轻度伤残职业康复者生活质量状况及其与不同层次复工结局的关联

doi:10.3969/j.issn.1006-9771.2026.09.010

摘要/Abstract

摘要：

目的探讨综合职业康复对轻度工伤致残者生活质量及复工结局的影响。

方法本研究为纵向观察性研究。选择2023年6月至2024年12月在广东省工伤康复医院进行综合职业康复的工伤职工作为研究对象，调查入院时和出院时的中文版简明健康状况调查简表(SF-36)评分，并在其出院后1年内进行随访，登记复工情况，比较不同复工结局(原岗位复工/新岗位复工/未复工)人群SF-36各维度得分的差异及其与复工结局的关联特征，识别不同层次复工结局的独立影响因素。

结果综合职业康复干预能改善工伤职工生理功能(PF)、生理职能(RP)、情感职能(RE)(P < 0.05)。出院时，原岗位复工组PF、RP、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、精神健康(MH)维度得分，新岗位复工组PF、BP、GH、SF维度得分均优于未复工组(P < 0.05)。以未复工为参照，多分类Logistic回归显示，原岗位复工组复工的不利因素有低学历(大专以下)、现场安置服务、损失工作日增加、低就业意愿(考虑前、考虑阶段)，有利因素是积极的健康变化(HT)评价；新岗位复工组复工的不利因素有低就业意愿(考虑前阶段)、损失工作日增加，有利因素是现场安置服务、积极的HT评价。

结论综合职业康复能提升工伤职工的生活质量，良好的生活质量状态对工伤职工复工结局存在正向积极作用，HT、学历、工作安置方式、损失工作日、就业意愿是不同层次复工结局的独立影响因素。

关键词: 轻度伤残, 工伤职工, 职业康复, 复工结局, 中文版简明健康状况调查简表, 健康变化, 损失工作日

Abstract:

Objective To explore the impact of comprehensive vocational rehabilitation on quality of life and return-to-work outcomes for individuals with mild work-related disability.

Methods A longitudinal observational study was conducted. A total of 343 work-injured employees receiving comprehensive vocational rehabilitation intervention in Guangdong Work Injury Rehabilitation Hospital from June, 2023 to December, 2024 were selected. The 36-item Short Form Health Survey (SF-36) was adopted to assess their health-related quality of life at admission and discharge. All subjects were followed up within one year after discharge to collect their return-to-work status. The differences in each dimension score of SF-36 among patients with different return-to-work outcomes (return to original post, transfer to new post and non-return to work) were compared, and the independent influencing factors of return-to-work outcomes were identified.

Results Comprehensive vocational rehabilitation intervention significantly improved the scores of physical functioning (PF), role-physical (RP) and role-emotional (RE) among work-injured employees (P < 0.05). At discharge, compared with patients who failed to return to work, patients returning to original post obtained significantly higher scores in PF, RP, bodily pain (BP), general health (GH), vitality (VT), social functioning (SF) and mental health (MH), patients transferred to new post achieved significantly higher scores in PF, BP, GH and SF (P < 0.05). Taking non-return-to-work status as the reference category, the multinomial logistic regression model showed the adverse factors for return to original post included low educational attainment (college diploma or below), on-site placement service, increased lost workdays and low employment intention (pre-contemplation and contemplation stages); the protective factor was positive evaluation of health transition (HT); for patients transferred to new posts, adverse factors were low employment intention (pre-contemplation stage) and increased lost workdays, while protective factors covered on-site placement service and positive HT evaluation.

Conclusion Comprehensive vocational rehabilitation can improve the quality of life for injured workers. Better quality of life is positively associated with return-to-work outcomes. HT, education level, job placement mode, lost workdays and employment willingness are independent factors impacting return-to-work outcomes.

Key words: mild work-related disability, injured workers, vocational rehabilitation, return-to-work outcomes, the 36-item Short Form Health Survey, health changes, lost workdays

中图分类号:

R492

周慧玲, 曾嘉彦, 陈冰. 轻度伤残职业康复者生活质量状况及其与不同层次复工结局的关联[J]. 《中国康复理论与实践》, 2026, 32(9): 1078-1086.

Zhou Huiling, Zeng Jiayan, Chen Bing. Quality of life among vocational rehabilitation patients with mild work-related disability and its association with return-to-work outcomes[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(9): 1078-1086.

