline questionnaire and were followed up via register data for 1 year. Multivariate logistic regression analyses indicated that subjects with negative recovery beliefs (OR: 2.41; CI: 1.22-4.77), low sense of mastery (OR: 2.08; CI: 1.27-3.40), perceived high mental demands at work (OR: 1.77; CI: 1.05-2.99), and prior experiences of long-term sick absenteeism (OR: 1.86; CI: 1.02-3.37) had an increased probability of receiving sickness benefits at follow-up. We conclude that prolonged sickness absence contributes strongly to increase patients' sense of helplessness, lower self-efficacy, and hinder future work return. To improve work return, patients' maladaptive beliefs should be clarified and challenged early in the rehabilitation process.
康复信念被认为可以预测各种临床情况下的康复结果和重返工作岗位的情况,但在肌肉骨骼疾病中较少受到评估。我们检验了这样一个假设:康复信念是患有非特异性慢性肌肉骨骼疾病的男性和女性长期持续缺勤的一个风险因素。共有233名近期或正在经历长期病假的受试者被纳入一项前瞻性研究设计中。受试者回答了一份邮寄的基线调查问卷,并通过登记数据进行了为期1年的随访。多变量逻辑回归分析表明,具有消极康复信念的受试者(比值比:2.41;置信区间:1.22 - 4.77)、低掌控感(比值比:2.08;置信区间:1.27 - 3.40)、工作中感知到的高心理需求(比值比:1.77;置信区间:1.05 - 2.99)以及长期缺勤的既往经历(比值比:1.86;置信区间:1.02 - 3.37)在随访时领取疾病津贴的可能性增加。我们得出结论,长期病假极大地导致患者无助感增加、自我效能降低,并阻碍未来重返工作岗位。为了改善重返工作岗位的情况,应在康复过程早期澄清并挑战患者的适应不良信念。