Sullivan Michael, Adams Heather, Thibault Pascal, Moore Emily, Carriere Junie S, Larivière Christian
Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
Department of Psychology, McGill University, Montreal, Canada.
Pain. 2017 May;158(5):980-987. doi: 10.1097/j.pain.0000000000000871.
This study examined the relation between return to work and the maintenance of treatment gains made over the course of a rehabilitation intervention. The study sample consisted of 110 individuals who had sustained whiplash injuries in rear collision motor vehicle accidents and were work-disabled at the time of enrolment in the study. Participants completed pre- and post-treatment measures of pain severity, disability, cervical range of motion, depression, posttraumatic stress symptoms, and catastrophizing. Pain severity was assessed again at 1-year follow-up. At 1-year follow-up, 73 participants had returned to work and 37 remained work-disabled. Analyses revealed that participants who returned to work were more likely to maintain treatment gains (77.5%) than participants who remained work-disabled (48%), χ = 6.3, P < 0.01. The results of a regression analysis revealed that the relation between return to work and the maintenance of treatment gains remained significant (β = 0.30, P < 0.01), even when controlling for potential confounders such as pain severity, restricted range of motion, depression, and pain catastrophizing. The Discussion addresses the processes by which prolonged work-disability might contribute to the failure to maintain treatment gains. Important knowledge gaps still remain concerning the individual, workplace, and system variables that might play a role in whether or not the gains made in the rehabilitation of whiplash injury are maintained. Clinical implications of the findings are also addressed.
本研究探讨了重返工作岗位与康复干预过程中治疗效果维持之间的关系。研究样本包括110名在机动车追尾事故中遭受颈部挥鞭伤且在研究入组时无法工作的个体。参与者完成了治疗前和治疗后的疼痛严重程度、残疾程度、颈椎活动范围、抑郁、创伤后应激症状及灾难化思维的测量。在1年随访时再次评估疼痛严重程度。在1年随访时，73名参与者已重返工作岗位，37名仍无法工作。分析显示，重返工作岗位的参与者比仍无法工作的参与者更有可能维持治疗效果（77.5% 对48%），χ = 6.3，P < 0.01。回归分析结果显示，即使在控制了疼痛严重程度、活动范围受限、抑郁和疼痛灾难化思维等潜在混杂因素后，重返工作岗位与治疗效果维持之间的关系仍然显著（β = 0.30，P < 0.01）。讨论部分阐述了长期无法工作可能导致治疗效果无法维持的过程。关于可能影响颈部挥鞭伤康复效果维持与否的个体、工作场所和系统变量，仍存在重要的知识空白。本研究结果的临床意义也在文中进行了探讨。
