Mohr B, Gräf Th, Forster M, Krohn-Grimberghe B, Kurzeja R, Mantel F, Thomsen M, Hampel P
Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen, Bremen.
Rehabilitation (Stuttg). 2008 Oct;47(5):284-98. doi: 10.1055/s-2008-1076708. Epub 2008 Oct 20.
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.
目前，对于慢性下腰痛患者康复结局中抑郁症状及性别特异性因素的影响知之甚少。我们对116例慢性下腰痛患者（43名女性，73名男性；平均年龄48岁；国际疾病分类第10版诊断：M45.4/M45.5，M54.4/M54.5）在康复结束时、康复后3个月及6个月时，研究了性别和抑郁症状对康复结局的影响。康复结束时，所有康复指标均有中等效应量的总体改善。相比之下，康复6个月后，只有与疼痛相关的指标有中度改善。此外，中期结局受性别和抑郁症状影响；女性在疼痛强度、与家庭/休闲相关的功能受损以及“感知自我能力”和“放松”等应对疼痛策略方面的康复结局更稳定。相比之下，尤其是有严重抑郁症状的男性患者，在与疼痛相关的变量以及“认知重构”应对疼痛策略方面，康复结局出现倒退。在事后分析中，中期时，与康复前相比，他们甚至出现了功能能力和躯体化的恶化。我们的结果表明，通过实施一般的性别特异性治疗以及针对有严重但亚临床抑郁症状患者的抑郁治疗要素，骨科康复的结局可能会持续改善。
