Oyeflaten Irene, Hysing Mari, Eriksen Hege R
Attføringssenteret i Rauland, Rauland, Norway.
J Rehabil Med. 2008 Jul;40(7):548-54. doi: 10.2340/16501977-0202.
The number of people in Western countries on long-term sick-leave and disability pension due to musculoskeletal complaints and psychological health problems is increasing. The main objective of this study was to examine whether fear-avoidance beliefs, illness perceptions, subjective health complaints, and coping are prognostic factors for return to work after multidisciplinary vocational rehabilitation, and to assess the relative importance and inter-relationship of these factors.
A prospective cohort study with a 1-year follow-up period was performed. A total of 135 individuals on long-term sick-leave (87 women, mean age 45 years) participated in a 4-week inpatient multidisciplinary vocational rehabilitation programme. The participants had been out of work for an average of 10.5 months.
Fear-avoidance beliefs about work was the most important risk factor for not returning to work, both at 3 months (odds ratio (OR) 3.8; confidence interval (CI) 1.30-11.32) and 1 year (OR 9.5; CI 2.40-37.53) after the intervention. Forty-eight percent of the variance in fear-avoidance beliefs was explained by subjective health complaints, illness perceptions and education. Coping explained only 1% of the variance.
These findings indicate that interventions for these patients should target fear of returning to work and illness perceptions about subjective health complaints.
在西方国家，因肌肉骨骼问题和心理健康问题而长期休病假及领取残疾抚恤金的人数正在增加。本研究的主要目的是检验恐惧回避信念、疾病认知、主观健康问题及应对方式是否为多学科职业康复后重返工作岗位的预后因素，并评估这些因素的相对重要性及相互关系。
进行了一项为期1年随访期的前瞻性队列研究。共有135名长期休病假的个体（87名女性，平均年龄45岁）参加了为期4周的住院多学科职业康复项目。参与者平均失业10.5个月。
干预后3个月（优势比（OR）3.8；置信区间（CI）1.30 - 11.32）和1年（OR 9.5；CI 2.40 - 37.53），对工作的恐惧回避信念是未重返工作岗位的最重要风险因素。恐惧回避信念中48%的变异可由主观健康问题、疾病认知和教育来解释。应对方式仅解释了1%的变异。
这些发现表明，针对这些患者的干预措施应针对对重返工作的恐惧以及对主观健康问题的疾病认知。
