Currently, little is known about the influence of depressive symptoms and gender-specific aspects in rehabilitation outcome of patients with chronic low back pain. Effects of gender and depressive symptoms on rehabilitation outcome were examined immediately after rehabilitation, as well as three and six months after rehabilitation in 116 patients with chronic low back pain (43 women, 73 men; M=48 yrs.; ICD-10 diagnoses: M45.4/M45.5, M54.4/M54.5). Immediately after rehabilitation, general improvements with medium effect sizes in all rehabilitation measures were found. In contrast, six months after rehabilitation, only pain-related measures showed moderate improvements. Additionally, the mid-term outcomes were influenced by gender and depressive symptoms; women showed more stable rehabilitation outcomes in pain intensity, in the impaired function related to family/leisure, and the coping with pain strategies of "perceived self-competence" and "relaxation". In contrast, especially male patients with severe depressive symptoms revealed regressive rehabilitation outcomes, both in pain-related variables as well as marginally in the coping with pain strategy of "cognitive restructuring". In post-hoc analyses, in the mid-term, they even showed a deterioration of functional capacity and somatisation compared to prior to rehabilitation. Our results suggest that the outcome of orthopaedic rehabilitation may be persistently improved by implementing gender-specific treatments in general and elements of depression treatments for the patients with severe but sub-clinical depressive symptoms.
Results support the notion that rehabilitation outcome is significantly influenced by pain staging and gender. Thus, clinical-psychological and gender-specific interventions should be incorporated in future therapeutic regimens to increase the rehabilitation outcomes in patients with higher chronicity of back pain.
Beneficial effects on psychological measures in orthopedic inpatient rehabilitation of patients with chronic low back pain (CLBP) and co-exist-ing depressive symptoms have been shown only for multidisciplinary approaches that incorporate psychotherapeutic interventions. Aim of this study was to verify these findings for pain coping outcomes (pain-related psychological disability, pain-related coping). Short-, mid-, and long-term effects of a standard pain management program that was either solely provided or combined with a supplemental cognitive-behavioral depression management were examined in a consecutive sample of n=84. Patients in both groups showed long-term beneficial effects in pain coping measures. Thus, the standard rehabilitation revealed specific and long-term effects on pain coping. However, further evidence suggests that diagnosis-specific psychotherapeutic treatment elements are required to improve psychological symptoms.
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.
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