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

Application of Functional Capacity Evaluation in Return-to-work Ability Assessment of Work-related Injury Patients with Local Factures

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.