功能性能力评估在局部骨折工伤患者复工能力评估中的应用
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摘要
目的:研究功能性能力评估(FCE)对不同局部骨折工伤患者就业状况的预测效度,同时研究疼痛对该预测效度的影响情况。方法:根据入选标准及排除标准筛选出300例工伤患者,按受伤部位分为上肢骨折组、下肢骨折组、躯干骨折组。这些参加者出院复工前给予FCE和疼痛情况评估,并根据FCE评估结果给予相应复工结局建议,包括渐进复工、工作任务调整、转换岗位、暂不予复工就业,并在3个月内电话跟进其就业状况,最后研究FCE的复工建议与实际就业情况的一致性程度是否有统计学意义,以此研究FCE预测不同局部骨折工伤患者就业风险效度的情况,并研究患者疼痛相关情况是否影响FCE对各种局部骨折患者就业风险的预测效度。结果:FCE评估结果与上肢骨折(Kappa=0.428,P<0.05)、下肢骨折(Kappa=0.384,P<0.05)和躯干骨折(Kappa=0.280,P<0.05)患者的实际就业结果一致性有统计学意义,能够预测这些类型患者职业能力,显示其就业风险。上肢骨折组VAS得分(1.3±1.9)分,下肢骨折组VAS得分(1.9±1.6)分,躯干骨折组VAS得分(2.6±1.6)分,单因素二元logistic回归分析显示疼痛程度是FCE对下肢骨折及躯干骨折患者的就业状况预测效度的影响因素(P<0.05),疼痛程度不是FCE对上肢骨折患者的就业状况预测效度的影响因素(P>0.05)。结论:对于局部骨折的患者,FCE是一种有效的预测复工风险的工具;对有主诉疼痛的下肢骨折和躯干骨折患者给予FCE评估时,建议结合其他基于疼痛的心理社会因素评估项目,以减少疼痛对评估的干扰。
Objective: To explore the predictive validity of Functional Capacity Evaluation(FCE) on the employment status of work-related injured patients at different injured sites, and to explore the effect of pain on the predictive validity. Methods: A total of300 work-related injuries were divided into three groups base on the injured sites: group One, upper extremity fractures patients; group Two, lower extremity fractures patients; group Three, trunk fractures patients. Base on the FCE and the pain-related assessments, participants who would leave hospital soon received recommendations of return-to-work(It includes four kinds of suggestions: 1. Return to previous job; 2. Return to previous job but adjust task; 3. Do the other job; 4. Do not return to work). After three months, participants were contacted by telephone to ascertain their employment status and to observe the Kappa of actual employment and FCE assessment for patients. At the same time, we explored the effect of pain on the predictive validity of FCE. Results: There were all significant relationships between recommendations of return-to-work and employment rate within three months for all patients(group One: Kappa=0.428, P<0.05; group Two: Kappa=0.384, P<0.05; group Three: Kappa=0.280, P<0.05). The VAS scores of three groups were(1.3±1.9),(1.9±1.6),(2.6±1.6) respectively. The pain had the effect on the predictive validity of FCE about lower extremity fractures patients and trunk fractures patients(P<0.05). Conclusion: FCE is an effective assessment tool about return-to-work. If lower extremity fractures patients and trunk fractures patients are painful, they can't be evaluated by FCE only, they can be evaluated by FCE and other pain-based psychosocial factors.
Objective: To explore the predictive validity of Functional Capacity Evaluation(FCE) on the employment status of work-related injured patients at different injured sites, and to explore the effect of pain on the predictive validity. Methods: A total of300 work-related injuries were divided into three groups base on the injured sites: group One, upper extremity fractures patients; group Two, lower extremity fractures patients; group Three, trunk fractures patients. Base on the FCE and the pain-related assessments, participants who would leave hospital soon received recommendations of return-to-work(It includes four kinds of suggestions: 1. Return to previous job; 2. Return to previous job but adjust task; 3. Do the other job; 4. Do not return to work). After three months, participants were contacted by telephone to ascertain their employment status and to observe the Kappa of actual employment and FCE assessment for patients. At the same time, we explored the effect of pain on the predictive validity of FCE. Results: There were all significant relationships between recommendations of return-to-work and employment rate within three months for all patients(group One: Kappa=0.428, P<0.05; group Two: Kappa=0.384, P<0.05; group Three: Kappa=0.280, P<0.05). The VAS scores of three groups were(1.3±1.9),(1.9±1.6),(2.6±1.6) respectively. The pain had the effect on the predictive validity of FCE about lower extremity fractures patients and trunk fractures patients(P<0.05). Conclusion: FCE is an effective assessment tool about return-to-work. If lower extremity fractures patients and trunk fractures patients are painful, they can't be evaluated by FCE only, they can be evaluated by FCE and other pain-based psychosocial factors.