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参考文献 31

[1]	中华人民共和国人力资源和社会保障部. 2024年度人力资源和社会保障事业发展统计公报[EB/OL]. (2025-06-13)[2026-05-03]. https://www.mohrss.gov.cn/xxgk2020/fdzdgknr/ghtj/tj/ndtj/202506/t20250616_543689.html.
[2]	刘晓敏, 徐艳文, 卢讯文. 肢体骨折工伤患者就业意愿转变现象及对复工的影响[J]. 中国康复医学杂志, 2023, 38(2): 212-215.
	Liu X M, Xu Y W, Lu X W. Phenomenon of employment willingness change and its influence on return to work among patients with work-related limb fractures[J]. Chin J Rehabil Med, 2023, 38(2): 212-215.
[3]	李鲁, 王红妹, 沈毅. SF-36健康调查量表中文版的研制及其性能测试[J]. 中华预防医学杂志, 2002, 36(2): 38-42.
	Li L, Wang H M, Shen Y. Development and psychometric tests of a Chinese version of the SF-36 Health Survey Scales[J]. Chin J Prev Med, 2002, 36(2): 38-42.
[4]	周慧玲, 陈冰, 曾嘉彦, 等. 中文版SF-36量表在广东职业康复患者中信效度研究[J]. 康复学报, 2018, 28(3): 12-15.
	Zhou H L, Chen B, Zeng J Y, et al. Reliability and validity of the Chinese Version of SF-36 Scale in Guangdong occupational rehabilitation[J]. J Rehabil, 2018, 28(3): 12-15.
[5]	陈阳, 王洁, 赵政晔, 等. 1型神经纤维瘤病伴脊柱侧凸患者术前SRS-22、SF-36问卷心理健康评分分析[J]. 中华骨与关节外科杂志, 2025, 18(6): 540-544.
	Chen Y, Wang J, Zhao Z Y, et al. Analysis of preoperative mental health scores of SRS-22 and SF-36 questionnaire in patients with scoliosis secondary to neurofibromatosis type 1[J]. Chin J Bone Joint Surg, 2025, 18(6): 540-544.
[6]	周慧玲, 曾嘉彦, 陈冰. 广东省工伤职业康复者SF-36量表评价参考值[J]. 中国康复医学杂志, 2020, 35(6): 726-729.
	Zhou H L, Zeng J Y, Chen B. Reference values of SF-36 scale for occupational rehabilitation injured workers in Guangdong province[J]. Chin J Rehabil Med, 2020, 35(6): 726-729.
[7]	中华人民共和国国务院. 工伤保险条例:国务院令第375号[EB/OL]. (2010-12-20)[2026-05-06]. https://www.mohrss.gov.cn/xxgk2020/fdzdgknr/zcfg/fg/202011/t20201103_394950.html.
[8]	GB/T 16180-2014 劳动能力鉴定职工工伤与职业病致残等级[S].
	GB/T 16180-2014 Standard for identify work ability: Gradation of disability caused by work-related injuries and occupational diseases[S].
[9]	周慧玲, 蔡东星, 邱梓瑜, 等. 广东地区工伤职业康复者复工特点及影响因素分析[J]. 中国康复医学杂志, 2019, 34(6): 711-713.
	Zhou H L, Cai D X, Qiu Z Y, et al. Analysis on characteristics and influencing factors of return to work of occupational rehabilitation patients with work injuries in Guangdong[J]. Chin J Rehabil Med, 2019, 34(6): 711-713.
[10]	邱梓瑜, 黄茹, 何文珊, 等. 广州轻中型颅脑损伤患者复工影响因素及职业康复策略研究[J]. 中国康复, 2025, 40(11): 699-704.
	Qiu Z Y, Huang R, He W S, et al. Influencing factors of return to work and vocational rehabilitation strategies for patients with mild-to-moderate traumatic brain injury in Guangzhou[J]. Chin J Rehabil, 2025, 40(11): 699-704.
[11]	徐艳文, 罗筱媛, 卢讯文, 等. 林氏就业准备量表在工伤职业康复中信度和效度的研究[J]. 中国康复理论与实践, 2014, 20(6): 592-596.
	Xu Y W, Luo X Y, Lu X W, et al. Reliability and validity of the Lam Assessment of Employment Readiness for Injured Workers[J]. Chin J Rehabil Theory Pract, 2014, 20(6): 592-596.
[12]	周慧玲, 卢讯文, 徐艳文, 等. 现场工作安置对一线工伤者复工率及出院后误工时间的影响[J]. 中国康复, 2018, 33(5): 405-407.
	Zhou H L, Lu X W, Xu Y W, et al. Effects of on-site work placement on return-to-work rate and post-discharge work absence time of frontline workers with occupational injuries[J]. Chin J Rehabil, 2018, 33(5): 405-407.
[13]	Van Berkel R, Breit E. Organizational practices and their outcomes for employees with disabilities: a review and synthesis of quantitative studies[J]. J Occup Rehabil, 2026, 36(1): 117-130. doi: 10.1007/s10926-025-10283-6
[14]	Gross T, Morell S, Amsler F. Medically graded reduced capacity to work (RCW) following significant injury as explained by Patient Related Outcome Measures (PROMs): a prospective trauma center evaluation[J]. Disabil Health J, 2021, 14(4): 101114. doi: 10.1016/j.dhjo.2021.101114
[15]	张晨瑶, 吴晓蕾, 史梦龙, 等. "以患者为中心"临床结局评估的选择与开发[J]. 中国循证医学杂志, 2024, 24(4): 472-477.
	Zhang C Y, Wu X L, Shi M L, et al. Selecting and developing clinical outcome assessments in patient-focused drug development[J]. Chin J Evid Based Med, 2024, 24(4): 472-477.
[16]	祖力亚尔·塔力甫, 褚宏宇, 赵艺皓, 等. 中国人口康复服务需要、供给与利用:基于多源数据的实证分析[J]. 中国康复, 2026, 41(2): 104-111.
