Department of Psychology, Royal Holloway, University of London, Egham, UK.
Pain. 2011 Dec;152(12):2813-2818. doi: 10.1016/j.pain.2011.09.010.
Research has demonstrated that health care practitioners' adherence to guidelines for managing low back pain (LBP) remain suboptimal in recommending work absence, but specific beliefs about their role in maintaining patients at work have not been adequately researched. We examined private musculoskeletal practitioners' (chiropractors, osteopaths, and physiotherapists) beliefs and reported clinical behaviours in reference to patients' work. A cross-sectional postal questionnaire of 900 musculoskeletal practitioners included the Attitudes to Back pain in musculoskeletal practitioners questionnaires, reported frequency of four work-related behaviours, and a new measure of practitioners' work-related beliefs. Data from 337 respondents (37%) were analysed. Eighty percent of respondents reported recommending work absence to patients with LBP sometimes, and 14% recommended a work absence often or always. Seventy percent of practitioners never visit the patient's workplace. Most practitioners report that they prescribe exercises that can be carried out at work. Physiotherapists visited the workplace more frequently and gave less sick leave certification than either of the other groups. They also regarded work as more beneficial and less of a threat to exacerbate patients' LBP. There were small but significant correlations between work-related beliefs and reported behaviours. Our study confirms that, in contrast to current guidelines, many practitioners believe that LBP necessitates work absence. Overall, practitioners perceived their role in returning patients to work as limited, and believed that direct contact with employers was beyond their remit. In the UK, physiotherapists appear to be better placed to liaise with work in terms of both their beliefs and activities.
研究表明，医疗保健从业者在推荐患者缺勤方面，对管理腰痛（LBP）的指南的依从性仍然不理想，但他们在维持患者工作方面的特定信念尚未得到充分研究。我们研究了私人肌肉骨骼从业者（脊椎指压治疗师、整骨医生和物理治疗师）在涉及患者工作时的信念和报告的临床行为。一项针对 900 名肌肉骨骼从业者的横断面邮寄问卷调查包括肌肉骨骼从业者对背痛的态度问卷、报告四种与工作相关的行为的频率，以及一种新的从业者与工作相关的信念衡量标准。对 337 名受访者（37%）的数据进行了分析。80%的受访者报告有时会建议腰痛患者缺勤，14%的人建议经常或总是缺勤。70%的从业者从未访问过患者的工作场所。大多数从业者报告说，他们开的处方锻炼可以在工作中进行。物理治疗师更频繁地访问工作场所，并比其他两组开出的病假证明更少。他们还认为工作对患者的腰痛没有好处，也不会加重病情。工作相关的信念和报告的行为之间存在着小而显著的相关性。我们的研究证实，与当前的指南相反，许多从业者认为腰痛需要缺勤。总的来说，从业者认为他们让患者重返工作岗位的角色有限，并认为与雇主直接接触超出了他们的职权范围。在英国，就其信念和活动而言，物理治疗师似乎更适合与工作联系。