引文
[1] SOER R,RENEMAN M F,FRINGS-DRESEN M H. Experts opinion on the use of normative data for functional capacity evaluation in occupational and rehabilitation medicine and disability claims[J]. J Occup Rehabil,2014,24(4):806-811.
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[3]黄茹,徐艳文.工伤病人出院前一周内就业意愿与疼痛分级相关性研究[J].按摩与康复医学,2015,6(12):133-134.
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[5]林呈亮.论我国工伤职业康复制度的困境与出路[D].上海:上海师范大学,2015:2-5.
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[7] GROSS D P,ASANTE A K,MICIAK M,et al. A cluster randomized clinical trial comparing functional capacity evaluation and functional interviewing as components of occupational rehabilitation programs[J]. J Occup Rehabil,2014,24(4):617-630.
[8]刘延青.崔健君.实用疼痛学[M].北京:人民卫生出版社,2013:155-156.
[9] TREEDE RD,RIEF W,BARKE A. ICD-Ⅱ慢性疼痛分类[J].胡理,罗层,陈军,译.中国疼痛医学杂志,2015,21(7):486-488.
[10] TUHINA NEOGI,江颖颖,赵华. IASP关节痛文献资料,《中国疼痛医学杂志》组织翻译第九篇:关节痛的流行病学[J].中国疼痛医学杂志,2016,22(6):481-481.
[11] BOHL D D,AHN J,COLLINS M,et al. Functional capacity evaluation following spinal fusion surgery[J]. Spine,2016,41(13):1104-1110.
[12] LEGGE J,BURGESS-LIMERICK R,PEETERS G. A new preemployment functional capacity evaluation predicts LongerTerm risk of musculoskeletal injury in healthy workers a prospective cohort study[J]. Spine,2013,38(25):2208-2215.
[13] RATZON N Z,AMIT Y,FRIEDMAN S,et al. Functional capacity evaluation:Does it change the determination of the degree of work disability?[J]. Disabil Health J,2015,8(1):80-85.
[14] WILLIAMS A C,CRAIG K D. Updating the definition of pain[J].Pain,2016,157(11):2420-2423.
[15]韩睿,廖琴,阳晓燕,等.一种新的疼痛分类方法和治疗思路[J].中国疼痛医学杂志,2017,23(5):328-330.
[16]吴大明.全球每年工伤事故与职业病损失[J].劳动保护,2017(10):101.
[17] FERRY T,BERGSTROM U,HEDSTROM E M,et al. Epidemiology of acute knee injuries seen at the Emergency Department at UmeAyen University Hospital,Sweden,during 15 years[J].Knee Surg Sports Traumatol Arthrosc,2014,22(5):1149-1155.
[18]方仲毅,范帅,姜鑫,等.髌骨横行骨折经张力带加克氏针固定术后的早期康复[J].康复学报,2016,26(1):6-9.
[19]侯大龙.膝关节韧带损伤所致关节僵硬早期治疗的研究进展[D].大连:大连医科大学,2015:20-21.
[20]姜迎萍,孙云丰,周益凡.基于表面肌电评价术前康复治疗对单膝关节置换术后功能恢复的影响[J].康复学报,2015,25(3):43-45.
[21]张铭华.骨折后软组织肿胀的机制研究及治疗进展[J].医学综述,2013,19(15):2816-2818.
[22]刘仁超,周建英.银质针疗法治疗软组织疼痛概况[J].实用中医药杂志,2017,33(2):205-207.
[23]张长杰.肌肉骨骼康复学[M].北京:人民卫生出版社,2016:251-253.
[24]刘泽军.心理因素对术后疼痛结果的影响[D].重庆:西南大学,2017:7-10.
[25] NEBLETT R,MAYER T G,WILLIAMS M J,et al. The fearavoidance components scale(FACS):responsiveness to functional restoration treatment in a chronic musculoskeletal pain disorder(CMPD)population[J]. Clin J Pain,2017,33(12):1088-1099.
[26] SCHWEGLER U,ANNER J,ANDREA GLASSEL. Towards comprehensive and transparent reporting:context-specific additions to the ICF taxonomy for medical evaluations of work capacity involving claimants with chronic widespread pain and low back pain[J]. BMC Health Serv Res,2014,14:361.
[27] OESCH P,MEYER K,JANSEN B,et al. Functional capacity evaluation:performance of patients with chronic non-specific low back pain without waddell signs[J]. J Occup Rehabil,2015,25(2):257-266.
[28] CHENG A S,CHENG S W. The predictive validity of job-specific functional capacity evaluation on the employment status of patients with nonspecific low back pain[J]. J Occup Environ Med,2010,52(7):719-724.
[2]钟巍,卢讯文.浅谈功能性能力评估(FCE)在职业康复中的应用[J].按摩与康复医学,2016,7(21):6-8.
