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基于跨诊断预后重返工作因素的长期病假亚组:一项横断面潜在类别分析。

Subgroups of Long-Term Sick-Listed Based on Prognostic Return to Work Factors Across Diagnoses: A Cross-Sectional Latent Class Analysis.

机构信息

Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

出版信息

J Occup Rehabil. 2021 Jun;31(2):383-392. doi: 10.1007/s10926-020-09928-5. Epub 2020 Oct 14.

Abstract

Comorbidity is common among long-term sick-listed and many prognostic factors for return to work (RTW) are shared across diagnoses. RTW interventions have small effects, possibly due to being averaged across heterogeneous samples. Identifying subgroups based on prognostic RTW factors independent of diagnoses might help stratify interventions. The aim of this study was to identify and describe subgroups of long-term sick-listed workers, independent of diagnoses, based on prognostic factors for RTW. Latent class analysis of 532 workers sick-listed for eight weeks was used to identify subgroups based on seven prognostic RTW factors (self-reported health, anxiety and depressive symptoms, pain, self-efficacy, work ability, RTW expectations) and four covariates (age, gender, education, physical work). Four classes were identified: Class 1 (45% of participants) was characterized by favorable scores on the prognostic factors; Class 2 (22%) by high anxiety and depressive symptoms, younger age and higher education; Class 3 (16%) by overall poor scores including high pain levels; Class 4 (17%) by physical work and lack of workplace adjustments. Class 2 included more individuals with a psychological diagnosis, while diagnoses were distributed more proportionate to the sample in the other classes. The identified classes illustrate common subgroups of RTW prognosis among long-term sick-listed individuals largely independent of diagnosis. These classes could in the future assist RTW services to provide appropriate type and extent of follow-up, however more research is needed to validate the class structure and examine how these classes predict outcomes and respond to interventions.

摘要

共病在长期请病假者中很常见,许多与重返工作岗位(RTW)相关的预后因素在不同诊断中是共有的。RTW 干预的效果较小,可能是因为在异质样本中进行了平均处理。基于与诊断无关的 RTW 预后因素来确定亚组可能有助于分层干预措施。本研究的目的是基于 RTW 的预后因素,独立于诊断,确定长期请病假工人的亚组并对其进行描述。对 532 名请病假 8 周的工人进行潜在类别分析,根据 7 个 RTW 预后因素(自我报告的健康、焦虑和抑郁症状、疼痛、自我效能、工作能力、RTW 预期)和 4 个协变量(年龄、性别、教育、体力工作)确定亚组。确定了 4 个类别:第 1 类(45%的参与者)的预后因素得分较好;第 2 类(22%)的特点是焦虑和抑郁症状高、年龄较小、教育程度较高;第 3 类(16%)的特点是整体预后较差,包括疼痛水平较高;第 4 类(17%)的特点是从事体力工作和缺乏工作场所调整。第 2 类包括更多有心理诊断的个体,而其他类别中诊断的分布与样本更相称。所确定的类别说明了长期请病假者 RTW 预后的常见亚组,在很大程度上独立于诊断。这些类别将来可以帮助 RTW 服务提供适当类型和程度的随访,但是需要更多的研究来验证类别结构,并研究这些类别如何预测结果以及对干预措施的反应。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4b3/8172395/756f5ce039b0/10926_2020_9928_Fig1_HTML.jpg

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