以國際健康功能與身心障礙分類模式分析骨外傷者的復工因子

目的：以實證文獻回顧探討因骨外傷導致上下肢損傷者，影響其復工的相關因子，並以國際健康功能與身心障礙分類模式切入，提供相關專業人員適切的臨床處置建議，協助個案及早恢復工作參與。方法：搜尋文獻資料庫選用SDOL、Scopus、PubMed和CINAHL，搜尋期間為2010年1月到2020年12月。搜尋針對骨科疾患、預後因子和回復工作、日常生活功能和心理社會表現。以國際健康功能與身心障礙分類模式分析。結果：納入文章共24篇，個案年齡介於18-95歲，分析期間為受傷後到七年，復工率為37.1%到95%。在身體功能和身體構造：受傷後上下肢功能缺損的程度、多部位傷害和受傷後的併發症等因子會影響其復工；在活動及參與：使用與上下肢相對應的功能性評估工具去評量傷後的活動與參與困難度，其結果與復工有顯著相關；個人因素則受到人口學與社經地位、工作類型、情緒行為的影響；環境因素對於復工結果不一致。結論：骨外傷病人的受傷嚴重程度及情緒行為與復工有負向關係，功能性評估工具可用來了解活動與參與的受限並預測復工。另外，需要更多高證據層級的文獻來佐證支持各因素對復工的影響。

關鍵字

骨外傷；復工因子；國際健康功能與身心障礙分類架構

並列摘要

Objective: The purpose of this study was to review the literatures regarding prognostic factors for return to work (RTW) in patients with orthopedic injuries based on the International Classification of Function, Disability and Health (ICF) framework. According to the identified prognostic factors, health care professionals are able to make clinical decisions to optimize the RTW process. Methods: The article search was conducted on SDOL, Scopus, PubMed and CINAHL databases from January 2010 to December 2020, including using the terms for orthopedic injuries, prognostic factors, RTW, activities of daily living and psychosocial well-being. The prognostic factors were identified and organized by using the ICF as the reference framework. Results: Twenty-four studies were included with a follow-up period from the time since injury to seven years. Based on all the included studies, the patients aged 18 to 95 years and the range of average rate of return to original or modified work was 37.1% to 95%. In the aspects of body functions and structures, impairment severity, multiple body parts injured and complications were found to have impacts on RTW. In the aspects of activities and participation, several functional assessments for upper and lower extremity were found significantly related to RTW. For the personal factors, socioeconomic data, job type and emotional behavior were significantly related to RTW; however, there is no consistent evidence for environmental factors. Conclusions: Based on the review, impairment severity and emotional behavior were negatively related to RTW in patients with orthopedic trauma. Functional assessments were suggested to evaluate the limitations in activity and participation and to predict RTW. In addition, further high-quality studies are required to provide more evidence for investigating the influence of prognostic factors for RTW.

並列關鍵字

orthopedic trauma ； factors of return to work ； ICF model

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