肢體創傷勞工復工之兩年長期追蹤研究

Two-year Longitudinal Studies of Returning to Work among Traumatic Limb Injury Workers

侯文萱(Wen-Hsuan Hou)

指導教授 ： 莊弘毅

高雄醫學大學/健康科學院/職業安全衛生研究所/博士(2012年)

https://doi.org/10.6832/KMU.2012.00066

摘要

背景目的：肢體創傷勞工的回復工作是近年來職業復健領域中一個重要的議題。然而，至今仍鮮有對於台灣肢體創傷勞工完整而長期的重覆測量追蹤研究。因此，本研究依國際健康功能與身心分類系統(International Classification of Functioning, Disability, and Health, ICF)的架構來探討肢體創傷後勞工的復工情形、生活品質、軌跡曲線和失能調整請假天數。

研究方法：本研究收集於民國98年1至12月間，因肢體創傷住院義大醫院整型外科和骨科的1201位病人，利用重覆測量和存活分析方法，以復工時間和內容為主要觀察結果，ICF架構下的身體功能、活動參與、個人及環境等面向為次要結果，探討復工對生活品質的影響。

結果與討論：於受傷兩週內及1、3、6、12、18、24個月的追蹤只有38%的勞工可以順利維持復工，超過一半的人在半年內達到第一次復工。肢體創傷工人總共可以區分出持續、加速、漸進式的三種的復工軌跡，其分別佔21.5, 50.7和27.8%。復工狀態是身體功能、活動參與、個人和環境等因素中對生活品質影響最顯著的影響因子，而且復工同時也是影響肢體創傷工人生活品質中顯著的正向影響因子(??=0.215, p<0.0001, R2=0.234)。其中，年紀大、已婚、低教育程度、藍領、受傷嚴重、憂鬱、低自我效能和生活品質者較困難復工。另外，在調整過失能指數之後，新指標失能調整請假天數的改變從28.7%~186.6%不等，尤其是低教育程度和藍領工人改變較大（分別為185.7%和155.8%），不同次族群間的失能調整請假天數也都有統計上顯著的意義。

結論：從肢體創傷勞工復工之兩年長期追蹤研究發現，復工對勞工生活品質有獨立且顯著的影響，三組復工軌跡曲線皆有其獨特預測因子，以及失能調整請假天數新指標可以提供勞工職業健康政策的參考。

關鍵詞：復工、生活品質，失能、肢體創傷、國際健康功能與身心障礙分類系統

關鍵字

復工 ； 生活品質 ； 失能 ； 肢體創傷 ； 國際健康功能與身心障礙分類系統

並列摘要

Background and Objectives: Return-to-work (RTW) for workers with traumatic limb injury is a worldwide issue in the field of vocational rehabilitation. However, few comprehensive longitudinal repeated follow-up studies on traumatic limb injury have focused on workers in Taiwan. Therefore, the purpose of this study is to explore the RTW condition, health-related quality of life (HRQoL), trajectory patterns, and disability-adjusted leave days (DALD) of workers in Taiwan.

Methods: Patients diagnosed with limb injuries and hospitalized in the orthopedic and plastic surgery ward of E-Da hospital were recruited from January to December 2009 and followed until December 2011. Repeated measures, at 2 weeks post-injury and at 1, 3, 6, 12, 18, and 24 months post-injury, were conducted in order to assess the primary outcome of the time to RTW and the RTW status. Domain factors of the International Classification of Functioning, Disability, and Health (ICF) model (i.e., body function; activity/participation; and personal and environmental factors) were evaluated as our secondary outcomes.

Results: The results revealed that only 38% of workers maintained work status after RTW. We identified three RTW trajectories: persisted, accelerated, and progressive RTW. The estimated proportions were 21.5%, 50.7%, and 27.8%, respectively. Workers who are older, married, and less educated, and those having blue-collar jobs, severe injury, low self-efficacy, and low HRQoL, have more difficulty with RTW. As for the outcome of HRQoL, RTW is the most influential factor in comparison with other domains of ICF. The RTW status was positively associated with an increased score of HRQoL (??=0.215, p<0.0001, R2=0.234). In addition, women and older workers tended to have longer LDs than men and younger workers, with increases in percentage change of 16.0% and 139.5%, respectively. After adjusting for DI, the corresponding figures for DALDs were both increased, to 28.7% and 186.6%. The percentages for the less-educated workers and blue-collar workers were 185.7% and 155.8%. The expected DALDs showed statistically significant differences in all subgroup analyses.

Conclusions: Our two-year longitudinal repeated follow-up study concluded that RTW is an independent and significant factor in HRQoL, that the predictors of RTW trajectories are distinct, and that the DALD novel indicator may provide further implications for occupational health policy.

Keywords: return-to-work, health-related quality-of-life, disability, traumatic limb injuries, International Classification of Functioning, Disability, and Health

並列關鍵字

return-to-work ； health-related quality-of-life ； disability ； traumatic limb injuries ； International Classification of Functioning, Disability, and Health

參考文獻

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