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与工作相关的暴露因素对颈肩痛预后的影响。

The influence of work-related exposures on the prognosis of neck/shoulder pain.

作者信息

Grooten Wilhelmus Johannes Andreas, Mulder Marie, Josephson Malin, Alfredsson Lars, Wiktorin Christina

机构信息

Department of Public Health Sciences, Division of Occupational Medicine, Karolinska Institutet, Norrbacka, 171 76, Stockholm, Sweden.

出版信息

Eur Spine J. 2007 Dec;16(12):2083-91. doi: 10.1007/s00586-007-0481-0. Epub 2007 Aug 25.

Abstract

To determine associations between work-related exposures and the prognosis of self-reported neck/shoulder pain. This prospective cohort study was based on 803 working subjects who reported neck/shoulder pain at baseline. The proportion of subjects who 5-6 years later were symptom-free was calculated. Data concerning work-related biomechanical, psychosocial, and organizational exposures were collected at baseline. The Cox regression analyses were used to calculate the relative chances (RC) of being symptom-free at the end of the study for single exposures, and also for up to three simultaneous work-related exposures. Adjustments were made for sex and age. Only 36% of the subjects were symptom-free 5-6 years later. The relative chance for being symptom-free at the end of the study was 1.32 (95% CI = 0.99-1.74) for subjects who were exposed to sitting > or =75% of the working time and 1.53 (95% CI = 1.02-2.29) for subjects who were exposed to job strain, i.e., the combination of high demands and low decision latitude. The relative chance of being symptom-free at the end of the study was 0.61 (95% CI = 0.40-0.94) for subjects with at least two out of three simultaneous biomechanical exposures at work; manual handling, working with the hands above shoulder level, and working with vibrating tools. In a heterogeneous population with moderate nonspecific neck/shoulder pain, sedentary work enhanced the chance of being symptom-free 5-6 years later, whereas simultaneous exposures to at least two of manual handling, working with hands above shoulder level and working with vibrating tools were associated with a lower chance of being symptom-free at the end of the study. This could imply that subjects with neck/shoulder pain should avoid such simultaneous exposures.

摘要

确定与工作相关的暴露因素与自我报告的颈部/肩部疼痛预后之间的关联。这项前瞻性队列研究基于803名在基线时报告有颈部/肩部疼痛的在职受试者。计算了5至6年后无症状受试者的比例。在基线时收集了与工作相关的生物力学、心理社会和组织暴露的数据。使用Cox回归分析计算单次暴露以及同时存在的多达三种与工作相关暴露情况下,在研究结束时无症状的相对概率(RC)。对性别和年龄进行了调整。5至6年后只有36%的受试者无症状。对于工作时间中坐姿≥75%的受试者,在研究结束时无症状的相对概率为1.32(95%置信区间=0.99 - 1.74);对于暴露于工作压力(即高要求与低决策自由度相结合)的受试者,该相对概率为1.53(95%置信区间=1.02 - 2.29)。对于在工作中同时存在三种生物力学暴露中的至少两种(手工搬运、在肩部以上高度用手工作以及使用振动工具)的受试者,在研究结束时无症状的相对概率为0.61(95%置信区间=0.40 - 0.94)。在患有中度非特异性颈部/肩部疼痛的异质人群中,久坐工作增加了5至6年后无症状的可能性,而同时暴露于手工搬运、在肩部以上高度用手工作和使用振动工具中的至少两种情况与研究结束时无症状的可能性较低相关。这可能意味着患有颈部/肩部疼痛的受试者应避免这种同时暴露的情况。

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