A clinical return-to-work rule for patients with back pain
A clinical return-to-work rule for patients with back pain
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DOI：
10.1503/cmaj.1041159
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发表时间：
2005-06-07
影响因子：
14.6
通讯作者：
Larocque, I
中科院分区：
文献类型：
--
作者：
Dionne, CE;Bourbonnais, R;Larocque, I
背景：早期识别具有不良职业后果高风险的背痛工人的工具将有助于将临床注意力集中在最需要的患者身上，同时有助于减少不必要的干预（和成本）等。本研究的目的是制定和验证临床规则，以预测在初级保健机构中就非特异性背痛进行咨询的人的 2 年工作残疾状态。方法：这是在魁北克市地区 7 个初级保健机构中进行的一项为期 2 年的前瞻性队列研究。该研究招募了 1007 名年龄在 18 至 64 岁之间的工人（参与，其中 68.4% 的潜在参与者预计符合资格），他们因至少缺勤 1 天相关的非特异性背痛进行咨询。大多数人 (86%) 完成了 5 次电话采访，记录了大量变量。临床信息是从医疗档案中提取的。结果衡量标准是两年后“健康地重返工作岗位”，该变量结合了患者的职业状态、功能限制和缺勤复发情况。我们对 40% 的研究对象随机样本采用递归划分方法开发了 2 年结果的预测模型，然后对其余对象进行验证。结果：最佳预测模型包括 7 个基线变量（患者的康复预期、放射痛、既往背部手术、疼痛强度、因背痛而频繁改变体位、易怒和脾气暴躁以及睡眠困难），并且在识别无不良职业结果的患者方面特别有效（阴性预测值 78% - 94%）。解释：临床预测规则准确地识别出大部分在初级保健机构接受背痛咨询的工作人员，这些工作人员出现不良职业结果的风险较低。
Background: Tools for early identification of workers with back pain who are at high risk of adverse occupational outcome would help concentrate clinical attention on the patients who need it most, while helping reduce unnecessary interventions ( and costs) among the others. This study was conducted to develop and validate clinical rules to predict the 2-year work disability status of people consulting for nonspecific back pain in primary care settings.Methods: This was a 2-year prospective cohort study conducted in 7 primary care settings in the Quebec City area. The study enrolled 1007 workers ( participation, 68.4% of potential participants expected to be eligible) aged 18 - 64 years who consulted for nonspecific back pain associated with at least 1 day's absence from work. The majority (86%) completed 5 telephone interviews documenting a large array of variables. Clinical information was abstracted from the medical files. The outcome measure was "return to work in good health" at 2 years, a variable that combined patients' occupational status, functional limitations and recurrences of work absence. Predictive models of 2-year outcome were developed with a recursive partitioning approach on a 40% random sample of our study subjects, then validated on the rest.Results: The best predictive model included 7 baseline variables ( patient's recovery expectations, radiating pain, previous back surgery, pain intensity, frequent change of position because of back pain, irritability and bad temper, and difficulty sleeping) and was particularly efficient at identifying patients with no adverse occupational outcome ( negative predictive value 78% - 94%).Interpretation: A clinical prediction rule accurately identified a large proportion of workers with back pain consulting in a primary care setting who were at a low risk of an adverse occupational outcome.