	Talifu Z L Y E, Chu H Y, Zhao Y H, et al. Need, supply, and utilization of rehabilitation services in China: an empirical analysis based on multi-source data[J]. Chin J Rehabil, 2026, 41(2): 104-111.
[17]	Margheritti S, Corthésy-Blondin L, Vila Masse S, et al. Work-related psychosocial risk and protective factors influencing sickness absence: a systematic literature review[J]. J Occup Rehabil, 2026, 36(1): 1-22. doi: 10.1007/s10926-024-10265-0
[18]	郑玄波. 坚持以人民为中心发展思想推动实现工伤康复事业高质量发展[J]. 中国人力资源社会保障, 2024(8): 10-11.
[19]	张元鸣飞, 张华, 杨延砚, 等. 2021-2023年我国重点病种早期康复介入情况:基于医院质量监测系统病案首页数据[J]. 中国康复医学杂志, 2025, 40(11): 1707-1712.
	Zhang Y M F, Zhang H, Yang Y Y, et al. Early rehabilitation intervention of key diseases in China from 2021 to 2023: based on medical record homepage data of hospital quality monitoring system[J]. Chin J Rehabil Med, 2025, 40(11): 1707-1712.
[20]	陈园月, 朱军, 胡晶军, 等. 工伤康复的介入时间和康复时间及其相关因素[J]. 中国康复理论与实践, 2025, 31(3): 348-355. doi: 10.3969/j.issn.1006-9771.2025.03.012
	Chen Y Y, Zhu J, Hu J J, et al. Intervention time and rehabilitation duration of work-related injury rehabilitation and related influencing factors[J]. Chin J Rehabil Theory Pract, 2025, 31(3): 348-355.
[21]	Dobson K G, Chien Y C, Carnide N, et al. Uncovering mental health profiles of workers with a physically disabling injury or illness using the complete state mental health framework[J]. J Occup Rehabil, 2025, 35(4): 929-944. doi: 10.1007/s10926-024-10254-3
[22]	冯兰芳, 卢讯文, 钟巍, 等. 参与式人体工效学干预对腰背损伤患者复工意愿的影响[J]. 中国康复医学杂志, 2024, 39(7): 995-1000.
	Feng L F, Lu X W, Zhong W, et al. Effects of participatory ergonomic intervention on the willingness to return to work in patients with back injuries[J]. Chin J Rehabil Med, 2024, 39(7): 995-1000.
[23]	Hellström L, Christensen T N, Bojesen A B, et al. Predictors of return to work for people with anxiety or depression participating in a randomized trial investigating the effect of a supported employment intervention[J]. J Occup Rehabil, 2023, 33(1): 61-70. doi: 10.1007/s10926-022-10046-7
[24]	Abedi M, Aplin T, Gane E, et al. Exploring the perspectives of key stakeholders in returning to work after minor to serious road traffic injuries: a qualitative study[J]. J Occup Rehabil, 2023, 33(1): 93-106. doi: 10.1007/s10926-022-10051-w
[25]	Bartoníčková D, Gurková E, Zeleníková R, et al. Return to work after ischaemic stroke in young adults: a scoping review[J]. Cent Eur J Public Health, 2024, 32(2): 108-118. doi: 10.21101/cejph.a7936
[26]	Pearce G, O'Donnell J, Pimentel R, et al. Interventions to facilitate return to work after stroke: a systematic review[J]. Int J Environ Res Public Health, 2023, 20(15): 6469. doi: 10.3390/ijerph20156469
[27]	Chen N Y C, Dong Y H, Kua Z L J. Addressing mood and fatigue in return-to-work programmes after stroke: a systematic review[J]. Front Neurol, 2023, 14: 1145705. doi: 10.3389/fneur.2023.1145705
[28]	Neuman B J, Wang K Y, Harris A B, et al. Return to work after adult spinal deformity surgery[J]. Spine Deform, 2023, 11(1): 197-204. doi: 10.1007/s43390-022-00552-2 pmid: 36219391
[29]	莫航沣, 陈亚萍, 韩慧, 等. 临床预测模型研究方法与步骤[J]. 中国循证医学杂志, 2024, 24(2): 228-236.
	Mo H F, Chen Y P, Han H, et al. Methods and procedures of clinical predictive model[J]. Chin J Evid Based Med, 2024, 24(2): 228-236.
[30]	李笑丛, 王闯世, 郝军, 等. 临床预测模型校准与更新方法介绍及R软件实现[J]. 中国循证医学杂志, 2023, 23(1): 112-119.
	Li X C, Wang C S, Hao J, et al. An introduction to the calibration and update methods of clinical prediction models and its implementation by R software[J]. Chin J Evid Based Med, 2023, 23(1): 112-119.
[31]	Snippen N C, de Vries H J, Roelen C A M, et al. The associations between illness perceptions and expectations about return to work of workers with chronic diseases and their significant others: a dyadic analysis[J]. J Occup Rehabil, 2023, 33(1): 189-200. doi: 10.1007/s10926-022-10062-7

