Der Einfluss von Depressivität und Geschlecht auf den Rehabilitationserfolg bei chronischem Rückenschmerz: Eine Pilotstudie

Abstract

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.

Effects of gender and cognitive-behavioral management of depressive symptoms on rehabilitation outcome among inpatient orthopedic patients with chronic low back pain: a 1 year longitudinal study

“…Hence, patients with moderate and severe depressive symptoms who participated in the multidisciplinary standard rehabilitation without the supplemental psychological component did not benefit. These results are in line with a pilot study, suggesting insufficient rehabilitation success in psychosocial outcome measures among this subgroup, which is affected by considerable strain [23].…”

“…Gender-specific mid-and long-term rehabilitation effects Consistent with our preceding study, females benefited more from treatments than males [23]. Females showed persistent improvements in mental health at both follow-up assessments.…”

“…Since prior research has provided evidence that psychological problems or manifest psychiatric disorders augment chronicity of pain [6,21,22,28,31] and impair the rehabilitation outcome [23,41], we designed a cognitivebehavioral management training of depressive symptoms for participants with moderate and severe depressive symptoms to improve treatment outcomes in this high-risk subpopulation. An inpatient program was initiated, as patients with CLBP in Germany are used to be treated in rehabilitation clinics far from home.…”

“…Patients with moderate and severe depressive symptoms benefited less from a standard multidisciplinary rehabilitation program compared to patients with no and mild depressive symptoms [23]. Interestingly, improvements in self-rated depressive symptoms and disability during inpatient multidisciplinary rehabilitation had a prognostic value [27].…”

“…Likewise, inconsistent findings were reported regarding the predictive validity of gender for rehabilitation success, with studies finding either no gender effects [35] or better rehabilitation outcomes among females [18,19,23].…”