Psychosocial factors and the rehabilitation of patients with chronic work-related upper extremity disorders
Psychosocial factors and the rehabilitation of patients with chronic work-related upper extremity disorders
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DOI：
10.1007/bf02767360
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发表时间：
1997-09-01
影响因子：
3.3
通讯作者：
Gatchel, RJ
中科院分区：
文献类型：
--
作者：
Burton, K;Polatin, PB;Gatchel, RJ
这项前瞻性队列研究调查了心理社会因素对长期就业结果的影响，这些长期就业结果的样本是已完成跨学科功能恢复计划的慢性工作相关上肢疼痛障碍患者。检查的因素包括以下内容：DSM-III-R轴I和轴II诊断，来自DSM-III-R（SCID）的结构化临床访谈;由SCID引起的儿童虐待史;量化疼痛绘图，评估感知的疼痛强度;百万视觉模拟量表，测量感知的残疾水平;贝克抑郁量表，评估抑郁水平。结果从单因素分析表明，返回到工作状态I年后康复预测以下社会心理变量：轴I障碍的数量，过去的诊断药物滥用，过去和/或目前的诊断焦虑症的边缘性人格障碍的诊断，儿童虐待史，抑郁情绪的自我报告，和中度到高度的自认为残疾。此外，年龄，种族，残疾的长度，和先前的手术治疗预测返回到工作的比赛。多元Logistic回归进一步显示，年龄较大的上肢患者;高加索人，目前诊断为焦虑症，并且他们对残疾的感知从术前到术后恶化，在一年随访时重返工作岗位的可能性显着降低。总的来说，研究结果表明，心理社会变量影响上肢残疾患者的成功康复，这表明这些患者应进行评估和治疗的心理社会功能障碍与他们的康复，以优化治疗后的良好结果。
This prospective cohort study investigated the effects of psychosocial factors on long-term employment outcome of a sample of chronic work-related upper-extremity pain disorder patients who had completed an interdisciplinary functional restoration program. Factors examined included the following: DSM-III-R Axis I and Axis II diagnoses, derived from the Structured Clinical Interview for DSM-III-R (SCID); history of childhood abuse experienced as elicited by the SCID; the Quantitated Pain Drawing, which evaluated perceived pain intensity; Million Visual Analog Scale, which measures perceived level of disability; and the Beck Depression Inventory, which assessed the level of depression. Results fi om univariate analyses demonstrated that return-to-work status I year following rehabilitation was predicted by the following psychosocial variables: The number of Axis I disorders, a past diagnosis of substance abuse, a past and/or current diagnosis of an anxiety disorder a diagnosis of borderline personality disorder a history of childhood abuse, self-report of depressed mood, and a moderate to high level of perceived disability. Additionally, age, race, length of disability, and prior surgical treatment predicted return-to-work races. A multiple logistic regression further revealed that upper extremity patients who were older; Caucasian, had a current diagnosis of an anxiety disorder and whose perception of their disability deteriorated from pre-to post-program were significantly less likely to return to work at one-year follow-lip. Overall, the findings indicate that psychosocial variables influence the successful rehabilitation of patients with upper extremity disability, suggesting that these patients should be assessed and treated for psychosocial dysfunctions in conjunction with their rehabilitation so as to optimize favorable outcomes after treatment.