Stochkendahl Mette Jensen, Nim Casper Glissmann, Boyle Eleanor, Larsen Ole Kristoffer, Axén Iben, Kvammen Ole Christian, Myburgh Corrie
1Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230 Odense M, Denmark.
2Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.
Chiropr Man Therap. 2019 Jan 11;27:1. doi: 10.1186/s12998-018-0230-y. eCollection 2019.
Musculoskeletal pain is a major cause of work disability. Many patients with musculoskeletal pain seek care from health care providers other than their general practitioners, including a range of musculoskeletal practitioners. Therefore, these musculoskeletal practitioners may play a key role by engaging in sickness absence management and work disability prevention. This study aimed to determine the prevalence of musculoskeletal practitioners' practice behaviours, and their perceptions and beliefs about sickness absence management by using Scandinavian chiropractors as an example, as well as to examine the association between these characteristics and two different practice behaviours.
As part of a mixed-methods study, we surveyed members of the national chiropractic associations in Denmark, Norway, and Sweden in 2016. Descriptive statistics were used to describe prevalence. Multilevel logistic regression with backwards stepping was used to estimate odds ratios with 95% confidence intervals between each of the two practice behaviours and the characteristics.
Out of the 802 respondents (response rate 56%), 372 were Danish, 349 Norwegian, and 81 Swedish. In Denmark and Norway, 38.7 and 37.8% always/often considered if sick leave was appropriate for their patient compared to 21.0% in Sweden ( = 0.007); and 86.5% of the Norwegian chiropractors always/often recommended to return-to-work versus 64.5 and 66.7% in Denmark and Sweden respectively ( < 0.001). In the final models, factors associated with the two practice behaviours were age, level of clinical experience, working as a teacher, the tendency to be updated on current legislations and policies using social services, contact with general practitioners, relevance of engagement in SAM, consideration of workplace factors, SAM as part of the clinical tool box, patient out-of-pocket fee, and recommending fast return-to-work.
Whilst not always engaged in sickness absence management with regards to musculoskeletal pain, chiropractors favour a 'return-to-work' rather than a 'stay-at-home' approach. Several practice behaviours and perceptions and beliefs are associated with these outcomes; however, system or organisational barriers are linked to clinician non-engagement.
肌肉骨骼疼痛是工作残疾的主要原因。许多患有肌肉骨骼疼痛的患者会向全科医生以外的医疗服务提供者寻求治疗，包括一系列肌肉骨骼方面的从业者。因此，这些肌肉骨骼方面的从业者可能通过参与病假管理和预防工作残疾发挥关键作用。本研究旨在以斯堪的纳维亚脊医为例，确定肌肉骨骼方面从业者的执业行为患病率，以及他们对病假管理的看法和信念，并研究这些特征与两种不同执业行为之间的关联。
作为一项混合方法研究的一部分，我们在2016年对丹麦、挪威和瑞典的国家脊医协会成员进行了调查。描述性统计用于描述患病率。采用向后逐步法的多水平逻辑回归来估计两种执业行为与各特征之间的比值比及95%置信区间。
802名受访者（回复率56%）中，372名是丹麦人，349名是挪威人，81名是瑞典人。在丹麦和挪威，分别有38.7%和37.8%的人总是/经常考虑病假是否适合他们的患者，而在瑞典这一比例为21.0%（P = 0.007）；86.5%的挪威脊医总是/经常建议患者重返工作岗位，而丹麦和瑞典的这一比例分别为64.5%和66.7%（P < 0.001）。在最终模型中，与这两种执业行为相关的因素包括年龄、临床经验水平、担任教师、利用社会服务了解当前法律法规和政策的倾向、与全科医生的联系、参与病假管理的相关性、对工作场所因素的考虑、病假管理作为临床工具的一部分、患者自付费用以及建议快速重返工作岗位。
虽然脊医并非总是参与肌肉骨骼疼痛的病假管理，但他们倾向于采用“重返工作岗位”而非“居家休息”的方法。这些结果与几种执业行为、看法和信念相关；然而，系统或组织障碍与临床医生不参与有关。
