Cole D C, Hudak P L
Institute for Work and Health. Toronto, Ontario, Canada.
Am J Ind Med. 1996 Jun;29(6):657-68. doi: 10.1002/(SICI)1097-0274(199606)29:6<657::AID-AJIM10>3.0.CO;2-Z.
Reviews of work-related musculoskeletal disorders (WMD) of the neck and upper extremity have typically supplied little information on prognosis. This paper reports on the methods and results of a systematic search for evidence on clinical course and prognosis of nonspecific WMD i.e., those without specific clinical diagnoses. Articles were deemed relevant if they provided primary data on current or former worker cases of WMD followed over time. WMD status had to be based on clinical evaluations. The 13 studies which met these criteria were evaluated using clinical epidemiological criteria for validity of prognostic studies. None of the studies was sufficiently strong across the criteria to provide more than weaker evidence on prognosis. Prognostic factors with promise include duration of symptoms and workplace demands. In order to improve the evidence on prognosis of WMD, we recommend closer attention to the following: clear operational definition of cases; documentation of prognostic factors including duration of symptoms and severity at baseline; incorporation of multiple follow-up assessments; inclusion of a range of outcomes; and analysis using stratified or multivariate methods.
关于颈部和上肢与工作相关的肌肉骨骼疾病（WMD）的综述通常很少提供预后方面的信息。本文报告了一项系统检索的方法和结果，该检索旨在寻找关于非特异性WMD（即那些没有特定临床诊断的疾病）临床病程和预后的证据。如果文章提供了对WMD现职或离职工人病例随时间跟踪的原始数据，则被视为相关文章。WMD状态必须基于临床评估。使用临床流行病学标准对符合这些标准的13项研究进行预后研究有效性评估。没有一项研究在所有标准上都足够有力，能够提供比关于预后的较弱证据更多的信息。有前景的预后因素包括症状持续时间和工作场所要求。为了改善关于WMD预后的证据，我们建议密切关注以下方面：病例的明确操作定义；预后因素的记录，包括症状持续时间和基线严重程度；纳入多次随访评估；纳入一系列结局；以及使用分层或多变量方法进行分析。
