Crook J, Moldofsky H, Shannon H
Faculty of Health Sciences, McMaster University Hamilton, Ontario, Canada.
J Rheumatol. 1998 Aug;25(8):1570-7.
Musculoskeletal soft tissue injuries consume considerable resources in personal suffering, medical care, work absenteeism, and compensation benefits. Our aim was to determine specific clinical and behavioral factors that prognostically influence return to work following musculoskeletal work related injuries.
A longitudinal cohort study was conducted on 148 randomly selected workers who had not returned to work in 3 months following musculoskeletal soft tissue injury. The cohort was identified from the files of the Workers' Compensation Board of Ontario, Canada. The workers were interviewed and assessed at 3, 9, 15, and 21 months after injury. The WHO Classification of Impairment, Disabilities and Handicap was used as the conceptual framework. The analysis employed a proportional hazards regression model with allowance for time dependent covariates.
The rate of return to work for men was 1.5 times that for women, and 20% less for every 10 year increase in age. Controlling for sex and age, psychological distress and functional disability were associated with a slower rate of return to work. The rate of return to work for workers who were provided with modified jobs was 2 times higher than for those with no such accommodation in employment.
The negative effect of psychological distress and functional disability on return to work rates must be considered in the design and delivery of rehabilitation programming for workers with musculoskeletal soft tissue injuries. The employer's provision of a "modified job" is important in the prevention of continued disability.
肌肉骨骼软组织损伤在个人痛苦、医疗护理、旷工和补偿福利方面消耗了大量资源。我们的目的是确定在肌肉骨骼工作相关损伤后，对恢复工作有预后影响的具体临床和行为因素。
对148名随机选择的工人进行了一项纵向队列研究，这些工人在肌肉骨骼软组织损伤后3个月内未恢复工作。该队列是从加拿大安大略省工人赔偿委员会的档案中确定的。在受伤后3、9、15和21个月对这些工人进行了访谈和评估。采用世界卫生组织的损伤、残疾和障碍分类作为概念框架。分析采用了允许时间依赖性协变量的比例风险回归模型。
男性的恢复工作率是女性的1.5倍，年龄每增加10岁，恢复工作率就降低20%。在控制性别和年龄后，心理困扰和功能残疾与恢复工作的速度较慢有关。获得工作调整的工人的恢复工作率比没有这种工作调整的工人高出2倍。
在为肌肉骨骼软组织损伤工人设计和提供康复计划时，必须考虑心理困扰和功能残疾对恢复工作率的负面影响。雇主提供“调整后的工作”对预防持续残疾很重要。
