Evaluation of a behavioral-medical inpatient rehabilitation treatment including booster sessions: a randomized controlled study.
OBJECTIVE
The aim of this randomized controlled study was to investigate whether additional psychologic interventions in the context of multidisciplinary inpatient pain treatment increases treatment efficacy compared with normal orthopedic rehabilitation. In addition, we aimed to demonstrate the additional benefit of a subsequent maintenance program in further stabilizing treatment successes.


METHODS
We randomly assigned 363 chronic back pain patients to 1 of 3 treatment conditions: traditional orthopedic rehabilitation, multidisciplinary (behavioral-medical) rehabilitation alone, and multidisciplinary rehabilitation with subsequent booster sessions. Pain disability, depression, self-efficacy, health status, life satisfaction, and coping strategies were assessed at admission, discharge, and 12 months follow-up. The completion rate was 94%.


RESULTS
All 3 treatment conditions were effective in improving core outcome measures in chronic back pain patients in the short term. The results were almost maintained at follow-up (small-to-medium within-group effect sizes). Significant advantages in favor of behavioral-medical interventions were found on almost all pain coping strategies and depression compared with traditional orthopedic rehabilitation. We found only slight advantages for the behavioral-medical treatment with subsequent booster sessions compared with the condition without a further maintenance program.


CONCLUSIONS
The results concerning the efficacy of the multidisciplinary treatment are in accordance with former meta-analyses. Surprisingly, the findings suggest that the presented traditional orthopedic treatment was inherently very effective. The implications of these findings are discussed with respect to the benefit of additional psychologic interventions and the benefit of aftercare approaches for chronic pain patients.
Mangels
Marija
M
Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany. mangelsm@staff.uni-marburg.de
Schwarz
Susanne
S
Worringen
Ulrike
U
Holme
Martin
M
Rief
Winfried
W
D001416:Back Pain / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D001521:Behavior Therapy / Q000379:methods* / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D015995:Prevalence; D011788:Quality of Life; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D016896:Treatment Outcome