本研究的目的是在探討基層門診中，下背痛患者發生工作失能的決定因子。本研究為一橫斷性研究，選擇臺北市某聯合門診復健科之就診患者中，以下背痛為唯一主訴，並且仍在就業中之患者做為評估對象。下背痛的評估包括:病史問診、理學檢查、及其他必要檢查;並以問卷方式，評量其個人婚姻及教育狀況、下背痛嚴重程度、工作內容，以及過去發生工作失能之情形。工作失能的評估包括:自覺下背痛對工作的妨礙、以及過去一週內是否因下背痛而請假。自民國八十七年十一月至民國八十八年五月之研究期間中，共有185名17至65歲之間的下背痛就診患者符合研究對象的條件，177位同意參與研究，參與率為95.7%。就診前一週因背痛而請假至少一天的比例為22.6%。受試者自覺下背痛對工作妨礙程度，與其自覺疼痛嚴重程度有明顯相關。利用Logistic迴歸分析，決定過去一週內是否因背痛而請假至少一天之重要因子為:新近一週內發作之背痛，以及自覺下背痛程度嚴重或對自覺下背痛對工作妨礙明顯者。而視過去一週請假天數為等距變項，再以線性迴歸分析，結果顯示教育程度在大學以下、以及自覺疼痛對工作妨礙嚴重者為顯著決定因子。

Study Design. This is a cross-sectional study focusing on low back pain patients in a primary care.
Objectives. Our goal is to survey the occurrence of back pain-related sick-leave among low back patients in a primary care. We also try to explore the determinants of these work disabilities.
Methods. All eligible patients visiting a primary care in Taipei were recruited between Nov 1998 and May 1999 and received interview and physical examination by a licensed physiatrist. They were also asked to answer a self-administered questionnaire voluntarily. The outcome evaluated included sick-leave days in the previous one week and self-reported interference to work due to low back pain. Information on demography, psychological status, and work history was also obtained through the questionnaire.
Results. One hundred and seventy-seven out of 185 eligible low back pain patients, aged 15 to 65 and employed, were recruited in the present study. 22.6% subjects reported at least one day sick leave due to low back pain in the past one week. Results showed that self-reported severity of low back pain is significantly associated with self-reported interference to work due to low back pain . With multiple logistic regression analysis, duration of low back pain, and self-reported severity of pain or interference to work due to work were found the significant determinants of sick-leave one week prior to this clinical visit. Treating the number of sick-leave —day as dependent variables in the multiple linear regression analysis, educational level and self-reported interference to works due to low back pain were found important determinants in the model.
Conclusion. The occurrence of low back pain-related work hour loss was low in the study clinic in comparison with reports in western countries. Important determinants of short-term work disabilities among these patients included educational level, low back pain duration and self- reported interference to work due to low back pain.

中文摘要.......................................................I
英文摘要......................................................II
表目錄........................................................IV
圖目錄........................................................VI
壹. 前言
第一節 下背痛之流行病學調查..................................1
第二節 下背痛在職業醫學上之重要性............................5
第三節 下背痛與工作失能......................................8
第四節 研究目的..............................................12
貳. 研究方法
第一節 樣本選取.............................................13
第二節 評估內容.............................................14
第三節 統計方法.............................................17
參. 結果
第一節 樣本收集.............................................18
第二節 疼痛病史及理學檢查...................................20
第三節 問卷結果.............................................22
第四節 下背痛嚴重程度與其他因子之相關.......................32
第五節 工作失能相關因子之探討.................................33
肆. 討論......................................................42
伍. 結論......................................................51
陸. 參考文獻................................................. 52
柒. 附錄......................................................59

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