Hazard R G, Bendix A, Fenwick J W
Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, Williston, Vermont.
Spine (Phila Pa 1976). 1991 Sep;16(9):1062-7. doi: 10.1097/00007632-199109000-00009.
Many of the individual biological, psychological, and social factors attributed to low-back disability have been tested previously for their ability to predict treatment outcomes. To test the assumption that disability exaggeration affects treatment outcomes, models were developed to quantify this complex characteristic and to test its predictive value. Two hundred fifty-eight patients with chronic back disability entering a program of functional restoration were initially evaluated with a battery of tests, including measurements of trunk flexibility, lifting capacity, cycling endurance, self-assessments of pain and disability, and psychological attributes. On the basis of these measurements, patients were characterized as disability exaggerators if by peer comparison their self-assessments of pain and disability were in the most severe range despite high levels of physical capacity. Program completion and work status 1 and 2 years after treatment were compared between disability exaggerators and their peers. Individual initial attributes associated with program completion included pain intensity and Million Visual Analogue scores, lifting capacity, trunk flexibility, some Minnesota Multiphasic Personality Inventory and Million Behavioral Health Inventory scales, and cigarette smoking. One-year re-employment was associated with Minnesota Multiphasic Personality Inventory Scale 8, Wechsler Adult Intelligence Score-Revised, and cycling endurance. There were no significant associations between any individual factor and 2-year work status. Only two of the 12 disability exaggeration models distinguished between program graduates and dropouts, and none of the models accurately predicted return to work following treatment. Prescription of intensive multidisciplinary treatment should not be denied on the basis of any individual patient attribute or of disability exaggeration, as measured in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
许多被认为与腰背部残疾相关的个体生物学、心理学和社会因素，此前都已针对其预测治疗效果的能力进行过测试。为了检验残疾夸大影响治疗效果这一假设，研究人员开发了模型来量化这一复杂特征并测试其预测价值。258名患有慢性腰背部残疾并进入功能恢复计划的患者，最初接受了一系列测试评估，包括躯干灵活性测量、举重能力、骑行耐力、疼痛和残疾自评以及心理特征评估。基于这些测量结果，如果通过与同龄人比较，尽管身体能力水平较高，但患者对疼痛和残疾的自评仍处于最严重范围，那么这些患者就被归类为残疾夸大者。研究比较了残疾夸大者与其同龄人在治疗后1年和2年的项目完成情况及工作状态。与项目完成相关的个体初始特征包括疼痛强度和视觉模拟评分、举重能力、躯干灵活性、一些明尼苏达多相人格问卷和行为健康问卷量表，以及吸烟情况。1年后重新就业与明尼苏达多相人格问卷第8量表、韦氏成人智力量表修订版以及骑行耐力相关。任何个体因素与2年工作状态之间均无显著关联。在12个残疾夸大模型中，只有两个能够区分项目毕业生和辍学者，而且没有一个模型能够准确预测治疗后的重返工作情况。不应基于本研究中所测量的任何个体患者特征或残疾夸大情况而拒绝给予强化多学科治疗。（摘要截选至250字）
