Greitemann B, Dibbelt S, Büschel C
Klinik für orthopädisch-rheumatologische Erkrankungen, Klinik Münsterland, Bad Rothenfelde.
Z Orthop Ihre Grenzgeb. 2006 May-Jun;144(3):255-66. doi: 10.1055/s-2006-933441.
According to a recent review by Hüppe and Raspe effects of multidisciplinary treatment programs for patients with chronic low back pain in Germany seem to be rather weak and not to have persisting effects. Factors which could counteract possible benefits of treatment are, among others, psychic and job-related stresses and strains persisting after treatment. A multidisciplinary, in-patient treatment program for patients with chronic low back pain, therefore, was amended by multidisciplinary diagnosis and assignment and measures to support vocational solutions.
To evaluate the effects of the multidisciplinary program in comparison to a control group with the usual care, a prospective longitudinal study was conducted. 307 patients were assigned to the multidisciplinary in-patient treatment program, whereas 176 patients with comparable complaints had the standard rehabilitation program. Besides the full sample, we analyzed a subgroup of patients with chronic low back pain.
We found positive moderate and strong effects in the intervention group concerning function, pain, psychic strains as well as the number of sick days and return to work rates 10 months after discharge. Effects in the intervention group exceeded the effects achieved in the control group. Beside the full sample, we analyzed a subgroup of patients with chronic low back pain, who received an intense activating group treatment. Also in this subgroup we found moderate and strong effects of treatment superior to those in the control group for function, psychic strains and sick days.
We attribute these persisting and superior effects in the treatment group to an efficient treatment of occupational and psychic problems as well as to more homogeneous treatment groups attained by a multidisciplinary diagnosis and team-based assignment. They also show the significance of in-patient-treatment which is effective, when -- based on multidisciplinary diagnosis -- differential treatment groups can be formed.
根据胡佩和拉斯佩最近的一项综述，德国针对慢性腰痛患者的多学科治疗方案的效果似乎相当微弱，且没有持续效果。除其他因素外，治疗后持续存在的心理和与工作相关的压力及紧张情绪可能会抵消治疗的潜在益处。因此，针对慢性腰痛患者的多学科住院治疗方案通过多学科诊断与分配以及支持职业解决方案的措施进行了修订。
为了评估多学科方案相较于接受常规护理的对照组的效果，开展了一项前瞻性纵向研究。307名患者被分配至多学科住院治疗方案，而176名有类似症状的患者接受标准康复方案。除了整个样本，我们还分析了慢性腰痛患者的一个亚组。
我们发现干预组在出院10个月后，在功能、疼痛、心理压力以及病假天数和重返工作率方面有中度和显著的积极效果。干预组的效果超过了对照组。除了整个样本，我们还分析了接受强化激励性小组治疗的慢性腰痛患者亚组。在这个亚组中，我们也发现治疗在功能、心理压力和病假天数方面有中度和显著效果，优于对照组。
我们将治疗组这些持续且更优的效果归因于对职业和心理问题的有效治疗，以及通过多学科诊断和基于团队的分配所实现的更同质化的治疗组。这些结果还表明了住院治疗的重要性，当基于多学科诊断能够形成差异化治疗组时，住院治疗是有效的。
