title: Effectiveness of a Multimodal Therapy for Patients with Chronic Low Back Pain Regarding Pre-Admission Healthcare Utilization.
abstract: OBJECTIVE
  The aim of the study was to examine the effectiveness of an intensive inpatient three-week multimodal therapy. We focused especially on the impact on the multimodal therapy outcome of the pre-admission number of treatment types patients had received and of medical specialist groups patients had consulted.
  
  
  METHODS
  155 patients with chronic low back pain and indication for multimodal therapy were evaluated with respect to pain intensity, depression, anxiety, well-being, and pre-admission health care utilization. In our controlled clinical trial we compared N = 66 patients on the waiting list with N = 89 patients who received immediate treatment. The waiting list patients likewise attended multimodal therapy after the waiting period. Longitudinal post-treatment data for both were collected at three- and twelve-month follow-ups. The impact of pre-admission health care utilization on multimodal therapy outcome (post) was analysed by structural equation model.
  
  
  RESULTS
  Compared to the control group, multimodal therapy patients' pain intensity and psychological variables were significantly reduced. Longitudinal effects with respect to pre-measures were significant at three-month follow-up for pain intensity (ES = -0.48), well-being (ES = 0.78), anxiety (ES = -0.33), and depression (ES = -0.30). Effect sizes at twelve-month follow-up were small for anxiety (ES = -0.22), and moderate for general well-being (ES = 0.61). Structural equation model revealed that a higher number of pre-admission treatment types was associated with poorer post-treatment outcomes in pain intensity, well-being, and depression.
  
  
  CONCLUSIONS
  Multimodal therapy proved to be effective with regard to improvements in pain intensity, depression, anxiety, and well-being. The association between treatment effect and number of pre-admission pain treatment types suggests that patients would benefit more from attending multimodal therapy in an earlier stage of health care.
authors.affiliation: University Hospital Jena, Institute of Psychosocial Medicine and Psychotherapy, Friedrich -Schiller-University Jena, Jena, Germany.
authors.forename: Constanze
authors.initials: C
authors.lastname: Borys
authors.affiliation: Interdisciplinary Pain Center, Central Hospital Bad Berka, Bad Berka, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Lutz
authors.affiliation: University Hospital Jena, Institute of Psychosocial Medicine and Psychotherapy, Friedrich -Schiller-University Jena, Jena, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Strauss
authors.affiliation: University Hospital Jena, Institute of Psychosocial Medicine and Psychotherapy, Friedrich -Schiller-University Jena, Jena, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Altmann
mesh_terms: D000368:Aged; D000465:Algorithms; D001007:Anxiety / Q000628:therapy; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy / Q000379:methods*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003863:Depression / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010343:Patient Admission; D011613:Psychotherapy; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome