Borys Constanze, Lutz Johannes, Strauss Bernhard, Altmann Uwe
University Hospital Jena, Institute of Psychosocial Medicine and Psychotherapy, Friedrich -Schiller-University Jena, Jena, Germany.
Interdisciplinary Pain Center, Central Hospital Bad Berka, Bad Berka, Germany.
PLoS One. 2015 Nov 23;10(11):e0143139. doi: 10.1371/journal.pone.0143139. eCollection 2015.
The aim of the study was to examine the effectiveness of an intensive inpatient three-week multimodal therapy. We focused especially on the impact on the multimodal therapy outcome of the pre-admission number of treatment types patients had received and of medical specialist groups patients had consulted.
155 patients with chronic low back pain and indication for multimodal therapy were evaluated with respect to pain intensity, depression, anxiety, well-being, and pre-admission health care utilization. In our controlled clinical trial we compared N = 66 patients on the waiting list with N = 89 patients who received immediate treatment. The waiting list patients likewise attended multimodal therapy after the waiting period. Longitudinal post-treatment data for both were collected at three- and twelve-month follow-ups. The impact of pre-admission health care utilization on multimodal therapy outcome (post) was analysed by structural equation model.
Compared to the control group, multimodal therapy patients' pain intensity and psychological variables were significantly reduced. Longitudinal effects with respect to pre-measures were significant at three-month follow-up for pain intensity (ES = -0.48), well-being (ES = 0.78), anxiety (ES = -0.33), and depression (ES = -0.30). Effect sizes at twelve-month follow-up were small for anxiety (ES = -0.22), and moderate for general well-being (ES = 0.61). Structural equation model revealed that a higher number of pre-admission treatment types was associated with poorer post-treatment outcomes in pain intensity, well-being, and depression.
Multimodal therapy proved to be effective with regard to improvements in pain intensity, depression, anxiety, and well-being. The association between treatment effect and number of pre-admission pain treatment types suggests that patients would benefit more from attending multimodal therapy in an earlier stage of health care.
本研究旨在检验为期三周的强化住院多模式治疗的有效性。我们特别关注患者入院前接受的治疗类型数量以及咨询的医学专科组对多模式治疗结果的影响。
对155例慢性腰痛且有接受多模式治疗指征的患者进行疼痛强度、抑郁、焦虑、幸福感及入院前医疗保健利用情况的评估。在我们的对照临床试验中，我们将66名等待名单上的患者与89名接受立即治疗的患者进行了比较。等待名单上的患者在等待期后同样接受了多模式治疗。在三个月和十二个月的随访中收集了两组患者治疗后的纵向数据。通过结构方程模型分析入院前医疗保健利用情况对多模式治疗结果（治疗后）的影响。
与对照组相比，多模式治疗患者的疼痛强度和心理变量显著降低。在三个月的随访中，疼痛强度（效应量= -0.48）、幸福感（效应量= 0.78）、焦虑（效应量= -0.33）和抑郁（效应量= -0.30）方面的纵向效应相对于测量前显著。十二个月随访时，焦虑的效应量较小（效应量= -0.22），总体幸福感的效应量适中（效应量= 0.61）。结构方程模型显示，入院前治疗类型数量较多与治疗后疼痛强度、幸福感和抑郁方面的较差结果相关。
多模式治疗在改善疼痛强度、抑郁、焦虑和幸福感方面被证明是有效的。治疗效果与入院前疼痛治疗类型数量之间的关联表明，患者在医疗保健的早期阶段接受多模式治疗将获益更多。
