Coronel Institute of Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Occup Environ Med. 2019 Oct;76(10):772-779. doi: 10.1136/oemed-2019-105797. Epub 2019 Jul 11.
Sciatica impacts on the ability to work and may lead to a reduced return to work. This study reviewed and summarised prognostic factors of work participation in patients who received conservative or surgical treatment for clinically diagnosed sciatica. We searched MEDLINE, CINAHL, EMBASE and PsycINFO until January 2018. Cohort studies, using a measure of work participation as outcome, were included. Two independent reviewers performed study inclusion and used the Quality In Prognosis Studies tool for risk of bias assessment and GRADE to rate the quality of the evidence. Based on seven studies describing six cohorts (n=1408 patients) that assessed 21 potential prognostic factors, favourable factors for return to work (follow-up ranging from 3 months to 10 years) included younger age, better general health, less low back pain or sciatica bothersomeness, better physical function, negative straight leg raise-test, physician expecting surgery to be beneficial, better pain coping, less depression and mental stress, less fear of movement and low physical work load. Study results could not be pooled. Using GRADE, the quality of the evidence ranged from moderate to very low, with downgrading mainly for a high risk of bias and imprecision. Several prognostic factors like pain, disability and psychological factors were identified and reviewed, and these could be targeted using additional interventions to optimise return to work. PROSPERO registration number: CRD42016042497.
坐骨神经痛会影响工作能力，并可能导致工作恢复减少。本研究回顾和总结了接受保守或手术治疗的临床诊断为坐骨神经痛患者的工作参与的预后因素。我们检索了 MEDLINE、CINAHL、EMBASE 和 PsycINFO，截至 2018 年 1 月。纳入了使用工作参与作为结局的队列研究。两位独立的审查员进行了研究纳入，并使用预后研究质量工具（Quality In Prognosis Studies tool）评估偏倚风险，并使用 GRADE 评估证据质量。基于描述六个队列（n=1408 名患者）的 21 个潜在预后因素的七项研究（随访时间 3 个月至 10 年），有利于重返工作岗位的因素包括年龄较小、一般健康状况较好、腰痛或坐骨神经痛较少、身体功能较好、直腿抬高试验阴性、医生预期手术有益、更好的疼痛应对能力、较少的抑郁和精神压力、较少的运动恐惧和较低的体力工作负荷。研究结果无法进行汇总。使用 GRADE，证据质量从中等至极低，主要降级原因是偏倚风险高和不精确。确定并回顾了一些预后因素，如疼痛、残疾和心理因素，可通过额外的干预措施来优化重返工作岗位的效果。PROSPERO 注册号：CRD42016042497。