维度	干预前	干预后	生活质量变化方向(提升例数/下降例数)	Z值	P值
PF	60.00 (40.00, 80.00)	70.00 (50.00, 80.00)	提升(184/105)	-4.534	< 0.001
RP	0.00 (0.00, 25.00)	0.00 (0.00, 50.00)	提升(96/65)	-3.225	0.001
BP	46.00 (33.50, 57.00)	46.00 (37.00, 69.00)	提升(158/93)	-4.697	< 0.001
GH	50.00 (40.00, 65.00)	51.00 (40.00, 66.00)	提升(152/143)	-0.699	0.485
VT	55.00 (45.00, 70.00)	55.00 (45.00, 70.00)	提升(144/140)	-0.933	0.351
SF	50.00 (37.50, 62.50)	62.50 (50.00, 75.00)	提升(148/103)	-2.709	0.007
RE	33.33 (0.00, 66.67)	33.33 (0.00, 100.00)	提升(109/74)	-3.185	0.001
MH	64.00 (52.00, 76.00)	64.00 (52.00, 80.00)	提升(157/141)	-0.366	0.715

维度	模型Omnibus χ² (P)	干预前得分B (95%CI)	干预前得分P值	其他显著协变量(P值)
PF	177.280 (< 0.001)	0.012 (0.010~0.014)	< 0.001	—
RP	7.969 (0.093)	0.003 (0.000~0.005)	0.023	—
BP	118.855 (< 0.001)	0.011 (0.009~0.013)	< 0.001	病程(0.003)、学历(0.026)
GH	158.485 (< 0.001)	0.013 (0.011~0.015)	< 0.001	—
VT	164.895 (< 0.001)	0.013 (0.011~0.015)	< 0.001	病程(0.049)
SF	92.107 (< 0.001)	0.009 (0.007~0.011)	< 0.001	学历(0.047)
RE	13.274 (0.010)	0.002 (0.001~0.004)	< 0.001	—
MH	157.267 (< 0.001)	0.010 (0.009~0.012)	< 0.001	—

