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

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 longterm 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.Keywords Chronic low back pain Á Depressive symptoms Á Gender Á Multidisciplinary inpatient orthopedic rehabilitation Á Cognitive-behavioral management of depressive symptoms

Long-term effects of a cognitive-behavioral training program for the management of depressive symptoms among patients in orthopedic inpatient rehabilitation of chronic low back pain: a 2-year follow-up

“…The assignment was conducted by an independent doctoral student at the University of Bremen. Thus, the physicians and nursing staff at both clinics were blinded to the patients' group assignments (for further details, see [18]). …”

“…For brevity, essential elements of the cognitive-behavioral programs are summarized below. For a detailed description, see [18].…”

“…Moreover, between and within-group effect sizes were calculated using Cohen's d (cf. [18]). Effect sizes d = 0.20 were considered to be small, d = 0.50 medium, and d = 0.80 high [23].…”

“…As a final analysis of our 1-year longitudinal study [18], the purpose here was to examine gender-specific long-term effects of an additional cognitive-behavioral training program for the management of depressive symptoms compared with the standard rehabilitation among patients with CLBP and co-existing depressive symptoms during a period of 2 years. Moreover, a third group of patients with no or mild depressive symptoms was treated with the standard rehabilitation, which has been proven to be effective among this subgroup [7].…”

“…Moreover, a third group of patients with no or mild depressive symptoms was treated with the standard rehabilitation, which has been proven to be effective among this subgroup [7]. In our 1-year follow-up, favorable long-term rehabilitation effects were observed for psychological outcome measures [18]. Hence, the results presented here focus on depressive symptoms, anxiety, and mental health.…”