基于随机对照试验的一项综合关怀计划预防慢性下腰痛致工作残疾：过程评价。
An integrated care program to prevent work disability due to chronic low back pain: a process evaluation within a randomized controlled trial.
机构信息
EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands.
出版信息
BMC Musculoskelet Disord. 2009 Nov 30;10:147. doi: 10.1186/1471-2474-10-147.
BACKGROUND
In the past decade, a considerable amount of research has been carried out to evaluate the effectiveness of innovative low back pain (LBP) interventions. Although some interventions proved to be effective, they are not always applied in daily practice. To successfully implement an innovative program it is important to identify barriers and facilitators in order to change practice routine. Because usual care is not directly aimed at return to work (RTW), we evaluated an integrated care program, combining a patient-directed and a workplace-directed intervention provided by a multidisciplinary team, including a clinical occupational physician to reduce occupational disability in chronic LBP patients. The aims of this study were to describe the feasibility of the implementation of the integrated care program, to assess the satisfaction and expectations of the involved stakeholders and to describe the needs for improvement of the program.
METHODS
Eligible for this study were patients who had been on sick leave due to chronic LBP. Data were collected from the patients, their supervisors and the involved health care professionals, by means of questionnaires and structured charts, during 3-month follow-up. Implementation, satisfaction and expectations were investigated.
RESULTS
Of the 40 patients who were eligible to participate in the integrated care program, 37 patients, their supervisors and the health care professionals actually participated in the intervention. Adherence to the integrated care program was in accordance with the protocol, and the patients, their supervisors and the health care professionals were (very) satisfied with the program. The role of the clinical occupational physician was of additional value in the RTW process. Time-investment was the only barrier for implementation reported by the multidisciplinary team.
CONCLUSION
The implementation of this program will not be influenced by any flaws in its application that are related to the program itself, or to the adherence of patients with chronic LBP and their health care professionals. This program is promising in terms of feasibility, satisfaction and compliance of the patients, their supervisors and the health care professionals. Before implementation on a wider scale, the communication and the information technology of the program should be improved.
背景
在过去的十年中，已经进行了相当数量的研究来评估创新型腰痛（LBP）干预措施的有效性。尽管一些干预措施已被证明有效，但它们并不总是在日常实践中应用。为了成功实施创新计划，重要的是要确定障碍和促进因素，以便改变实践常规。由于常规护理并非直接针对重返工作岗位（RTW），因此我们评估了一种综合护理计划，该计划结合了多学科团队提供的患者指导和工作场所指导干预措施，包括临床职业医生，以减少慢性 LBP 患者的职业残疾。本研究的目的是描述综合护理计划实施的可行性，评估利益相关者的满意度和期望，并描述计划改进的需求。
方法
本研究纳入了因慢性 LBP 而休病假的患者。通过问卷调查和结构化图表，在 3 个月的随访期间，从患者、他们的主管和参与的医疗保健专业人员那里收集数据。调查实施情况、满意度和期望。
结果
在符合综合护理计划条件的 40 名患者中，有 37 名患者、他们的主管和医疗保健专业人员实际参与了干预。综合护理计划的依从性符合方案，患者、他们的主管和医疗保健专业人员对该计划非常满意。临床职业医生在 RTW 过程中的作用具有附加价值。多学科团队报告的实施障碍只有时间投入。
结论
该计划的实施不会受到与其应用相关的任何缺陷的影响，这些缺陷与计划本身或慢性 LBP 患者及其医疗保健专业人员的依从性有关。该计划在患者、他们的主管和医疗保健专业人员的可行性、满意度和依从性方面具有很大的潜力。在更广泛的范围内实施之前，应改进该计划的沟通和信息技术。
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