维度	原岗位复工组 (n = 201)	新岗位复工组 (n = 79)	未复工组 (n = 63)	Kruskal-Wallis H检验		Mann-Whitney U检验两两比较P值
维度	原岗位复工组 (n = 201)	新岗位复工组 (n = 79)	未复工组 (n = 63)	H值	P值	a	b	c
PF	70.00 (52.50, 82.50)	70.00 (55.00, 80.00)	50.00 (25.00, 70.00)	24.256	< 0.001	1.000	< 0.001	< 0.001
RP	0.00 (0.00, 50.00)	0.00 (0.00, 50.00)	0.00 (0.00, 25.00)	9.941	0.007	0.195	0.010	0.854
BP	57.00 (46.00, 69.50)	46.00 (37.00, 69.00)	46.00 (24.50, 57.00)	15.185	0.001	0.831	< 0.001	0.040
GH	55.00 (43.00, 66.00)	51.00 (40.00, 65.00)	40.00 (35.00, 56.00)	13.902	0.001	1.000	0.001	0.043
VT	60.00 (50.00, 70.00)	55.00 (45.00, 70.00)	55.00 (40.00, 65.00)	10.835	0.004	0.372	0.004	0.375
SF	62.50 (50.00, 75.00)	50.00 (50.00, 75.00)	50.00 (25.00, 62.50)	16.587	< 0.001	0.789	< 0.001	0.028
RE	66.67 (0.00, 100.00)	33.33 (0.00, 100.00)	33.33 (0.00, 66.67)	4.479	0.107	1	1	1
MH	68.00 (56.00, 80.00)	60.00 (52.00, 76.00)	60.00 (52.00, 72.00)	16.768	< 0.001	0.59	< 0.001	0.431

变量	原岗位vs.未复工		新岗位vs.未复工
变量	Exp(B) (95%CI)	P值	Exp(B) (95%CI)	P值
就业意愿(准备)
就业意愿(考虑前)	3×10^-8(3×10^-9~3×10^-7)	< 0.001	2×10^-8(6×10^-9~7×10^-8)	< 0.001
就业意愿(考虑)	8×10^-8(1×10^-8~6×10^-7)	< 0.001	2×10^-8(2×10^-9~2×10^-8)	—
就业意愿(行动)	9.104(< 0.001~上限不可估)	0.999	2.998(< 0.001~上限不可估)	1.000
学历(大专及以上)
学历(小学及以下)	0.025(0.003~0.199)	< 0.001	0.312(0.031~3.184)	0.326
学历(初中/高中)	0.039(0.007~0.206)	< 0.001	0.713(0.096~5.290)	0.741
损失工作日(线性项)	0.981(0.976~0.986)	< 0.001	0.986(0.980~0.991)	< 0.001
损失工作日(二次项)	1.000(1.000~1.000)	< 0.001	1.000(1.000~1.000)	< 0.001
出院时
PF	1.005(0.978~1.033)	0.708	1.006(0.976~1.037)	0.693
RP	1.009(0.989~1.028)	0.380	1.007(0.986~1.028)	0.553
BP	0.998(0.962~1.036)	0.925	0.980(0.941~1.021)	0.332
GH	0.995(0.960~1.031)	0.780	0.999(0.964~1.035)	0.944
VT	0.980(0.939~1.022)	0.341	0.991(0.947~1.038)	0.709
SF	1.006(0.978~1.035)	0.688	1.014(0.981~1.048)	0.401
RE	0.984(0.968~1.000)	0.047	0.985(0.969~1.002)	0.077
MH	1.044(0.998~1.093)	0.063	1.011(0.963~1.061)	0.661
HT	1.772(1.184~2.651)	0.005	1.693(1.104~2.597)	0.016
性别(女)
性别(男)	0.469(0.128~1.727	0.255	0.757(0.194~2.947)	0.688
工种(专业技术人员)
工种(行政及文职人员)	0.072(0.008~0.681)	0.022	0.107(0.008~1.382)	0.087
工种(一线工人)	0.553(0.111~2.756)	0.470	0.489(0.079~3.030)	0.442
工种(商业服务业人员)	0.557(0.087~3.579)	0.537	0.499(0.064~3.915)	0.508
参保地(省直及其他地市)
参保地(广州)	0.639(0.204~2.005)	0.443	0.559(0.168~1.859)	0.343
安置服务(远程安置)
安置服务(现场安置)	0.110(0.031~0.391)	0.001	7.065(2.230~22.380)	0.001