Department of Public and Occupational Health, The EMGO+ Institute for Health and Care Research, VU University Medical Center (VUmc), van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
Research Center for Insurance Medicine (KCVG), AMC-UMCG-UWV-VUmc, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
J Occup Rehabil. 2017 Sep;27(3):434-444. doi: 10.1007/s10926-016-9674-x.
Purpose The purpose of this study was to obtain consensus among physicians of several medical specialties on the level of limitations to work-related functioning of people with persistent "medically unexplained" physical symptoms (PPS). Methods A modified Delphi study was conducted with 15 physicians of five different medical specialties. The study involved two email rounds and one meeting. In each round, the physicians prioritized the level of limitations in 78 work-related functioning items for four different PPS cases. These items were based on the Dutch Functional Ability List, national guidelines and scientific literature regarding the International Classification of Functioning. Results In all four cases, the physicians reached consensus on the level of limitations to work-related functioning in 49 items. The physicians reported the highest number and level of limitations for PPS of the back and lower extremities, but they reported hardly any limitations for PPS of the abdomen and genitals. For PPS of the head, they reported mainly limitations to personal and social functioning; for PPS of the neck, back and upper or lower extremities, they reported mainly limitations to dynamic movements and static postures. The physicians could not reach consensus on limitations in the category of working hours. Conclusion Physicians reached consensus on the level of limitations in a substantial part of work-related functioning items for PPS. There was a difference in the number and severity of limitations between different cases of PPS. The assessment of functioning seems to be based more on the specific impairment than on the disease.
目的 本研究的目的是在几位医学专业医生中就具有持续性“医学无法解释”躯体症状（PPS）的人群的工作相关功能受限程度达成共识。
方法 采用改良 Delphi 法，对 5 个不同医学专业的 15 名医生进行研究。该研究共进行了两轮电子邮件和一轮会议。在每一轮中，医生根据荷兰功能能力清单、国家指南以及与国际功能、残疾和健康分类相关的科学文献，对 4 种不同 PPS 病例的 78 项与工作相关的功能受限项目进行了优先级排序。
结果 在所有 4 种情况下，医生均就 49 项与工作相关的功能受限项目达成了共识。医生报告称，背部和下肢 PPS 的受限项目数量和程度最高，但腹部和生殖器 PPS 的受限项目很少。头部 PPS 主要表现为个人和社会功能受限；颈部、背部和上肢或下肢 PPS 主要表现为动态运动和静态姿势受限。对于工作时间受限的类别，医生们无法达成共识。
结论 医生就 PPS 的工作相关功能受限项目的大部分达成了共识。不同 PPS 病例的受限项目数量和严重程度存在差异。功能评估似乎更多地基于特定的损伤，而不是疾病。
