A multimodal program is not superior to a general exercise program in influencing the process leading to chronic LBP in a population of nurses with a history of pain. The most likely explanation is a common psychological mechanism leading to improved pain interference that is irrespective of the program used. Considering the lower resources of the general exercise program, the expense for a multimodal program is not justified for the secondary prevention of LBP and disability.

Systematic reviews have shown that as non-operative treatments exercise, behavioural and multimodal treatment programs are effective for chronic low back pain. There is, however, a lack of knowledge concerning the association between changes in treatment process variables and changes in outcome for the three treatment forms. The objective of this systematic review was to evaluate which changes in treatment process variables predict outcome of exercise, behavioural and multimodal treatment of chronic low back pain. Medline, Embase and PsychInfo were systematically searched. A descriptive analysis was used to summarize the results regarding the outcomes pain, disability and return to work (RTW). 13 studies were identified. The results showed that functional coping mechanisms and pain reduction were associated with a decrease in disability and increase in RTW, and physical performance factors were not. Related to pain reduction decreases in disability, functional coping mechanisms as well as physical performance factors were associated. Strong conclusions cannot be drawn from this review, because of the heterogeneity and the limited number of studies. The results of this review raise the question if changes in behavioural variables and reductions of disability which facilitate an improvement in function, may be more important than physical performance factors for successful treatment of chronic low back pain. This is relevant for the refinement of future treatment programs.

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Owing to methodologic limitations, strong conclusions cannot be drawn from this study. The findings suggest that treatment success in exercise and multidisciplinary interventions might be influenced by the same change factors, namely changes in pain and psychologic factors. The results raise the question of whether the mechanism through which exercise works, is improve in physical variables, or rather a change in psychologic attributes, in that people correct their irrational cognitions by making experiences that differ from their expectations. If these findings can be confirmed in longitudinal studies with more measurement points, they would have implications for treatment refinement.

ZusammenfassungFragestellung: Ziel dieses Übersichtsartikels ist die Darstellung des aktuellen Wissensstandes hinsichtlich der Effektivität von Präventionsprogrammen bei Pflegekräften mit Rückenschmer-zen. In der Prävention von Rückenschmerzen ist die Vermeidung von Chronifizierung ein Hauptziel. Daher fokussiert dieser Artikel auf sekundär präventiven Maûnahmen. Methodik: Die Literaturidentifikation wurde in drei Schritten durchgeführt: Zunächst wurde in Medline, Embase und Psychinfo nach Reviewartikeln für den Zeitraum von 1997 ± 2003 zu diesem Thema gesucht. Die Suchstrategie beinhaltete zunächst Reviews, die sich allgemein mit der Effektivität von Maûnahmen zur Prävention von Rückenbeschwerden und deren Chronifizierung beschäftig-ten. In einem zweiten und dritten Schritt wurden jene Reviews und randomisierte klinische Studien identifiziert, die sich speziell auf Präventionsprogramme gegen Rückenbeschwerden bei Pflegekräften konzentrierten. Ergebnisse: Zusammenfassend kann man feststellen, dass es einen Mangel an gesicherter Evidenz bezüglich der Effektivität von Präventionsmaûnahmen gegen Rückenbeschwerden gibt. Aussagen darüber, welche Interventionen für welche Art von Beschwerden und welche Zielgruppe geeignet sind, konnten nicht gefunden werden. Methodische Schwächen sowie eine Vielzahl unterschiedlicher Ansätze, Interventionen und Zielgruppen erklären diesen Wissensmangel, der im Gegensatz zu den Ressourcen steht, die für ent- AbstractPurpose: Aim of this article is to give an overview of the current literature on the effectiveness of prevention programs, especially for nurses with back pain. As the avoidance of chronicity is a major goal in the prevention of back pain, the article focuses on secondary prevention. Materials and method: This literature-overview was conducted in three phases. Firstly, three electronic databases were searched for reviews in the years 1997 ± 2003: Medline, Embase and Psychinfo. Reviews were selected if they are reporting on interventions designed to prevent some form of back pain or interventions designed to prevent chronicity. Additionally we focused in a second phase on reviews which dealt exclusively with the situation of nurses. Finally, in a third phase, we searched in the databases for randomised controlled trials (RCT's) on the same topic. Results: In general, there is a lack of evidence concerning the effectiveness of preventive interventions against back pain and which type of preventive intervention is most effective for what type of back pain problem and target group. Methodological deficiencies, the diversity of approaches and contents and the heterogeneity of settings may explain these discouraging results. An astonishing gap between the amount of resources spent on prevention of back pain and the effectiveness of these efforts has to be acknowledged. This is true for hospital employees and nurses in particular. In summary, only exercise programs have shown positive preventive effects Übersicht 13