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Objective: To investigate return to work and cost-effectiveness of the addition of cognitive-behavioral treatment to standard therapy compared to standard 3-week inpatient rehabilitation for patients with chronic low back pain., Methods: A prospective economic evaluation alongside a randomized controlled trial was performed. Outcomes included days off work due to spinal complaints, health-related quality of life, and direct and indirect disease-related costs., Results: A total of 409 patients with chronic low back pain, who were admitted to a 3-week inpatient rehabilitation, were randomly assigned to usual care or usual care plus cognitive behavioral treatment. Average incremental costs for psychological treatment during rehabilitation were Euros 127 (95% CI 125.6, 130.9; p < 0.001). Six months after rehabilitation, patients in the intervention group were absent from work an average of 5.4 (95% CI -1.4, 12.1; p = 0.12) days less than patients receiving usual treatment. Between groups, there were no significant differences in quality-adjusted life-years gained or in direct medical or nonmedical costs. The cognitive behavioral treatment showed lower indirect costs: Euros 751 (95% CI -145, 1641; p = 0.097)., Conclusion: Adding a cognitive behavioral component to standard therapy may reduce work days lost and thus decrease indirect costs. From a societal perspective, the cost of the psychological treatment was compensated by lower indirect costs.

Study Design: Psychometric testing of a translated, culturally adapted questionnaire., Objectives: Cross-cultural adaptation of a German version of the Oswestry Disability Index (ODI) and evaluation of its measurement properties., Summary of Background Data: The ODI, one of the most popular questionnaires for chronic low back pain (LBP), has been valid, reliable, and responsive. Recently, a Swiss version of the ODI has been published, but there is no validated version for Germany to date., Methods: The translated and adapted German version of the ODI (ODI-G) was validated in inpatients with chronic LBP during 3 weeks' medical rehabilitation care. The ODI-G was completed at admission, 1 day later, and at discharge. Comparison with both a generic and chronic LBP-specific measure (the SF-36 and Hannover Functional Ability Questionnaire) assessed criterion validity., Results: A very high level of test-retest-reliability was found (r = 0.91). Criterion validity showed high correlations between the ODI-G on 1 side, and the SF-36 and Hannover Functional Ability Questionnaire on the other. Standardized response means showed significant changes when health status improved (1.38) or deteriorated (1.35)., Conclusions: The ODI-G is valid, reliable, and responsive. It may be used to measure current state as well as changes in health status, and allows for cross-cultural comparisons. Further research comparing the 2 versions in German language seems to be necessary.

Study Design: Psychometric testing of translated, culturally adapted questionnaire., Objectives: Cross-cultural adaptation of the German version of the Extended Aberdeen Back Pain Scale (EABPS, three questionnaires), and to evaluate its use for assessing back pain related health status and disability in German patients., Summary of Background Data: The EABPS can be used as one questionnaire for the whole spine or three questionnaires for the three parts of the spine: neck, upper back, and lower back. It was shown to be valid, reliable, and responsive. No German version was available., Methods: The EABPS was translated and adapted. The three questionnaires were evaluated separately. A total of 158 outpatients with neck pain, upper back pain, and/or low back pain were assessed by the EABPS-G at admission, 148 patients 1 day later for retest. For testing responsiveness, the standardized response mean (SRM) was chosen and for criterion validity a generic and cLBP-specific measure (SF-36 and FFbH-R)., Results: Between the first and second questionnaire, high correlations (from 0.93 to 0.95) represent a very high level of test-retest reliability. Criterion validity showed high (negative) correlations between the questionnaires for the three spinal areas on the one side and the FFbH-R and the SF-36 on the other. The SRM for the three questionnaires indicated remarkable changes ranging from 1.36 to 1.96., Conclusions: The EABPS-G is a valid, reliable, and responsive questionnaire for assessing health status and disability influenced by pain in one or more area of the spine and allows intercultural comparisons with the original English version. It could be used for assessment of current state as well as measurement for change.

