gms | German Medical Science

Background: CLBP indicates high prevalence and often occurs with mental comorbidities [1]. Additionally, there is evidence for the association between the socio-economic status (SES) and CLBP. Moreover, the enhancement of pain self-efficacy and pain management are important outcome factors among patients with CLBP during multidisciplinary rehabilitation.

Aim: The aim of the study was to examine the longitudinal effects of the inpatient multidisciplinary rehabilitation program Debora [2] and the SES on pain self-efficacy and pain management among patients with CLBP.

Method: The prospective control group study with cluster-block randomization included n=394 patients with CLBP. A 2x3x5 (treatment condition x SES x time) repeated measures design with five sample points (pre, post, 6, 12 and 24 months after rehabilitation) was realized. The control group (CG) received a pain competence training and the intervention group (IG) an additional depression prevention training. The SES was calculated according to Deck [3]. Multi- and univariate analyses of variance were carried out, using per protocol analyses.

Results/findings: Regarding pain self-efficacy, the IG showed a long-term improvement in all social classes. In contrast, only patients from the upper class benefited from the CG in long-term. Furthermore, patients from social upper and middle class improved more in cognitive restructuring, perceived competence and counteracting activities in the long-term than patients from social lower class.

Discussion and conclusions: These results suggest the sustainable impact of multidisciplinary rehabilitation and the SES on pain self-efficacy and pain management. During conceptualization of cognitive-behavioral management trainings for patients with CLBP, the SES of the target group has to be taken into account.

The study was financed by Deutsche Rentenversicherung Bund.