Hampel Petra, Neumann Anne
Institut für Gesundheits-, Ernährungs- und Sportwissenschaften, Europa-Universität Flensburg, Flensburg, Germany.
Psychother Psychosom Med Psychol. 2023 Mar;73(3-04):101-111. doi: 10.1055/a-1827-3995. Epub 2022 Sep 7.
To investigate the effects of an intervention for pain competence and depression prevention for multidisciplinary inpatient rehabilitation of non-specific chronic low back pain on psychological and work-related outcomes over a 2-year period.
This prospective randomized controlled multicenter trial evaluated the effects of pain competence training with and without depression prevention on depressive symptoms (General Depression Scale; ADS; primary outcome), anxiety (Hospital Anxiety and Depression Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire) and subjective prognosis of gainful employment (SPE; secondary outcomes) in n=422 patients aged 32-64 years from four rehabilitation clinics. Per protocol analyses were conducted. In the three-factorial design with a repeated-measures factor, patients were stratified by treatment condition; the control group (CG) received only pain management training but the intervention group (IG) was additionally treated with depression prevention training (Debora). Based on the ADS, patients were assigned to without or low depressive symptoms (ADS<23; n=208) and medium or high depressive symptoms (ADS≥23; n=214). The fivefold repeated-measures factor included the following sample points: admission, immediately after and 6, 12, and 24 months after rehabilitation. Per protocol results of univariate 2×2×5 analyses of variance were validated by n=1225 multiple imputed data.
No significant effects of treatment condition over the 2-year period were yielded in the primary outcome "depressive symptoms", but only patients with the combined training Debora benefited in pain self-efficacy in the long term. Intention-to-treat analyses suggest incremental effects of Debora on pain self-efficacy and anxiety at 24-month follow-up. In the long term, patients with high levels of depressive symptoms improved exclusively in depressive symptoms or they benefited more than patients with low depression in anxiety. However, favorable effects receded in general from post rehabilitation to 24-month follow-up.
The results support that a disorder-specific depression prevention training is needed for the long-term improvement in pain self-efficacy, which is considered a crucial psychological protective factor in pain chronification. Findings on depressive symptoms support the effectiveness of multidisciplinary inpatient rehabilitation in high depression, but also the great importance of early treatment of depressive symptoms.
Overall, the results strengthen the need to implement psychotherapeutic treatment elements and, in particular, cognitive-behavioral methods and, moreover, a systematic allocation of patients to needs-based treatments in order to improve long-term effects.
探讨针对非特异性慢性下腰痛多学科住院康复的疼痛应对能力及抑郁预防干预措施在2年期间对心理和工作相关结局的影响。
这项前瞻性随机对照多中心试验评估了有或无抑郁预防的疼痛应对能力训练对来自四家康复诊所的422名年龄在32至64岁患者的抑郁症状（一般抑郁量表；ADS；主要结局）、焦虑（医院焦虑抑郁量表）、疼痛自我效能感（疼痛自我效能量表）和有收益就业主观预后（SPE；次要结局）的影响。进行了符合方案分析。在具有重复测量因素的三因素设计中，患者按治疗条件分层；对照组（CG）仅接受疼痛管理训练，而干预组（IG）还接受了抑郁预防训练（Debora）。根据ADS，患者被分为无或低抑郁症状（ADS<23；n = 208）以及中度或高度抑郁症状（ADS≥23；n = 214）。五重重复测量因素包括以下样本点：入院时、康复后即刻以及康复后6、12和24个月。符合方案的单变量2×2×5方差分析结果通过n = 1225个多重插补数据进行了验证。
在主要结局“抑郁症状”方面，2年期间治疗条件未产生显著影响，但只有接受联合训练Debora的患者在长期疼痛自我效能感方面受益。意向性分析表明，在24个月随访时，Debora对疼痛自我效能感和焦虑有递增效应。从长期来看，抑郁症状水平高的患者仅在抑郁症状方面有所改善，或者他们在焦虑方面比抑郁症状低的患者受益更多。然而，一般而言，从康复后到24个月随访，有益效果逐渐减弱。
结果支持需要针对特定疾病的抑郁预防训练以长期改善疼痛自我效能感，疼痛自我效能感被认为是疼痛慢性化的关键心理保护因素。关于抑郁症状的研究结果支持多学科住院康复对高抑郁患者的有效性，但也表明抑郁症状早期治疗的重要性。
总体而言，结果强化了实施心理治疗要素的必要性，尤其是认知行为方法，此外还需将患者系统地分配到基于需求的治疗中，以改善长期效果。
