Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Psychological factors have been found to be of major importance for the transition from acute to chronic low back pain (CLBP). Although some evidence has been provided that depressive symptoms occur secondarily to CLBP, psychological treatment modules that specifically address depressive symptoms are not yet included in German inpatient rehabilitation programs. In this study, a standard rehabilitation program for patients with CLBP and depressive symptoms was compared to a standard rehabilitation, into which a cognitive-behavioral management training of depressive symptoms was integrated. Moreover, treatment effects of this multidisciplinary standard rehabilitation program delivered to patients with either no or only mild depressive symptoms were investigated. As a further aim of the present study, gender effects on rehabilitation outcomes were examined. Short-, mid-, and long-term effects on individual global improvement as well as pain-related, psychological, and work-related measures were evaluated among N = 199 consecutively admitted patients with CLBP, aged from 24 to 62 years. The standard rehabilitation program had no persisting effects on psychological outcomes among patients with no and mild depressive symptoms. Patients with moderate and severe depressive symptoms in the standard rehabilitation program did not benefit with clinical importance at the 6- and 12-month follow-up assessments, but did show clinically significant improvements in psychological outcome measures at the 6-month follow-up assessment when the supplemental psychological component was applied. Additionally, days of sick leave decreased in the intervention group in the mid-term when compared to the baseline. Females benefited more in mental health than males. However, due to regression effects at the 12-month follow-up assessment, booster sessions are highly recommended. The results presented here support the notion that a more adequately tailored rehabilitation program seems to improve rehabilitation success and prevent further development of CLBP among this high-risk subpopulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Andersson G (1999) Epidemiological features of chronic low-back pain. Lancet 354:581–585

    Article  CAS  PubMed  Google Scholar 

  2. Bendix AF, Bendix T, Haestrup C, Busch E (1998) A prospective, randomized 5-year follow-up study of functional restoration in chronic low back pain patients. Eur Spine J 7:111–119

    Article  CAS  PubMed  Google Scholar 

  3. Buchner M, Neubauer E, Zahlten-Hingurange A, Schiltenwolf M (2007) The influence of the grade of chronicity on the outcome of multidisciplinary therapy for chronic low back pain. Spine 32:3060–3066

    Article  PubMed  Google Scholar 

  4. Bullinger M, Kirchberger I (1998) SF-36 Fragebogen zum Gesundheitszustand. SF-12 Kurzversion des SF-36 [SF-12. German short version of the SF-36]. Hogrefe, Göttingen

    Google Scholar 

  5. Cohen J (1977) Statistical power for the behavioural sciences. Academic Press, New York

    Google Scholar 

  6. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS (1997) Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 13:116–137

    Article  CAS  PubMed  Google Scholar 

  7. Flor H, Fydrich T, Turk DC (1992) Efficacy of multidisciplinary pain treatment centers: a meta-analysis review. Pain 49:221–230

    Article  CAS  PubMed  Google Scholar 

  8. Flor H, Turk DC (1988) Chronic back pain and rheumatoid arthritis: predicting pain and disability from cognitive variables. J Behav Med 11:251–265

    Article  CAS  PubMed  Google Scholar 

  9. Franke G. SCL-90-R (1995) Die Symptom Checkliste von Derogatis—Deutsche Version [the symptom checklist—German version]. Beltz, Göttingen

    Google Scholar 

  10. Gatchel RJ (2004) Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. Am Psychol 59:795–805

    Article  PubMed  Google Scholar 

  11. Gatchel RJ, Rollings KH (2008) Evidence-informed management of chronic back pain with cognitive behavioral therapy. Spine J 8:40–44

    Article  PubMed  Google Scholar 

  12. Gerbershagen HU (1996) Das Mainzer Stadienkonzept des Schmerzes [Mainz Pain Staging System]. In: Klingler D, Morawetz R, Thoden U, Zimmermann M (eds) Antidepressiva als Analgetika. Arachne, Wien, pp 71–95

