上下肢職業傷害勞工復工因子探討

Factors Affecting Return to Work of Upper and Lower Limb Injury Workers

蔡念祖(Nien-Tsu Tsai)

指導教授 ： 陳美香

中山醫學大學/醫學科技學院/醫學檢驗暨生物技術學系碩士班/碩士(2014年)

https://doi.org/10.6834/CSMU.2014.00027

摘要

背景與目的：我國職業傷害造成身體傷害部位以上肢為最多，其次為下肢。而職業災害造成勞工的生理、心理、及社會適應等各方面有所限制，進而影響職業災害勞工復工。故本研究即針對職業災害族群最大宗—上肢與下肢職業傷害的勞工，依世界衛生組織「國際功能、失能和健康分類(ICF)」之概念分析復工活動，探討各層面影響職業災害勞工復工的因子，未來在協助職業災害勞工復工時，能提供合適的解決策略。
研究方法：本研究採方便抽樣（accidental sampling），與中部某醫院職業傷病防治中心合作，於102年10月開始至103年4月進行收案，共40位上肢與下肢損傷職災勞工完成問卷調查，以收集上肢與下肢損傷職災勞工復工情形以及其它生理、心裡、社會環境方面之狀況，並以獨立樣本t檢定、卡方檢定和多元迴歸分析何因子會影響到上下肢職災勞工復工及其復工天數，以及分析上肢與下肢損傷職災勞工復工之差異性。
研究結果：依據ICF架構可將變項分為身體功能與結構與環境因素兩大項。結果指出職業災害6個月後，已復工者與未復工者在身體功能與結構變項中，於「心理症狀」(p=0.000)、「職涯問難與問題」(p=0.000)、「一般醫療復健期間」(p=0.000)、「復工天數」(p=0.000)、「有無重複職災」(p=0.039)、「有無神經受損」(p=0.048)、以及「有無明顯併發症」(p=0.000)變項有顯著差異；在環境因素中，於「教育程度」(p=0.000)、「目前工作薪水」(p=0.009)、「職災前後薪水差異」(p=0.010)、「保險給付長度」(p=0.009)變項有顯著差異；而僅有「保險給付長度」對於復工之預測力最為顯著(β=0.541,P<0.05)；上肢損傷與下肢損傷職災勞工在「復工」(p=0.024)、「住院天數」(p=0.008)、「一般醫療復健天數期間」(p=0.023)、「復工天數」(p=0.008)及「給付時間長度」(p=0.046)變項有顯著差異。
結論：職災勞工的心理症狀和損傷嚴重情況，以及外在環境像是經濟需求等皆會影響復工，故需針對職災勞工於障礙各階段之需求，提供適時的服務，障礙急性期先提供醫療處理與復健，並灌輸職災勞工對於損傷恢復過程以及傷害癒後的結果有正確的觀念，到了慢性期開始接受職業重建並給予心理支持，幫助勞工生心理皆做好復工的準備，這將有助於縮短復工天數，進而縮短保險給付時間，而這一連續服務有賴前端醫療與後端職業重建單位資源的合作與努力

關鍵字

復工 ； 上肢與下肢損傷 ； 職業傷害

並列摘要

The number of persons who are injured on the work is increased year by year. Upper limbs injury is the most type of work-related injury, lower limbs injury is the second. The physical, psychological, and social function of workers may be restricted by work-related injury, thereby affecting workers return to work. The purpose of this study is to investigate the various factors, which affecting upper and lower limbs injured workers return to work, according to the "International Classification of Functioning, Disability and Health, ICF" concept, as well as to provide suitable strategies for assisting workers return to work.
Method：From October 2013 to April 2014, a total of 40 upper and lower limbs injured workers are recruited by accidental sampling. The data about workers' physical, psychological, social function, and work status are collected through the questionnaire. Independent t tests and Chi-square tests are used to analysis the differences between the workers who had been return to work and the workers who had not been. Independent t tests are used for continuous variables, Chi-square tests are used to compare categorical variables, and stepwise multiple regression analysis is used to analysis which factors can predict the time to return to work.
Results：After 6 months of work-related injury accidents, mental symptom(p=0.000), career difficulty(p=0.007), the period of medical rehabilitation(p=0.000), the time to return to work(p=0.000), repeated work-related injuries(p=0.039), nerve injury (p=0.048), medical complications(p=0.000), educational level(p=0.017), work salary(p=0.009), the difference of salary before and after injury(p=0.010), and the period of insurance benefits(p=0.009) are significant different between the workers who had been return to work and the workers who had not been. Besides, the period of insurance benefits can significantly predict the time to return to work(β=0.541,P<0.05). Work status(p=0.024), the number of days in hospital(p=0.027), the period of medical rehabilitation(p=0.023),the time to return to work(p=0.008), and the period of insurance benefits(p=0.046) are significant different between upper and lower limbs injuried workers.
Conclusion：The result of the study showed that the factors which effect the time to return to work includ the mental symptom, the order of injuried severity, the demand of economy and so on. Vocational rehabilitation staffs should provide timely services at every phase of injury. In the acute phase, it should provide medical services and rehabilitation, and should provide vocational rehabilitation and mental support in the chronic phase. This is beneficial to shorten the number of days to return to work and the period of insurance benefits, while this continuous service depends on cooperation and efforts of vocational rehabilitation and medical unit .

並列關鍵字

return to work ； upper and lower limbs injury ； work-related injury

參考文獻

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