MacKenzie E J, Morris J A, Jurkovich G J, Yasui Y, Cushing B M, Burgess A R, DeLateur B J, McAndrew M P, Swiontkowski M F
Center for Injury Research and Policy, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD., USA.
Am J Public Health. 1998 Nov;88(11):1630-7. doi: 10.2105/ajph.88.11.1630.
This study examined factors influencing return to work (RTW) following severe fracture to a lower extremity.
This prospective cohort study followed 312 individuals treated for a lower extremity fracture at 3 level-1 trauma centers. Kaplan-Meier estimates of the proportion of RTW were computed, and a Cox proportional hazards model was used to examine the contribution of multiple risk factors on RTW.
Cumulative proportions of RTW at 3, 6, 9, and 12 months post-injury were 0.26, 0.49, 0.60, and 0.72. After accounting for the extent of impairment, characteristics of the patient that correlated with higher rates of RTW included younger age, higher education, higher income, the presence of strong social support, and employment in a white-collar job that was not physically demanding. Receipt of disability compensation had a strong negative effect on RTW.
Despite relatively high rates of recovery, one quarter of persons with lower extremity fractures did not return to work by the end of 1 year. The analysis points to subgroups of individuals who are at high risk of delayed RTW, with implications for interventions at the patient, employer, and policy levels.
本研究探讨了影响下肢严重骨折后重返工作岗位（RTW）的因素。
这项前瞻性队列研究对3家一级创伤中心的312例接受下肢骨折治疗的患者进行了随访。计算了RTW比例的Kaplan-Meier估计值，并使用Cox比例风险模型来检验多种风险因素对RTW的影响。
受伤后3、6、9和12个月时RTW的累积比例分别为0.26、0.49、0.60和0.72。在考虑损伤程度后，与较高RTW率相关的患者特征包括年龄较小、教育程度较高、收入较高、有强大的社会支持以及从事非体力要求高的白领工作。领取残疾赔偿金对RTW有强烈的负面影响。
尽管恢复率相对较高，但四分之一的下肢骨折患者在1年末仍未重返工作岗位。该分析指出了RTW延迟风险较高的个体亚组，这对患者、雇主和政策层面的干预具有启示意义。
