Christoph Herda

The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome.

OBJECTIVE:Although the standard treatments for the irritable bowel syndrome (IBS) are medical, growing evidence indicates the substantial therapeutic value of psychological therapy. However, it has not been investigated whether the combination of multicomponent behavioral therapy plus medical treatment is more effective than medical treatment alone. The aim of this study was to investigate this question in patients consulting a tertiary gastrointestinal (GI) referral center.METHODS:Twenty-four IBS outpatients were randomly assigned to the combination of standardized multicomponent behavioral therapy plus standard medical treatment (SMBT) or standard medical treatment alone (SMT). SMBT included IBS information and education, progressive muscle relaxation, training in illness-related cognitive coping strategies, problem-solving, and assertiveness training in 10 sessions over 10 wk. SMT included standardized symptom-oriented medical treatment and regular visits to a gastroenterologist every second week. Posttreatment outcome measures consisted of quantification of GI, vegetative, and psychological symptoms by means of daily symptom diaries and the assessment of changes in rectovisceral perception thresholds, as well as of questionnaire measures on psychological distress, overall well-being, illness-related coping abilities, and quality of life. Follow-ups were conducted at 3- and 6-month intervals.RESULTS:Pre- and posttreatment evaluations showed significantly (p < 0.01) greater IBS symptom reduction as measured by daily symptom diaries for the SMBT group than for the SMT group. Rectovisceral perception remained unchanged by either treatment. Overall well-being significantly improved in the SMBT group but remained unchanged in the SMT group. Subjects in the SMBT group, unlike those in the SMT group, felt significantly more in control of their health, and quality of life was significantly improved in the SMBT group but remained unchanged in the SMT group.CONCLUSIONS:The data provide evidence that the combination of medical treatment plus multicomponent behavioral treatment is superior to medical treatment alone in the therapy of IBS.

The pain beliefs and perceptions inventory: further evidence for a 4-factor structure

&NA; This study employed the Pain Beliefs and Perceptions Inventory (PBPAI) (Williams and Thorn 1989) with a German sample (n = 193) of pain patients. The original version has 3 subscales:(1) self‐blame (S‐B),(2) perception of pain as mysterious (MYST), and(3) beliefs about the temporal stability of pain (TIME). Item statistics, factor structure, and discriminant validity are reported. Factor analysis favored a 4‐factor structure and replicated a finding by Strong et al. (1992). The TIME scale can be subdivided into 2 subscales: beliefs that pain is a constant and enduring experience (“Constancy”), and beliefs about the long‐term chronicity of pain (“Acceptance”). Constancy showed higher correlations with self‐reported psychological symptomatology (anxiety, general physical troubles, pain intensity) than did Acceptance, MYST, and S‐B.

Readiness to adopt adequate postural habits: an application of the Transtheoretical Model in the context of back pain prevention.

Based on a biomechanical model, an adequate body posture can contribute to the prevention of back pain and back pain chronicity. This study examines the explanatory value of the Transtheoretical Model (TTM) for the adoption of adequate postural habits in a cross-sectional sample of 149 employees of a German administration unit (mean age 40.2 years, 50% female). Using newly developed instruments with satisfactory psychometric properties, basic assumptions of the TTM could be confirmed: self-efficacy and the perceived pros for maintaining a good body posture increased significantly across the stages, while the perceived cons decreased. Additionally, the use of preventive strategies for back pain prevention increased linearly and significantly across the stages of change. The study supports the applicability of the TTM for postural behavior. Considering stages of change as an intervening variable may contribute to clarifying the relationship between participation in low back schools and prevention of back pain chronicity. Longitudinal and intervention study data are needed to support these assumptions.

