Razmjou Helen, Boljanovic Dragana, Elmaraghy Amr, Macritchie Iona, Roknic Carolyn, Medeiros Danielle, Richards Robin R
Working Condition Program, Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Orthop J Sports Med. 2017 Nov 20;5(11):2325967117739851. doi: 10.1177/2325967117739851. eCollection 2017 Nov.
The role of psychosocial factors has been established in patients with shoulder abnormalities. However, the prevalence of exaggerated pain behaviors and their association with the characteristics of injured workers have not been well studied.
To examine the prevalence of abnormal pain responses (APRs) in workers with active workers' compensation claims for a shoulder injury and to examine the differences between workers with APRs versus workers without APRs.
Cross-sectional study; Level of evidence, 3.
An analysis of electronic data files of injured workers was completed. An APR was defined as an exaggerated pain response during a clinical examination, including facial grimacing, shaking, withdrawal, nonanatomic dermatome or myotome disturbances, increased tenderness, regional symptoms, and verbal utterances such as groaning, moaning, or gasping. To control for potential confounders, patients with positive APRs (APR group) were matched with injured workers without APRs (control group) seen in the same clinic and matched for sex, age, and surgical candidacy.
Data from 1000 workers who had sustained a shoulder injury at work and who were referred for an early assessment by an orthopaedic surgeon and a physical therapist were reviewed. A total of 86 (9%) injured workers (mean age, 47 ± 11 years; 55 [64%] female) demonstrated APRs and were matched with 86 injured workers without APRs. There were no statistically significant between-group differences in the wait time, mechanism of injury, coexisting comorbidity, type of abnormality, or medication consumption. The APR group reported higher levels of disability ( < .0001) and psychological problems ( < .0001), presented with more inconsistency in range of motion ( = .04), and had more limitations at work ( = .02).
The presence of an APR after a compensable shoulder injury was associated with higher reports of disability and psychological problems. Patients with positive APRs were more likely to be off work and less likely to perform full duties.
心理社会因素在肩部异常患者中的作用已得到证实。然而，夸大疼痛行为的发生率及其与受伤工人特征的关联尚未得到充分研究。
研究因肩部损伤而提出有效工伤赔偿申请的工人中异常疼痛反应（APR）的发生率，并比较有APR的工人与无APR的工人之间的差异。
横断面研究；证据等级，3级。
完成了对受伤工人电子数据文件的分析。APR被定义为临床检查期间的夸大疼痛反应，包括面部 grimacing、颤抖、退缩、非解剖性皮节或肌节紊乱、压痛增加、局部症状以及诸如呻吟、呜咽或喘息等言语表达。为控制潜在混杂因素，将有阳性APR的患者（APR组）与在同一诊所就诊且在性别、年龄和手术候选资格方面相匹配的无APR的受伤工人（对照组）进行匹配。
回顾了1000名在工作中肩部受伤并由骨科医生和物理治疗师进行早期评估的工人的数据。共有86名（9%）受伤工人（平均年龄，47±11岁；55名[64%]为女性）表现出APR，并与86名无APR的受伤工人进行匹配。在等待时间、受伤机制、并存合并症、异常类型或药物消耗方面，两组之间无统计学显著差异。APR组报告的残疾水平更高（<0.0001）和心理问题更多（<0.0001），在活动范围方面表现出更多不一致（=0.04），并且在工作中有更多限制（=0.02）。
可赔偿的肩部损伤后出现APR与更高的残疾报告和心理问题相关。有阳性APR的患者更有可能缺勤且不太可能履行全部职责。
