Abstract
BackgroundThis study investigated the long-term effects (12 months post-rehabilitation) of a standard inpatient multidisciplinary rehabilitation program for patients with chronic low back pain (CLBP), in which a control group (CG) received pain competence training and an intervention group (IG) received combined pain competence and depression prevention training.MethodsIn this prospective control group study with cluster-block randomization, a total of n = 583 patients were included into per protocol analyses. To examine the effects of rehabilitation on depressive symptoms, pain self-efficacy, and work ability, patients were stratified in repeated-measures analyses of variance by treatment condition (IG vs. CG), level of depressive symptoms (low vs. high), and time of assessment (pre, post, 6, and 12 months after rehabilitation). The impact of each treatment on pain-related days of sick leave (DSL; dichotomized into ≤ vs. > 2 weeks) was determined separately by conducting non-parametric analyses. Multiple imputations (n = 1225) confirmed the results. Effects were interpreted if clinical significance was given.ResultsOnly patients with high levels of depressive symptoms showed long-term improvements in depressive symptoms and self-efficacy. Long-term improvements in work ability index and mental work ability item were restricted to the IG. Furthermore, long-term effects on pain-related DSL were ascertained by per protocol and multiple imputation analyses only for the IG.ConclusionsPatients with high levels of depressive symptoms showed improvements in depressive symptoms and self-efficacy, supporting the psychological effectiveness of both interventions. However, the beneficial long-term effects of rehabilitation on work ability and pain-related DSL among the IG support implementation of combined pain competence and depression prevention training.Trial registrationDRKS00015465 (German Clinical Trial Register DRKS); date of registration: 03.09.2018.
Highlights
Chronic low back pain (CLBP) is among the most common diseases in Western countries [1] and induces high medical as well as psychological and social costs [2]
The treatment condition consisted of the control group (CG; n = 288), who received pain competence training, and the intervention group (IG; n = 295), who received combined pain competence and depression prevention training
Due to incomplete data for the Center for Epidemiological Studies Depression Scale (CES-D) score or because of evidence of response bias, 48 participants were excluded from the analyses
Summary
Chronic low back pain (CLBP) is among the most common diseases in Western countries [1] and induces high medical as well as psychological and social costs [2]. Prior research provided strong evidence for the effectiveness of multimodal and multidisciplinary treatment of CLBP, in which psychological treatment elements were incorporated [4]. Those multimodal and multidisciplinary approaches were more effective than standard medical treatment, usual care, or physical treatment alone [5]. This study investigated the long-term effects (12 months post-rehabilitation) of a standard inpatient multidisciplinary rehabilitation program for patients with chronic low back pain (CLBP), in which a control group (CG) received pain competence training and an intervention group (IG) received combined pain competence and depression prevention training
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