Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
Liverpool Reviews & Implementation Group (LRiG), University of Liverpool, Liverpool, UK.
J Pain. 2022 Aug;23(8):1318-1342. doi: 10.1016/j.jpain.2022.02.003. Epub 2022 Feb 18.
Spinal surgeries to treat chronic low back pain (CLBP) have variable success rates, and despite the significant personal and socioeconomic implications, we lack consensus for prognostic factors. This systematic review and meta-analysis evaluated the evidence for preoperative predictors of return to work (RTW) after spinal surgery for CLBP. We searched electronic databases and references (January 1984 to March 2021), screened 2,622 unique citations, and included 8 reports (5 low and 3 high risk-of-bias) which involved adults with ≥3 months duration of CLBP with/without leg pain undergoing first elective lumbar surgery with RTW assessed ≥3 months later. Narrative synthesis and meta-analysis where possible found that individuals less likely to RTW were older (odds ratio [OR] = .58; 95% confidence interval [CI]: 0.46-0.72), not working before surgery, had longer sick leave (OR = .95; 95% CI: 0.93-0.97), higher physical workload, legal representation (OR = .61; 95% CI: 0.53-0.71), psychiatric comorbidities and depression (moderate quality-of-evidence, QoE), and longer CLBP duration and opioid use (low QoE), independent of potential confounders. Low quality and small number of studies limit our confidence in other associations. In conclusion, RTW after spinal surgery for CLBP likely depends on sociodemographic and affective psychological factors, and potentially also on symptom duration and opioid use. PERSPECTIVE: This systematic review and meta-analysis synthesizes and evaluates existing evidence for preoperative predictors of return to work after spinal surgery for chronic low back pain. Demonstrated associations between return to work and sociodemographic, health-related, and psychological factors can inform clinical decision-making and guide further research.
脊柱手术治疗慢性下腰痛 (CLBP) 的成功率各不相同，尽管对个人和社会经济有重大影响，但我们缺乏对预后因素的共识。本系统评价和荟萃分析评估了 CLBP 脊柱手术后重返工作岗位 (RTW) 的术前预测因素的证据。我们检索了电子数据库和参考文献（1984 年 1 月至 2021 年 3 月），筛选了 2622 篇独特的引文，并纳入了 8 项研究报告（5 项低风险和 3 项高风险），这些研究涉及患有 CLBP 且无腿部疼痛至少 3 个月且有/无腿部疼痛的成年人，进行首次选择性腰椎手术，且在至少 3 个月后评估 RTW。可能的叙述性综合分析和荟萃分析发现，不太可能重返工作岗位的个体年龄较大（比值比 [OR] =.58；95%置信区间 [CI]：0.46-0.72），手术前未工作，病假时间较长（OR =.95；95% CI：0.93-0.97），体力工作负荷较高，有法律代表（OR =.61；95% CI：0.53-0.71），合并精神疾病和抑郁（中等质量证据，QoE），CLBP 持续时间和阿片类药物使用时间较长（低质量证据，QoE），独立于潜在混杂因素。研究数量少和质量低限制了我们对其他关联的信心。总之，CLBP 脊柱手术后的 RTW 可能取决于社会人口统计学和情感心理因素，并且还可能取决于症状持续时间和阿片类药物使用。本系统评价和荟萃分析综合和评估了 CLBP 脊柱手术后重返工作岗位的术前预测因素的现有证据。证明 RTW 与社会人口统计学、健康相关和心理因素之间存在关联，可以为临床决策提供信息，并指导进一步的研究。
