Shaw William S, van der Windt Danielle A, Main Chris J, Loisel Patrick, Linton Steven J
Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA.
J Occup Rehabil. 2009 Mar;19(1):64-80. doi: 10.1007/s10926-008-9159-7. Epub 2008 Dec 12.
To develop a consensus plan for research and practice to encourage routine clinician screening of occupational factors associated with long-term back disability.
A 3-day conference workshop including 21 leading researchers and clinicians (the "Decade of the Flags Working Group") was held to review the scientific evidence concerning clinical, occupational, and policy factors in back disability and the development of feasible assessment and intervention strategies.
The Working Group identified seven workplace variables to include in early screening by clinicians: physical job demands, ability to modify work, job stress, workplace social support or dysfunction, job satisfaction, expectation for resuming work, and fear of re-injury. Five evaluation criteria for screening methods were established: reliability, predictive performance, feasibility, acceptability, and congruence with plausible interventions. An optimal screening method might include a stepped combination of questionnaire, interview, and worksite visit. Future research directions include improving available assessment methods, adopting simpler and more uniform conceptual frameworks, and tying screening results to plausible interventions.
There is a clear indication that occupational factors influence back disability, but to expand clinician practices in this area will require that patient screening methods show greater conceptual clarity, feasibility, and linkages to viable options for intervention.
制定一项研究与实践的共识计划，以鼓励临床医生对与长期背部残疾相关的职业因素进行常规筛查。
举办了一次为期3天的会议研讨会，有21位顶尖研究人员和临床医生（“旗帜十年工作组”）参加，以审查有关背部残疾的临床、职业和政策因素的科学证据，以及可行的评估和干预策略的制定情况。
工作组确定了七个工作场所变量，供临床医生在早期筛查中纳入：体力工作要求、工作调整能力、工作压力、工作场所社会支持或功能障碍、工作满意度、恢复工作的期望以及对再次受伤的恐惧。确立了筛查方法的五项评估标准：可靠性、预测性能、可行性、可接受性以及与合理干预措施的一致性。一种最佳筛查方法可能包括问卷调查、访谈和工作场所访问的分步组合。未来的研究方向包括改进现有的评估方法、采用更简单和更统一的概念框架，以及将筛查结果与合理的干预措施联系起来。
有明确迹象表明职业因素会影响背部残疾，但要扩大临床医生在这一领域的实践，就需要患者筛查方法在概念上更加清晰、具有可行性，并与可行的干预选项建立联系。
