Kadzielski John J, Bot Arjan G J, Ring David
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
J Hand Surg Am. 2012 Sep;37(9):1812-9. doi: 10.1016/j.jhsa.2012.05.023. Epub 2012 Jul 3.
Motivation, job satisfaction, burnout, and secondary gain are factors that can influence return to work and disability after orthopedic injuries. The current study evaluated the separate effects of job satisfaction, burnout, and secondary gain on arm-specific disability after a finger injury.
Ninety-three employed patients with finger injuries were enrolled in this prospective study, and 51 completed the follow-up. Burnout (measured with Shirom-Melamed's Burnout Measure), job satisfaction (measured with the Job Descriptive Index questionnaire), and demographics were assessed at the initial visit. After 6 months, arm-specific disability was measured with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and general health status was measured with the Short Form-36 (SF-36) survey, mental component summary (MCS) and physical component summary (PCS).
In the 51 patients with complete follow-up, the mean DASH score was 12, the mean SF-36 PCS was 48, the mean SF-36 MCS was 49, and the mean pain rating was 2.1. In multivariable analysis, pain and worker's compensation status explained 52% of the variability in DASH scores (pain alone accounted for 49%); pain accounted for 14% of the variability in SF-36 PCS scores; and worker's compensation accounted for 11% of the variation in the SF-36 MCS scores.
The majority of variation in the SF-36 PCS and MCS scores remained unaccounted for by the models, but pain and worker's compensation were more important than job burnout or job satisfaction. Pain and worker's compensation were also significant predictors of the DASH.
Worker's compensation and pain were more important than job satisfaction and burnout in explaining variations in arm-specific disability in patients with finger injuries.
动机、工作满意度、职业倦怠和继发获益是影响骨科损伤后重返工作岗位及残疾状况的因素。本研究评估了工作满意度、职业倦怠和继发获益对手指损伤后上肢特定残疾的单独影响。
93名受雇的手指损伤患者纳入了这项前瞻性研究,51名完成了随访。在初次就诊时评估职业倦怠(采用希罗姆 - 梅拉梅德职业倦怠量表测量)、工作满意度(采用工作描述指数问卷测量)和人口统计学特征。6个月后,采用手臂、肩部和手部功能障碍(DASH)问卷测量上肢特定残疾情况,采用简明健康状况调查简表(SF - 36)、心理成分汇总(MCS)和身体成分汇总(PCS)测量总体健康状况。
在51名完成随访的患者中,DASH评分的平均值为12,SF - 36 PCS的平均值为48,SF - 36 MCS的平均值为49,平均疼痛评分为2.1。在多变量分析中,疼痛和工伤赔偿状况解释了DASH评分中52%的变异性(仅疼痛占49%);疼痛占SF - 36 PCS评分变异性的14%;工伤赔偿占SF - 36 MCS评分变异性的11%。
模型未解释SF - 36 PCS和MCS评分中的大部分变异性,但疼痛和工伤赔偿比职业倦怠或工作满意度更重要。疼痛和工伤赔偿也是DASH的重要预测因素。
在解释手指损伤患者上肢特定残疾的差异方面,工伤赔偿和疼痛比工作满意度和职业倦怠更重要。