Lewis M, Wynne-Jones G, Barton P, Whitehurst D G T, Wathall S, Foster N E, Hay E M, van der Windt D
Arthritis Research UK Primary Care Centre, Institute of Primary Care and Health Sciences, Keele University, Staffordshire, ST5 5BG, UK,
J Occup Rehabil. 2015 Sep;25(3):577-88. doi: 10.1007/s10926-014-9564-z.
Back pain is a common problem and has significant societal impact. Sickness certification is commonly issued to patients consulting their general practitioner with low back pain. The aim of this study was to investigate the association of certification for low back pain with clinical outcomes and cost consequences.
A prospective cohort study using linked questionnaire and medical record data from 806 low back pain patients in 8 UK general practices: comparison of 116 (14.4%) who received a sickness certificate versus 690 who did not receive certification. The primary clinical measure was the Roland and Morris Disability Questionnaire (RMDQ). Data on back pain consultation and work absenteeism were used to calculate healthcare and societal costs.
Participants issued a sickness certificate had higher back-related disability at baseline consultation and 6-month follow-up [mean difference 3.1 (95% CI 1.8, 4.4) on the RMDQ], indicating worse health status. After fully adjusting for baseline differences, most changes in clinical outcomes at 6 months were not significantly different between study groups. Productivity losses were significantly higher for the certification group, with most absence occurring after the expected end of certification; mean difference in costs due to absenteeism over 6 months was £1,956 (95% CI £941, £3040).
There was no clear evidence of a difference in clinical outcomes between individuals issued a sickness certificate and those not issued a certification for their back pain. With little overall contrast in clinical outcomes, policy makers and care providers may wish to draw on the likely difference in societal costs alongside issues in ethical and moral care in their consideration of patient care for low back pain.
背痛是一个常见问题，对社会有重大影响。全科医生通常会给因腰痛前来就诊的患者开具病假证明。本研究的目的是调查腰痛病假证明与临床结局及成本后果之间的关联。
一项前瞻性队列研究，使用来自英国8家全科诊所的806名腰痛患者的关联问卷和病历数据：比较116名（14.4%）获得病假证明的患者与690名未获得证明的患者。主要临床指标是罗兰-莫里斯残疾问卷（RMDQ）。利用腰痛咨询和旷工的数据来计算医疗保健和社会成本。
获得病假证明的参与者在基线咨询和6个月随访时与背部相关的残疾程度更高[RMDQ上的平均差异为3.1（95%CI 1.8，4.4）]，表明健康状况更差。在对基线差异进行充分调整后，研究组在6个月时的大多数临床结局变化没有显著差异。证明组的生产力损失显著更高，大多数缺勤发生在预期的证明结束后；6个月内因旷工导致的成本平均差异为1956英镑（95%CI 941英镑，3040英镑）。
没有明确证据表明获得病假证明的个体与未获得背痛证明的个体在临床结局上存在差异。由于临床结局总体差异不大，政策制定者和医疗服务提供者在考虑腰痛患者护理时，可能希望借鉴社会成本的可能差异以及道德护理方面的问题。
