THE PROGNOSTIC CONSEQUENCES IN THE MAKING OF THE INITIAL MEDICAL DIAGNOSIS OF WORK-RELATED BACK INJURIES
THE PROGNOSTIC CONSEQUENCES IN THE MAKING OF THE INITIAL MEDICAL DIAGNOSIS OF WORK-RELATED BACK INJURIES
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DOI：
10.1097/00007632-199504000-00010
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发表时间：
1995-04-01
期刊：
影响因子：
3
通讯作者：
SCOTT, S
中科院分区：
文献类型：
--
作者：
ABENHAIM, L;ROSSIGNOL, M;SCOTT, S
研究设计。本研究对1848名工人进行了为期24个月的跟踪调查，这些工人代表了所有工业部门，他们在1988年因腰背部受伤而获得了补偿，但在前两年没有得到补偿。确定医师对背部问题的初步诊断的预后价值。背景资料摘要。在背痛诊断缺乏标准化分类的情况下，本研究旨在为先前提出的由“特异性”和“非特异性”背痛组成的分类提供有效性元素。魁北克省工人赔偿委员会审查了病历，以提取治疗医生在缺勤第一天起7天内作出的诊断。诊断分为“特异性”（椎骨和椎间盘病变）和“非特异性”（疼痛、扭伤和拉伤）。在接下来的24个月里，获得了因腰痛而缺勤的历史。8.9%（165人）的工人有特殊诊断，占2年内累计缺勤6个月及以上患者的31.0%。年龄的增长和每日补偿量的增加也与慢性疾病的风险增加有关。医生的初步诊断与慢性风险高度相关。对这一结果的解释很复杂，涉及到潜在病变的性质以及诊断“标签”对工作人员和医患关系的影响。
Study Design. A cohort of 1848 workers, representative of all sectors of industry, who were compensated for a low back injury in 1988 but not in the previous 2 years, was followed over 24 months.Objectives. To determine the prognostic value of the physician's initial diagnosis of back problems.Summary of Background Data. In the absence of a standardized classification of diagnoses of back pain, this study aimed to provide an element of validity to a classification previously proposed that consists of ''specific'' and ''nonspecific'' back pain.Methods. Medical charts were reviewed at the Quebec Worker's Compensation Board to extract the diagnosis made by the treating physicians within 7 days of the first day of absence from work. Diagnoses were categorized into ''specific'' (lesions of vertebrae and discs) and ''nonspecific'' (pain, sprains, and strains). The history of compensated work absence for low back pain in the following 24 months was obtained.Results. A specific diagnosis was found in 8.9% (165) of the workers, accounting for 31.0% of the patients who accumulated 6 months or more of absence in 2 years. Increasing age and daily amount of compensation also were associated with an increased risk of chronicity.Conclusions. The physician's initial diagnosis was highly associated with the risk of chronicity. The explanation for this result is complex, involving the nature of the underlying lesion as well as the impact of the diagnosis ''label'' on the worker and on the physician-patient relationship.