Hazard R G, Fenwick J W, Kalisch S M, Redmond J, Reeves V, Reid S, Frymoyer J W
Department of Orthpaedics and Rehabilitation, McClure Musculoskeletal Research Center, Burlington, Vermont.
Spine (Phila Pa 1976). 1989 Feb;14(2):157-61.
Patients with chronic disabling low-back pain have poor prospects of returning to work. The authors tested a treatment program of functional restoration with behavioral support through 1 year prospective observation of patients disabled for an average of 19 months without evidence of surgically correctable disease. Ninety patients were studied: 59 program graduates, five program dropouts, 17 patients denied program authorization by their insurance carriers, and six crossover patients. Three patients were admitted but refused to participate in the treatment program. Initial demographic, physical, and self-assessment attributes were similar for all four groups. At year's end, 81% of program graduates, 40% of the dropouts, and 29% of those denied the program had returned to work. All six crossover patients were working 6 months after treatment. Program graduates showed significant improvements in self-assessed pain, disability, and depression, and in physical capacities after 3 weeks of treatment. These improvements were maintained through the year except for partial decreases in frequent lifting, cycling endurance, and isokinetic trunk extension strength. Functional restoration with behavioral support is an effective treatment for patients with chronic, disabling low-back pain, as measured by self-assessments, physical capacities, and return to work.
患有慢性致残性下背痛的患者恢复工作的前景不佳。作者通过对平均残疾19个月且无手术可矫正疾病证据的患者进行为期1年的前瞻性观察，测试了一种具有行为支持的功能恢复治疗方案。研究了90名患者：59名项目毕业生、5名项目辍学者、17名被保险公司拒绝项目授权的患者以及6名交叉患者。3名患者入院但拒绝参与治疗方案。所有四组患者的初始人口统计学、身体和自我评估属性相似。到年底时，81%的项目毕业生、40%的辍学者以及29%被拒绝项目的患者恢复了工作。所有6名交叉患者在治疗6个月后都在工作。项目毕业生在治疗3周后自我评估的疼痛、残疾和抑郁以及身体能力方面均有显著改善。除了频繁提举、骑行耐力和等速躯干伸展力量略有下降外，这些改善在一整年中都得以维持。通过自我评估、身体能力和恢复工作情况衡量，具有行为支持的功能恢复是治疗慢性致残性下背痛患者的有效方法。
