Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Rd, Hopkinton, MA 01748, USA.
Phys Ther. 2011 May;91(5):777-89. doi: 10.2522/ptj.20100263. Epub 2011 Mar 30.
There is mounting evidence that occupational factors influence the extent of sickness absence following an episode of low back pain, but there have been limited efforts to integrate the identification and management of occupational factors into the routine practice of physical therapists. Systematic reviews suggest that a client's report of heavy physical demands, inability to modify job tasks, work stress, lack of organizational support, job dissatisfaction, poor expectations for resuming usual work, and fear of reinjury are indications of significant barriers to returning to work. Recommended strategies for evaluating and addressing occupational factors are explored with respect to the physical therapist's role in client assessment, development of activity and lifestyle recommendations, therapeutic exercise, communication with other providers, and summary reports. Primary recommendations include: (1) administration of self-report questionnaires to assess a client's perspective of physical job demands, (2) client-centered interviewing to highlight individual return-to-work concerns, (3) early discussions with clients about possible job modifications, and (4) incorporation of clients' workplace concerns in progress reports and summaries. These strategies may improve low back pain outcomes by encouraging effective communication with key stakeholders and by developing clients' ability to resolve obstacles to returning to work.
越来越多的证据表明，职业因素会影响腰痛发作后请病假的时间长短，但在将职业因素的识别和管理纳入物理治疗师的常规实践方面，所做的努力有限。系统评价表明，客户报告的重体力需求、无法修改工作任务、工作压力、缺乏组织支持、工作不满、对恢复正常工作的期望较低以及对再次受伤的恐惧，这些都是阻碍重返工作岗位的重要因素。本文探讨了评估和处理职业因素的推荐策略，这些策略涉及物理治疗师在客户评估、活动和生活方式建议的制定、治疗性锻炼、与其他提供者的沟通以及总结报告方面的作用。主要建议包括：（1）使用自我报告问卷评估客户对体力工作要求的看法；（2）以客户为中心的访谈，突出个人重返工作的关注点；（3）尽早与客户讨论可能的工作调整；（4）在进展报告和总结中纳入客户对工作场所的关注。这些策略可以通过与利益相关者进行有效的沟通，以及提高客户解决重返工作障碍的能力，来改善腰痛的治疗效果。
