Pain usually is the major complaint of patients with problems of the back, thus making pain evaluation a fundamental requisite in the outcome assessment in spinal surgery. Pain intensity, pain-related disability, pain duration and pain affect are the aspects that define pain and its effects. For each of these aspects, different assessment instruments exist and are discussed in terms of advantages and disadvantages. Risk factors for the development of chronic pain have been a major topic in pain research in the past two decades. Now, it has been realised that psychological and psychosocial factors may substantially influence pain perception in patients with chronic pain and thus may influence the surgical outcome. With this background, pain acceptance, pain tolerance and pain-related anxiety as factors influencing coping strategies are discussed. Finally, a recommendation for a minimum as well as for a more comprehensive pain assessment is given.

Illegitimate tasks represent a task-level stressor derived from role and justice theories within the framework of “Stress-as–Offense-to-Self” (SOS; Semmer, Jacobshagen, Meier, & Elfering, 2007). Tasks are illegitimate if they violate norms about what an employee can properly be expected to do, because they are perceived as unnecessary or unreasonable; they imply a threat to one's professional identity. We report three studies testing associations between illegitimate tasks and well-being/strain. In two cross-sectional studies, illegitimate tasks predicted low self-esteem, feelings of resentment towards one's organization and burnout, controlling for role conflict, distributive injustice and social stressors in Study 1, and for distributive and procedural/interactional justice in Study 2. In Study 3, illegitimate tasks predicted two strain variables (feelings of resentment towards one's organization and irritability) over a period of two months, controlling for initial values of strain. Results confirm the unique contribution of illegitimate tasks to well-being and strain, beyond the effects of other predictors. Moreover, Study 3 demonstrated that illegitimate tasks predicted strain, rather than being predicted by it. We therefore conclude that illegitimate tasks represent an aspect of job design that deserves more attention, both in research and in decisions about task assignments.

Stress is related to goals being thwarted. Arguably, protecting one's self, both in terms of personal self-esteem and in terms of social self-esteem, is among the most prominent goals people pursue. Although this line of thought is hardly disputed, it does not play the prominent role in occupational health psychology that we think it deserves. Stress-as-Offense-to-Self theory focuses on threats and boosts to the self as important aspects of stressful, and resourceful, experiences at work. Within this framework we have developed the new concepts of illegitimate tasks and illegitimate stressors; we have investigated appreciation as a construct in its own right, rather than as part of larger constructs such as social support; and we propose that the threshold for noticing implications for the self in one's surroundings typically is low, implying that even subtle negative cues are likely to be appraised as offending, as exemplified by the concept of subtly offending feedback. Updating the first publication of the SOS concept, the current paper presents its theoretical rationale as well as research conducted so far. Research has covered a variety of phenomena, but the emphasis has been (a) on illegitimate tasks, which now can be considered as an established stressor, and (b) on appreciation, showing its importance in general and as a core element of social support. Furthermore, we discuss implications for further research as well as practical implications of an approach that is organized around threats and boosts to the self, thus complementing approaches that are organized around specific conditions or behaviors.

The present study examined the psychometric characteristics of a "core-set" of six individual questions (on pain, function, symptom-specific well-being, work disability, social disability and satisfaction) for use in low back pain (LBP) outcome assessment. A questionnaire booklet was administered to 277 German-speaking LBP patients with a range of common diagnoses, before and 6 months after surgical (N=187) or conservative (N=90) treatment. The core-set items were embedded in the booklet alongside validated 'reference' questionnaires: Likert scales for back/leg pain; Roland and Morris disability scale; WHO Quality of Life scale; Psychological General Well-Being Index. A further 45 patients with chronic LBP completed the booklet twice in 1-2 weeks. The minimal reliability (similar to Cronbach's alpha) for each core item was 0.42-0.78, increasing to 0.84 for a composite index score comprising all items plus an additional question on general well-being ('quality of life'). Floor or ceiling effects of 20-50% were observed for some items before surgery (function, symptom-specific well-being) and some items after it (disability, function). The intraclass correlation coefficient (ICC) ("test-retest reliability") was moderate to excellent (ICC, 0.67-0.95) for the individual core items and excellent (ICC, 0.91) for the composite index score. With the exception of "symptom-specific well-being", the correlations between each core item and its corresponding reference questionnaire ("validity") were between 0.61 and 0.79. Both the composite index and the individual items differentiated (P<0.001) between the severity of the back problem in surgical and conservative patients (validity). The composite index score had an effect size (sensitivity to change) of 0.95, which was larger than most of the reference questionnaires (0.47-1.01); for individual core items, the effect sizes were 0.52-0.87. The core items provide a simple, practical, reliable, valid and sensitive assessment of outcome in LBP patients. We recommend the widespread and consistent use of the core-set items and their composite score index to promote standardisation of outcome measurements in clinical trials, multicentre studies, routine quality management and surgical registry systems.

Functional social support can be described as emotional (i.e., caring, esteem, etc.) or instrumental (i.e., informational, tangible) support. Hypothesizing that instrumental support often is interpreted as helpful because of its emotional meaning (signalling caring, understanding, esteem), we asked hospital patients (N ϭ 67) to describe situations (N ϭ 109) during which they were supported, and to indicate why this support was helpful. Both the description of the supportive behaviors and the meaning attributed to them were coded with regard to their instrumental versus emotional quality. As expected, many situations that were instrumental in descriptive terms were emotional in terms of meaning; the reverse occurred very seldom. This effect was confined to "private" interactions (i.e. interactions involving family and friends), whereas instrumental behaviors of medical professionals were largely instrumental in meaning as well. Results underscore the importance of giving instrumental support in a way that communicates care and esteem.