工作強化於下背痛患者之療效

Abstract

本研究旨在探討下背痛個案於「工作強化」後之疼痛狀況、負重能力與工作狀態是否改變，並了解中長期追蹤時，接受「工作強化」的下背痛個案，其疼痛狀況、負重能力與工作狀態是否異於未接受「工作強化」者。同時探討長期追蹤時，人口學或其他社會心理因子與工作狀態的關聯性。受測者為23位因受傷而無法工作或工作困難之下背痛勞工，可接受完整介入者視為實驗組(13名)，而無法完成工作強化或接受訓練日數少於5天者視為控制組(10名)。工作強化前，兩組皆施予功能性能力評估與數字疼痛量尺，工作強化結束後，治療組接受再測。結案後一、三、六、十二個月，研究者電話追蹤個案之工作狀態。結案後平均3年，再次召回個案填寫工作與健康狀態追蹤問卷、數字疼痛量尺，並施測功能性能力評估。結果顯示經過平均三週的工作強化後，治療組個案之雙手搬運、雙手抬舉、抬舉能力符合比與疼痛值皆有顯著進步。而平均三年後再做長期追蹤，發現實驗組個案之搬運值、抬舉值、抬舉能力符合比與疼痛值仍顯著優於初測狀況，顯示工作強化療效可維持平均三年以上。同時發現傷後停止工作越久者越不易復工、傷病時間越久者越不易復工、女性較易復工、初始工作能力損失在25%以下者較易回復原工作。然而本研究非隨機分配試驗，僅採方便樣本，而且樣本數不足，易造成取樣偏差，建議往後採用更嚴謹實驗設計。最後，鑑於本研究之療效驗證，建議台灣復健專業人員可推廣工作強化，以協助下背痛勞工安全且順利的返回職場。

The purpose of this research was to examine the short and long term effectiveness of the work hardening program on the pain score, lifting and carrying capacity, and work status of the low back pain clients. Simultaneously, the relationship within the demographic, social, psychological factors, and the work status were studied as well. The subjects were 23 low back pain clients without job or with decreased workability. The clients receiving standard work hardening were experimental group (13 people) while the others couldn’t finish the program or received <5 days training were considered as control group (10 people). Both groups were examined with National Taiwan University Hospital Functional Capacity Evaluation (NTUH-FCE) and the Numerical Pain Scale (NRS) before the treatment. The experimental group was evaluated again at the time of discharge. The work status of all the clients was collected by phone at 1, 3, 6, and 12 months after discharge. Averagely three years after the discharge, the clients were recalled to complete the NTUH-FCE, NRS, and the work and health status questionnaire. Results revealed that after work hardening, the carrying capacity, lifting capacity, lifting match ratio, and the pain score of the experimental group improved. At the time of the long term follow up, subjects in the experiemental group had the same results as those of discharge, which meant that the effectiveness of the work hardening program lasted for at least 3 years. The study found that the people with longer injury days or sick leave days had more difficulty in returning to work and while the female clients and the ones with <25% work ability loss could keep their job easier. The primary limitations of this study were the small sample size and the methods of data collection. The study design should be refined. Finally, this study supported the effectiveness of the work hardening programfor the employees with low back pain to return to work safely.