Dersh Jeffrey, Mayer Tom, Gatchel Robert J, Towns Ben, Theodore Brian, Polatin Peter
PRIDE Research Foundation, Dallas, TX, USA.
Spine (Phila Pa 1976). 2007 Aug 1;32(17):1917-25. doi: 10.1097/BRS.0b013e31811329ac.
A prospective study conducted at a tertiary functional restoration center for patients with chronic disabling occupational spinal disorders (CDOSDs), comparing treatment outcome status 1-year posttreatment of patients with specific diagnosed psychiatric disorders to those without.
To evaluate if diagnosed psychopathology is a significant limiting factor in the successful interdisciplinary rehabilitation of CDOSD patients.
Research has demonstrated high prevalence rates of psychiatric disorders in patients with CDOSDs. Little is known about whether these disorders are associated with less successful treatment outcomes.
A consecutive group of CDOSD patients (n = 1323) averaging 19 months of prerehabilitation disability were evaluated for psychiatric disorders with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Patients participated in a functional restoration program. A structured clinical interview addressing work status, recurrent injury, healthcare utilization, and financial claims closure was administered 1 year after discharge. Logistic regression analyses were conducted to determine the unique contribution of the specific DSM-IV disorders that were significantly associated with the outcomes.
Patients with panic disorder, antisocial personality disorder (PD) and dependent PD were >2 times more likely to be program noncompleters. For successful program completers, those with opioid dependence disorder (ODD) were 2.7 times less likely to return to work and 2.6 times less likely to retain work. Patients with ODD were also 2.1 times more likely to seek postrehabilitation treatment from a new provider.
Despite intensive management of psychiatric disorders during interdisciplinary functional restoration for CDOSD, several disorders were found to be associated with less successful outcomes. Poorer work outcomes were more common with specific (and comorbid) Axis I psychiatric disorders. Opioid dependence was the single disorder associated most often with less successful outcomes. Despite these findings, the large majority of patients demonstrated successful outcomes. Depression did not independently link to less successful outcomes.
在一家三级功能恢复中心对慢性致残性职业性脊柱疾病（CDOSD）患者进行前瞻性研究，比较特定诊断精神障碍患者与无精神障碍患者治疗后1年的治疗结局状况。
评估已诊断的精神病理学是否是CDOSD患者成功进行多学科康复的重要限制因素。
研究表明CDOSD患者中精神障碍的患病率很高。对于这些障碍是否与不太成功的治疗结局相关知之甚少。
对一组连续的CDOSD患者（n = 1323）进行评估，这些患者平均有19个月的康复前残疾时间，使用《精神障碍诊断与统计手册》（DSM-IV）的结构化临床访谈来评估精神障碍。患者参加了功能恢复计划。出院1年后进行了一次结构化临床访谈，内容涉及工作状况、反复受伤、医疗保健利用和财务索赔结案情况。进行逻辑回归分析以确定与结局显著相关的特定DSM-IV障碍的独特作用。
患有惊恐障碍、反社会人格障碍（PD）和依赖型PD的患者成为项目未完成者的可能性高出2倍以上。对于成功完成项目的患者，患有阿片类物质依赖障碍（ODD）的患者重返工作岗位的可能性降低2.7倍，保住工作的可能性降低2.6倍。患有ODD的患者从新提供者处寻求康复后治疗的可能性也高出2.1倍。
尽管在CDOSD的多学科功能恢复过程中对精神障碍进行了强化管理，但发现几种障碍与不太成功的结局相关。特定（和共病）的I轴精神障碍更常出现较差的工作结局。阿片类物质依赖是最常与不太成功的结局相关的单一障碍。尽管有这些发现，但绝大多数患者都取得了成功的结局。抑郁症并未独立地与不太成功的结局相关。
