The lack of association between changes in functional outcomes and work retention in a chronic disabling occupational spinal disorder population: implications for the minimum clinical important difference.
The lack of association between changes in functional outcomes and work retention in a chronic disabling occupational spinal disorder population: implications for the minimum clinical important difference.
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DOI：
10.1097/brs.0b013e3181d41632
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发表时间：
2011-03-15
期刊：
影响因子：
3
通讯作者：
Gatchel RJ
中科院分区：
文献类型：
--
作者：
Wilson HD;Mayer TG;Gatchel RJ
一项针对慢性疼痛/残疾人群的前瞻性研究，研究了Oswestry残疾量表（ODI）以及SF-36的精神成分总结（MCS）和身体成分总结（PCS）与康复后一年工作保留（WR）状态的关系。探讨WR状态与ODI变化、SF-36的MCS和PCS之间的关系，并确定是否可以将WR作为所考虑患者组的外部标准来识别MCID。临床上有意义的改变可以通过自我报告、以医生为基础的或客观的改善标准来定义，尽管大多数评估都是基于自我报告的改善评估。与工作相关的脊柱疾病后发生的残疾有助于将自我报告措施锚定在治疗后1年的客观工作状态结果上。需要进一步的研究来评估变化和客观改进标记之间的关系。慢性致残性职业性脊柱疾病（CDOSDs）患者的连续队列（n= 2024）完成了跨学科的功能恢复计划，并在治疗后一年内接受了客观的社会经济结果的结构化临床访谈。在完成功能恢复计划后，计算成功保留工作的患者和未完成工作的患者的ODI以及SF-36的MCS和PCS的平均百分比变化。通过logistic回归分析评估百分比变化分数的预测能力。没有百分比差异变量是治疗后一年工作保留状态的强预测因子。目前的分析表明，当使用基于锚定方法的WR数据作为外部标准时，ODI和SF-36 MCS和PCS措施在个体患者水平上没有反应。这一发现与基于分布方法的反应性报告或使用自我报告变化锚点的方法形成对比。
A prospective study in a chronic pain/disability population, relating changes in the Oswestry Disability Inventory (ODI), as well as the Mental Component Summary (MCS) and Physical Component Summary (PCS) of the SF-36, to work retention (WR) status at one year post-rehabilitation. To explore the relationship between WR status and change in ODI, and the MCS and PCS of the SF-36, and determine if an MCID can be identified utilizing WR as an external criterion for the group of patients under consideration. Clinically meaningful change may be defined through self-report, physician-based, or objective criteria of improvement, although most assessments have been based on self-report assessment of improvement. The disability occurring after work-related spinal disorders lends itself to anchoring self-report measures to objective work status outcomes 1 year post-treatment. Additional research is needed to evaluate the relationship between change and objective markers of improvement. A consecutive cohort of patients (n=2,024) with chronic disabling occupational spinal disorders (CDOSDs) completed an interdisciplinary functional restoration program, and underwent a structured clinical interview for objective, socioeconomic outcomes at one year post-treatment. The average percent change in the ODI, as well as the MCS and PCS of the SF-36, were calculated for patients who successfully retained work and those who had not after completing a functional restoration program. Predictive ability of the percent change scores were evaluated through logistic regression analysis. No percent difference variables were strong predictors of work retention status one-year following treatment. The current analyses suggest that the ODI and SF-36 MCS and PCS measures are not responsive at the individual patient level when WR data are employed as the external criterion utilizing an anchor-based approach. This finding contrasts to reports of responsiveness based on distributional methods, or methods using self-report anchors of change.