    Google Scholar 

  13. Gerbershagen HJ, Özgur E, Straub K, Dagtekin O, Gerbershagen K, Petzke F, Heidenreich A, Lehmann KA, Sabatowski R (2008) Prevalence, severity, and chronicity of pain and general health-related quality of life in patients with localized prostate cancer. Eur J Pain 12:339–350

    Article  PubMed  Google Scholar 

  14. Guzmán J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C (2001) Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ 322:1511–1516

    Article  PubMed  Google Scholar 

  15. Hampel P, Moergel M (2009) Schmerzchronifizierung bei Rückenschmerzpatienten in der stationären Rehabilitation—Zur Validität des Mainzer Stadienmodells der Schmerzchronifizierung [staging of pain among patients with chronic low back pain in the inpatient rehabilitation—validity of the Mainz Pain Staging System]. Schmerz 23:154–165

    Article  CAS  PubMed  Google Scholar 

  16. Hautzinger M, Bailer M (1993) Allgemeine Depressionsskala (ADS). Die deutsche Version des CES-D. Manual [German version of the CES-D]. Beltz Test, Weinheim

    Google Scholar 

  17. Herrmann-Lingen CH, Buss U, Snaith RP (2005) HADS-D Hospital anxiety and depression scale—Deutsche Version [HADS-D Hospital anxiety and depression scale—German version], 2nd edn. Huber, Bern

    Google Scholar 

  18. Jensen IB, Bergström G, Ljungquist T, Bodin L (2005) A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain. Pain 115:273–283

    Article  PubMed  Google Scholar 

  19. Jensen IB, Bergström G, Ljungquist T, Bodin L, Nygren AL (2001) A randomized controlled component analysis of a behavioral medicine rehabilitation program for chronic spinal pain: are the effects dependent on gender? Pain 91:65–78

    Article  CAS  PubMed  Google Scholar 

  20. Koleck M, Mazaux JM, Rascle N, Bruchon-Schweitzer M (2006) Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: a prospective study. Eur J Pain 10:1–11

    Article  PubMed  Google Scholar 

  21. Linton SJ (2000) A review of psychological risk factors in back and neck pain. Spine 25:1148–1156

    Article  CAS  PubMed  Google Scholar 

  22. Magni G, Moreschi C, Rigatti-Luchini S, Mersky H (1994) Prospective study on the relationship between depression symptoms and chronic musculoskeletal pain. Pain 56:289–297

    Article  CAS  PubMed  Google Scholar 

  23. Mohr B, Gräf T, Forster M, Krohn-Grimberghe B, Kurzeja R, Mantel F, Thomsen M, Hampel P (2008) Der Einfluss von Depressivität und Geschlecht auf den Rehabilitationserfolg bei chronischem Rückenschmerz [Influence of depressive symptoms and gender in chronic low back pain rehabilitation outcome: a pilot study]. Rehabilitation 47:284–298

    Article  CAS  PubMed  Google Scholar 

  24. Morley S, Ecclestone C, Williams A (1999) Systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy and behavior therapy for chronic pain in adults, excluding headache. Pain 80:1–13

    Article  CAS  PubMed  Google Scholar 

  25. Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Linton SJ, Morley SJ, Assendelft WJJ (2008) Behavioural treatment for chronic low-back pain (Review). The Cochrane Library (2):CD002014. doi:10.1002/14651858.CD002014.pub2

  26. Patrick LE, Altmaier EM, Found E (2004) Long-term outcomes in multidisciplinary treatment of chronic low back pain. Results of a 13-year follow-up. Spine 29:850–855

    Article  PubMed  Google Scholar 

  27. Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P (1997) Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 73:77–85

    Article  CAS  PubMed  Google Scholar 

  28. Pincus T, Burton AK, Vogel S, Field AP (2002) A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 27:109–120

    Article  Google Scholar 

  29. Scascighini L, Toma V, Dober-Spielmann S, Sprott H (2008) Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatol 47:670–678

