Département des Sciences de l'Activité Physique, Canada; Institut Franco-Européen de Chiropraxie, Paris, France.
Département des Sciences de l'Activité Physique, Canada; Département de Psychologie, Canada; Groupe de Recherche sur les Affections Neuro-musculo-squelettiques, Canada; Groupe de Recherche en Cognition, Neurosciences, Affect et Comportement (CogNAC), Université du Québec à Trois-Rivières, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal - CRIUGM, Université de Montréal, Canada.
Appl Ergon. 2018 Apr;68:176-185. doi: 10.1016/j.apergo.2017.11.011. Epub 2017 Dec 1.
The objective of this study was to identify baseline predictors of disability and absenteeism in workers with a history of non-specific low back pain (LBP).
One hundred workers with a history of non-specific LBP participated in three evaluations (baseline, 7 and 15 months follow-up). Current and past history of LBP, clinical pain intensity, disability, absenteeism, fear-avoidance beliefs, pain catastrophizing, pain hypervigilance, work satisfaction and patient stratification based on "risk of poor clinical outcome assessment" (RPCO) were evaluated using questionnaires and interviews. In addition, cutaneous heat pain thresholds, cutaneous heat pain tolerance thresholds, conditioned pain modulation (CPM), trunk kinematics and muscle activity were measured during each evaluation. Logistic regression models were used to determine predictors of LBP disability and absenteeism at 15-months.
Sixty-eight workers returned for the 15-month follow-up and among this sample, 49% reported disability and 16% reported absenteeism at follow-up. Baseline clinical pain intensity predicted disability (OR = 1.08, 95%CI: 1.03-1.13) at 15-month while work satisfaction (OR = 0.93, 95%CI: 0.87-0.99) and RPCO (OR = 1.51, 95%CI: 1.05-2.16) predicted absenteeism. These results remained significant after adjustments for age, gender as well as type of work and intervention.
This study highlights the importance of clinical pain and psychological factors in the prediction and potentially the prevention of future disability. Screening tools assessing these risk factors can be useful to evaluate workers with past history of low back pain.
本研究旨在确定有非特异性下背痛（LBP）病史的工人残疾和缺勤的基线预测因素。
100 名有非特异性 LBP 病史的工人参加了三次评估（基线、7 个月和 15 个月随访）。使用问卷和访谈评估当前和过去的 LBP 病史、临床疼痛强度、残疾、缺勤、回避恐惧信念、疼痛灾难化、疼痛警觉、工作满意度以及基于“不良临床结局评估风险”（RPCO）的患者分层。此外，在每次评估期间测量皮肤热痛阈值、皮肤热痛耐受阈值、条件性疼痛调制（CPM）、躯干运动学和肌肉活动。使用逻辑回归模型确定 15 个月时 LBP 残疾和缺勤的预测因素。
68 名工人返回进行 15 个月随访，在该样本中，49%的工人在随访时报告残疾，16%的工人报告缺勤。基线临床疼痛强度预测 15 个月时的残疾（OR=1.08，95%CI：1.03-1.13），而工作满意度（OR=0.93，95%CI：0.87-0.99）和 RPCO（OR=1.51，95%CI：1.05-2.16）预测缺勤。这些结果在调整年龄、性别以及工作和干预类型后仍然显著。
本研究强调了临床疼痛和心理因素在预测和潜在预防未来残疾方面的重要性。评估这些危险因素的筛查工具可用于评估有过去下背痛病史的工人。