Because of their considerable socioeconomic costs rheumatic symptoms are a major concern in industrialized nations. Our study provides data on the prevalence of rheumatic symptoms in the general population and on their physical and psychosocial impact. We performed a survey of 1814 randomly selected non institutionalized persons, aged 40 to 69 years, living in the Federal Republic of Germany. The selected subjects were asked whether they had pain in one or more of the following sites: neck/back, joints of upper extremities, joints of lower extremities. Physical and psychosocial disability was assessed using a multidimensional questionnaire that included a German version of the Arthritis Impact Measurement Scales (AIMS) and validated instruments concerning psychosocial dimensions of health status. The prevalence of rheumatic symptoms increases between 40 and 59 years and decreases thereafter. Rheumatic symptoms are more frequent in women than in men. The predominant pain localization is the back. Individuals reporting pain in one region (back, upper and lower extremities) often feel pain in other areas as well and often suffer from additional symptoms such as weakness and sleep disturbance. We found significant disabilities in physical (mobility, activities of daily living, physical activities) and psychosocial (depression, anxiety, exhaustion, family problems) dimensions of health status in subjects reporting rheumatic symptoms.

In order to evaluate the objectivity and validity of radiographic parameters in rheumatoid arthritis (RA) we studied 56 patients with definite RA. Inter-observer variation was assessed comparing the scorings (Larsen classification) of two independent experienced observers. Total radiographic scores were highly significantly correlated (r = 0.89). Yet, we could not find relevant associations between radiographic findings and clinical outcome parameters (pain, morning stiffness, dexterity, grip strength, and patient's overall assessment). Thus, hand radiographs in RA provide highly reproducible results. Its validity concerning patient outcome, however, has to be interpreted very carefully.

Chronic low-back pain is a frequent symptom causing considerable socioeconomic costs in many countries. Outpatient treatment of low-back pain often remains unsatisfactory. In our prospective study, one hundred patients on the five months waiting list were allocated randomly to attending the hospital either four months or six months later, the latter serving as a control group for those undergoing treatment. Health status was assessed using a multidimensional questionnaire, which had proven a reliable, valid and sensitive instrument in former studies. After four to six weeks of multidisciplinary inpatient treatment, a significant decrease in pain, anxiety and depression was found, whereas no improvement was observed in the control group. Multidisciplinary inpatient treatment therefore at least has short-term positive effects on patients' health status.

Low back-pain is one of the most frequent symptoms and its chronicity causes considerable socioeconomic costs in many countries. To evaluate the efficiency of therapeutic approaches in low back-pain we need reliable information concerning patient health status in its physical and psychosocial dimensions. After adapting the MOPO-scales, which have proven a reliable instrument in other rheumatic diseases, to special requirements in low back-pain, we assessed patient outcome using eight scales and calculating a summated health score. Statistical analysis yielded evidence our instrument to be reliable, valid, sensitive and practicable in assessing patient outcome in low back-pain.

A pain management program is presented which enables patients to reduce pain by means of relaxation and attention-diversion, etc. The problems arising from applying a psychological training to organic diseases, and the most favourable therapist's behaviour in facing these difficulties are elucidated. Finally, controlled studies are cited showing that pain can be reduced and the emotional state improved by pain management techniques.

There is an increasing frequency of lumbar disc surgery in many countries. In the Federal Republic of Germany, many patients are admitted to in-patient rehabilitation immediately after surgery, which causes additional socioeconomic costs. In order to assess the efficiency of this therapy approach, we used the MOPO Scales, a thoroughly evaluated instrument describing patient health status in both its physical and psychosocial dimensions. In 79 patients who had been followed-up over six months post-discharge from in-patient rehabilitation, a significant increase in mobility, physical activity, activities of daily living, household activities, and social activities was found, as well as a significant decrease in pain, depression and anxiety. These results prove lumbar disc surgery combined with immediate post operative rehabilitation to be efficient.