[3]黄茹,徐艳文.工伤病人出院前一周内就业意愿与疼痛分级相关性研究[J].按摩与康复医学,2015,6(12):133-134.
[4]张长杰.肌肉骨骼康复学[M].北京:人民卫生出版社,2016:14-82.
[5]林呈亮.论我国工伤职业康复制度的困境与出路[D].上海:上海师范大学,2015:2-5.
[6] RENEMAN M F,SOER R,GROSS D P. Developing research on performance-based functional work assessment:report on the first international functional capacity evaluation research meeting[J].J Occup Rehabil,2013,23(4):513-515.
[7] GROSS D P,ASANTE A K,MICIAK M,et al. A cluster randomized clinical trial comparing functional capacity evaluation and functional interviewing as components of occupational rehabilitation programs[J]. J Occup Rehabil,2014,24(4):617-630.
[8]刘延青.崔健君.实用疼痛学[M].北京:人民卫生出版社,2013:155-156.
[9] TREEDE RD,RIEF W,BARKE A. ICD-Ⅱ慢性疼痛分类[J].胡理,罗层,陈军,译.中国疼痛医学杂志,2015,21(7):486-488.
[10] TUHINA NEOGI,江颖颖,赵华. IASP关节痛文献资料,《中国疼痛医学杂志》组织翻译第九篇:关节痛的流行病学[J].中国疼痛医学杂志,2016,22(6):481-481.
[11] BOHL D D,AHN J,COLLINS M,et al. Functional capacity evaluation following spinal fusion surgery[J]. Spine,2016,41(13):1104-1110.
[12] LEGGE J,BURGESS-LIMERICK R,PEETERS G. A new preemployment functional capacity evaluation predicts LongerTerm risk of musculoskeletal injury in healthy workers a prospective cohort study[J]. Spine,2013,38(25):2208-2215.
[13] RATZON N Z,AMIT Y,FRIEDMAN S,et al. Functional capacity evaluation:Does it change the determination of the degree of work disability?[J]. Disabil Health J,2015,8(1):80-85.
[14] WILLIAMS A C,CRAIG K D. Updating the definition of pain[J].Pain,2016,157(11):2420-2423.
[15]韩睿,廖琴,阳晓燕,等.一种新的疼痛分类方法和治疗思路[J].中国疼痛医学杂志,2017,23(5):328-330.
[16]吴大明.全球每年工伤事故与职业病损失[J].劳动保护,2017(10):101.
[17] FERRY T,BERGSTROM U,HEDSTROM E M,et al. Epidemiology of acute knee injuries seen at the Emergency Department at UmeAyen University Hospital,Sweden,during 15 years[J].Knee Surg Sports Traumatol Arthrosc,2014,22(5):1149-1155.
[18]方仲毅,范帅,姜鑫,等.髌骨横行骨折经张力带加克氏针固定术后的早期康复[J].康复学报,2016,26(1):6-9.
[19]侯大龙.膝关节韧带损伤所致关节僵硬早期治疗的研究进展[D].大连:大连医科大学,2015:20-21.
[20]姜迎萍,孙云丰,周益凡.基于表面肌电评价术前康复治疗对单膝关节置换术后功能恢复的影响[J].康复学报,2015,25(3):43-45.
[21]张铭华.骨折后软组织肿胀的机制研究及治疗进展[J].医学综述,2013,19(15):2816-2818.
[22]刘仁超,周建英.银质针疗法治疗软组织疼痛概况[J].实用中医药杂志,2017,33(2):205-207.
[23]张长杰.肌肉骨骼康复学[M].北京:人民卫生出版社,2016:251-253.
[24]刘泽军.心理因素对术后疼痛结果的影响[D].重庆:西南大学,2017:7-10.
[25] NEBLETT R,MAYER T G,WILLIAMS M J,et al. The fearavoidance components scale(FACS):responsiveness to functional restoration treatment in a chronic musculoskeletal pain disorder(CMPD)population[J]. Clin J Pain,2017,33(12):1088-1099.
[26] SCHWEGLER U,ANNER J,ANDREA GLASSEL. Towards comprehensive and transparent reporting:context-specific additions to the ICF taxonomy for medical evaluations of work capacity involving claimants with chronic widespread pain and low back pain[J]. BMC Health Serv Res,2014,14:361.
[27] OESCH P,MEYER K,JANSEN B,et al. Functional capacity evaluation:performance of patients with chronic non-specific low back pain without waddell signs[J]. J Occup Rehabil,2015,25(2):257-266.
[28] CHENG A S,CHENG S W. The predictive validity of job-specific functional capacity evaluation on the employment status of patients with nonspecific low back pain[J]. J Occup Environ Med,2010,52(7):719-724.