Prognose des Erfolges von Operationen an der Bandscheibe

The outcome of disk surgery in 40 consecutive patients was predicted by pre-treatment assessments of sociodemographic and psychological variables and findings in a standardised orthopaedic and neurological examination. The pre-surgery variables that proved to be associated with outcome criteria six months post surgery by means of a multiple stepwise regression procedure were selected for discriminant analyses, using three outcome criteria: functional status, patient evaluation of the outcome, and vocational rehabilitation. The correct classification rate was 85%, 77.5%, and 90%, respectively. No prediction was possible for postoperative pain behaviour and postoperative orthopaedic and neurological status. Significant predictors were time off work before surgery, active search for information about disease and surgery, presence of conditions that reinforce pain behaviour, and cognitive variables indicating helplessness.The outcome of disk surgery in 40 consecutive patients was predicted by pre-treatment assessments of sociodemographic and psychological variables and findings in a standardised orthopaedic and neurological examination. The pre-surgery variables that proved to be associated with outcome criteria six months post surgery by means of a multiple stepwise regression procedure were selected for discriminant analyses, using three outcome criteria: functional status, patient evaluation of the outcome, and vocational rehabilitation. The correct classification rate was 85%, 77.5%, and 90%, respectively. No prediction was possible for postoperative pain behaviour and postoperative orthopaedic and neurological status. Significant predictors were time off work before surgery, active search for information about disease and surgery, presence of conditions that reinforce pain behaviour, and cognitive variables indicating helplessness.ZusammenfassungVierzig konsekutive für eine Nukleotomie vorgesehene Patienten wurden daraufhin untersucht, ob der Operationserfolg neben orthopädisch-neurologischen Indikatoren auch durch psychologische Indikatoren vorhergesagt werden kann. Die psychologischen Indikatoren werden begründet durch verhaltensmedizinische Konzepte, die zur Chronifizierung von Schmerzen vorgelegt wurden. Der Operationserfolg wurde 1/2 Jahr postoperativ gemessen über die Schmerzintensität, den Funktionsstatus, die berufliche Rehabilitation, das Patientenrating des Erfolges und das Ergebnis der orthopädisch-neurologischen Untersuchung. Für die durch schrittweise multiple Regression aufgefundenen Prädiktorvariablen wurden Diskriminanzanalysen berechnet. Die Trefferquoten betrugen für den funktionellen Status 85%, für das Patientenrating des Operationserfolges 77,5% und für die berufliche Rehabilitation 90%. Postoperatives Schmerzverhalten und postoperativer orthopädisch-neurologischer Befund konnten nicht vorhergesagt werden. Bedeutsame Prädiktorvariablen sind die Dauer der Arbeitsunfähigkeit vor der Operation, die aktive Suche nach Information über die Erkrankung und die Operation, die Verstärkungsbedingungen des Schmerzverhaltens sowie Gedanken der Hilflosigkeit.

Good Postural Habits: A Pilot Investigation Using EMG Scanning of the Paraspinals

The assumption is tested that changes from poor to good postural habits can be identified by specific patterns in paraspinal activity. Paraspinal activity is measured by using an electromyographic (EMG) scanning procedure introduced by Cram. Two samples were addressed. The first sample consists of 32 pain-free medical students. Measurements were taken twice at intervals 3 min apart in a sitting position with arms hanging at the side. The first assessment refers to a normal and relaxed, and the second assessment to an upright “physiological” position of the spine recommended by Brügger. Data indicate that changes to good postural habits are represented by a significant decrease in the activity of the cervical paraspinal area (CPS), whereas in the trapezius and the thoracic area (T1, T6), the activity of the muscles is significantly increased. The hypothesis is put forward that these changes also occur as a consequence of a preventive low back school training. The second sample consists of 26 asymptomatic female employees of a medical hospital who had previously suffered from back pain attacks, but who were without pain during the assessments. Recordings taken before and after participation in the back school at 3 months apart show a similar pattern of significant changes in paraspinal activity (CPS, T6), although their magnitude is less pronounced. No pre-post changes could be observed in the trapezius. The findings partly support the hypothesis. Further research is needed to evaluate the relationship between EMG recordings and postural habits.

