[Patients with chronic low back pain: the impact of psychosocial features].
BACKGROUND
Chronic low back pain (CLBP) is often associated with clinical and subclinical levels of psychological problems. A higher stage of chronicity is associated with an increase in co-existing psychological disorders. Previous programmes of inpatient orthopaedic rehabilitation reveal little evidence of sustained rehabilitation effects, a finding which may be attributable to the absence of specific psychological treatment during the programme.


OBJECTIVE
Does cognitive-behavioural depression management training in patients with CLBP and depressive symptoms improve the inpatient orthopaedic rehabilitation success depending on the stage of chronicity?


METHODS
Effects of the new programme on psychological well-being (ADS depressive symptoms, HADS anxiety, SCL somatization and mental health of the SF-12) were investigated in n=75 patients with first and second stage of chronicity immediately after, six months after and 24 months after rehabilitation and were compared to standard rehabilitation without management of depressive symptoms.


RESULTS
All patients benefited from both treatments immediately after rehabilitation. However, six months after rehabilitation only patients of the intervention group showed significant beneficial effects with regard to depressive symptoms and mental health. The lowered depressive symptoms remained stable up to the 24-month follow-up assessment. Anxiety in the second stage of chronicity was reduced up to the 6-month follow-up and in the first stage up to the 24-month follow-up.


CONCLUSIONS
The new programme with a cognitive-behavioural depression management training revealed beneficial effects on mental health in the mid-term and on depressive symptoms in the long-term. However, the effects need to be further improved by after-care programmes.
Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen.
B
B
Mohr
B
B
Krohn-Grimberghe
T
T
Gräf
J
J
Schulze
F
F
Petermann
P
P
Hampel
D001416:Back Pain / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation*; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000209:etiology / Q000523:psychology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011584:Psychology; D016896:Treatment Outcome