    Article  CAS  Google Scholar 

  30. Spinhoven P, ter Kuile M, Kole-Snijders AMJ, Hutten Mansfeld M, den Ouden DJ, Vlaeyen JWS (2004) Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain. Eur J Pain 8:211–219

    Article  PubMed  Google Scholar 

  31. Sullivan MJ, Ressor K, Mikail S, Fisher R (1992) The treatment in chronic low back pain: review and recommendations. Pain 50:5–13

    Article  CAS  PubMed  Google Scholar 

  32. Teuber N, Thiele A, Eberhardt B (2006) Geschlechtsrolle und Schmerzerleben [A questionnaire study of the relationship between gender and chronic pain]. Schmerz 20:307–313

    Article  CAS  PubMed  Google Scholar 

  33. Turk DC, Flor H (1984) Etiological theories and treatments for chronic back pain. II: psychological models and interventions. Pain 19:209–233

    Article  CAS  PubMed  Google Scholar 

  34. Turk DS, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, Cleeland C, Dionne R (2003) Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain 106:337–345

    Article  PubMed  Google Scholar 

  35. van der Hulst M, Vollenbroek-Hutten MMR, Ijzerman MJ (2005) A systematic review of sociodemographic, physical, and psychological predictors of multidisciplinary rehabilitation or, back school treatment outcome in patients with chronic low back pain. Spine 30:813–825

    Article  PubMed  Google Scholar 

  36. van der Roer N, van Tulder MW, Barendse J, Knol D, van Mechelen W, de Vet H (2008) Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial. Eur Spine J 17:1193–1200

    Article  PubMed  Google Scholar 

  37. van Tulder MW, Koes B, Malmvaara A (2006) Outcome of non-invasive treatment modalities on back pain. An evidence-based review. Eur Spine J 15:S64–S81

    Article  PubMed  Google Scholar 

  38. van Tulder MW, Koes BW, Bouter LM (1995) A cost-of-illness study of back pain in the Netherlands. Pain 62:233–240

    Article  PubMed  Google Scholar 

  39. van Tulder MW, Ostelo R, Vlaeyen JWS, Linton SJ, Morley SJ, Assendelft WJJ (2000) Behavioral treatment for chronic low back pain. A systematic review within the framework of the Cochrane Back Review Group. Spine 26:270–281

    Article  Google Scholar 

  40. Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low-back pain and disability. Pain 52:157–168

    Article  CAS  PubMed  Google Scholar 

  41. Watson PJ, Booker CK, Moores L, Main CJ (2004) Returning the chronically unemployed with low back pain to employment. Eur J Pain 8:359–369

    Article  PubMed  Google Scholar 

  42. Wenig CM, Schmidt CO, Kohlmann T, Schweikert B (2009) Costs of back pain in Germany. Eur J Pain 13:280–286

    Article  PubMed  Google Scholar 

  43. Wessels T, van Tulder M, Sigl T, Ewert T, Limm H, Stucki G (2006) What predicts outcome in non-operative treatments of chronic low back pain? A systematic review. Eur Spine J 15:1633–1644

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was sponsored by the German Pension Insurance Company Oldenburg-Bremen.

Author information

Authors and Affiliations

  1. Center of Clinical Psychology and Rehabilitation, University of Bremen, Grazer Str. 6, 28359, Bremen, Germany

    Petra Hampel & Lisa Tlach

  2. Montanus-Clinic, Bad Schwalbach, German Pension Insurance Company Oldenburg-Bremen, Bremen, Germany

    Thomas Graef

  3. Clinic of Rheumatology, Bad Wildungen, German Pension Insurance Company Oldenburg-Bremen, Bremen, Germany

    Bernhard Krohn-Grimberghe

Authors
  1. Petra Hampel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Graef
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernhard Krohn-Grimberghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa Tlach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Petra Hampel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hampel, P., Graef, T., Krohn-Grimberghe, B. et al. 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. Eur Spine J 18, 1867–1880 (2009). https://doi.org/10.1007/s00586-009-1080-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-009-1080-z

Keywords

Search

Navigation