Saltychev Mikhail, Laimi Katri, Pentti Jaana, Kivimäki Mika, Vahtera Jussi
Department of Physical and Rehabilitation Medicine.
Department of Public Health, Turku University Hospital and University of Turku.
Int J Rehabil Res. 2018 Jun;41(2):159-165. doi: 10.1097/MRR.0000000000000263.
The objective of this study was to identify subgroups among the participants in inpatient multidisciplinary musculoskeletal rehabilitation based on the differences in the shapes of trajectories of pain medication consumption during the 9 years around the time of intervention. A register-based study among 4578 public sector employees was conducted. Group-based trajectory analysis was done on the purchase of prescribed pain medications during the 9 years around the time of rehabilitation. The participants were on an average 50.7 (SD=6.6) years of age, and 2955 (86%) were women. Average yearly purchase of pain medications increased during the follow-up period from 73.4 (SD=193.0) to 163.3 (SD=295.7) defined daily doses. The analysis suggested six-cluster model. The shapes of the trajectories of three clusters did not show any steep slopes, one trajectory demonstrated nonstop rising through the entire follow-up, and one trajectory was closed to the trajectory average of medication use. One trajectory (11% of the sample) demonstrated a steep growth before the intervention and steep drop after it. When comparing this cluster with all other clusters combined, odds ratios were 0.40 [95% confidence interval (CI): 0.19-0.85] for age group (older vs. younger), 0.78 (95% CI: 0.61-1.01) for sex (women vs. men), and 1.44 (95% CI: 1.09-1.90) for occupational status (lower vs. higher). In other words, the participants belonged to this cluster were younger employees with a lower occupational grade. It seems that younger employees in manual jobs benefitted of the studied multidisciplinary musculoskeletal rehabilitation the most, especially when the timing of intervention is bounded to the substantial rise of pain severity.
本研究的目的是根据干预前后9年期间止痛药物消费轨迹形状的差异，确定住院多学科肌肉骨骼康复参与者中的亚组。对4578名公共部门员工进行了一项基于登记的研究。对康复前后9年期间处方止痛药物的购买情况进行了基于组的轨迹分析。参与者的平均年龄为50.7岁（标准差=6.6），其中2955名（86%）为女性。随访期间，止痛药物的平均年购买量从73.4（标准差=193.0）定义日剂量增加到163.3（标准差=295.7）定义日剂量。分析提出了六聚类模型。三个聚类的轨迹形状没有显示出任何陡坡，一条轨迹在整个随访期间持续上升，一条轨迹接近药物使用的轨迹平均值。一条轨迹（样本的11%）在干预前显示出急剧增长，干预后急剧下降。将该聚类与所有其他聚类合并进行比较时，年龄组（年龄较大与年龄较小）的优势比为0.40[95%置信区间（CI）：0.19-0.85]，性别（女性与男性）的优势比为0.78（95%CI：0.61-1.01），职业地位（较低与较高）的优势比为1.44（95%CI：1.09-1.90）。换句话说，属于该聚类的参与者是职业等级较低的年轻员工。似乎从事体力工作的年轻员工从所研究的多学科肌肉骨骼康复中受益最大，尤其是当干预时间与疼痛严重程度的大幅上升相关时。