Rücken stärken—Konzept und Evaluation einer Rückenschule für den Arbeitsplatz

ZusammenfassungDie Rückenschule “Rücken stärken” zielt hin auf ein Prävention der Chronifizierung von Rückenschmerz und ist für den betrieblichen Bereich entwickelt worden. Sie orientiert sich an psychologischen Konzepten der Chronifizierung von Schmerz sowie an den von Brügger entwickelten Methoden eines Trainings von haltung und Bewegung. Folgende Bausteine sind enthalten: Ergonomische Analyse des Arbeitsplatzes, Training von Entspannung, Förderung der aktiven Aufrechthaltung sowie der damit verbundenen Aktivitäten des täglichen Lebens, Übung von Dehnfähigkeit, Kraft und Beweglichkeit, Es werden 12 im Regelfall 2stündige Sitzungen nach einem standardisierten Manual durch zuvor geschulte Krankengymnastinnen durchgeführt. Es findet routinemäßig eine wissenschaftliche Begleitforschung statt. Vollständige Daten aus 31 Kursen von 283 Personen (77% der Teilnehmer) zeigen im Prä-post-Vergleich eine Reduktion des Rückenschmerzes, eine Verbesserung von Gesundheitszustand und Befinden und eine gute Umsetzbarkeit des trainierten Verhaltens am Arbeitsplatz. Mit einer Teilstichprobe von 74 Mitarbeitern des Klinikums Marburg wurde eine kontrollierte Studie durchgeführt. Kontrollpersonen wurden nach den Kriterien Geschlecht, Alter und Arbeitsplatz parallelisiert. Datenerhebungen fanden jeweils prä, post und zum 9-Monats-Follow-Up statt. Neben Fragebogenangaben wurden videogestützte Verhaltensbeobachtungen von Haltung und Bewegungsmustern vorgenommen (Inter-Rater-Reliabilitätr=0,91). Varianzanalytische methoden belegen eine deutliche, auch langfristig vorhandene, Verbesserung des Verhaltens ausschließlich in der Versuchsgruppe. Unter der Annahme, das gegenwärtige Verhalten stehe in einem Zusammenhang mit zukünftigen Rückenbeschwerden, muß diesem Befund unter präventiven Gesichtspunkten große Bedeutung zugesprochen werden. Während die aktive Aufrechthaltung sowie auch die Durchführung der Dehn- und Kräftigungsübungen im alltäglichen Handeln gut umsetzbar erscheinen, können nur etwa 50% der Kursteilnehmer auch die Empfehlungen zur Veränderung des Arbeitsplatzes realisieren. Dieser Sachverhalt läßt es als sinnvoll erscheinen, das verhaltensorientierte Übungsprogramm durch solche Gesundheitsförderungsmaßnahmen im Betrieb zu ergänzen, die der Veränderung der Arbeitsverhältnisse dienen.AbstractIntroductionOur knowledge of the risk factors involved in the process by which acute pain becomes chronic has improved. Psychological conceptualizations of chronic pain presently include (1) the pain-tension cycle, with special reference to a diathesis-stress model, (2) the operant conditioning model, and (3) the interrelationship between vulnerability to pain attacks on the one hand and body posture, gait and activities of daily living on the other. With reference to these conceptualizations and to psychological procedures for the enhancement of self-management strategies, a low back school was implemented at the worksite as a preventive measure.The target population is characterized by (1) rare but recurrent pain episodes, (2) mild pain that has had little impact on daily activities, and (3) pain contingent on particular activities or situations.Low back schoolA low back school called “Turn your back on backache” consists of the following elements: (1) analysis of labour conditions and adaptation of the worksite to the person, (2) relaxation and stress management, (3) training of posture, gait, and activities of daily living, and (4) stretching and stengthening of the muscles involved.The programme comprises 12 2-h sessions and is conducted by a physiotherapist according to a manual, after an introduction to self-management procedures including behavioural training for working with groups. For homework, participants are asked to practise the exercises demonstrated.Method and resultsIn a preventive context, pain ratings should be of minor importance as an outcome measure. Assuming that future pain is interrelated with present behaviour, changes in behaviour should be the predominant criteria applied to assess the effects of the training. Therefore, as well as assessments of pain episodes and wellbeing, a behavioural observation method based on video-taped behavioural assessment in a standardized situation was used. Course members had to demonstrate a sequence of different activities, including standing and walking, lifting and bending. Each sequence was rated on a four-point scale reflecting the degree to which adequate posture and gait were achieved. The final scale consists of 13 items with an inter-rater-reliability of 0.91 (Cronbach Alpha). The data for 283 persons attending in 31 courses in different industrial and administrative settings was used to evaluate the outcome. A marked decrease in pain episodes and an increase in health status and wellbeing were reported. Behaviour that was learned in the course had been incorporated into everyday activities at the worksite. The behavioural observation method was utilized in a subgroup of this sample who were on the staff of a university hospital. The study used a 2×2 repeated-measures design with the between-subject factor of treatment condition (training vs nontraining) and the within-subject factor of assessment period (pre-treatment=t1, post-treatment=12, 9-month follow-up=t3) allowing for analyses of variance (AN-OVA). Following a matched-pair design, for every person that participated in the training a control person was included in the study to allow control for gender, age, and occupation. This sample consists of 74 pairs and comprises nurses, administration personnel, physicians and physical therapists. Most (80%) are female. So far only 28 pairs have been reassessed at t3. A comparison of the overall scores obtained with the above items before and after treatment demonstrates an extremely significant interaction effect, indicating an increase of adequate behaviours in the treatment group. At the follow-up assessment, the observed effect was maintained.Conclusions(1) A back school training for the worksite results in a decreased frequency of back pain episodes and an increase in reported health status and wellbeing. (2) The effects of behavioural training of posture, gait, and activities of daily living in hospital staff are clearly demonstrated by observational methods. (3) Assuming that present posture, gait, and daily activities are interrelated with future pain conditions, an increase in the exercise of adequate behaviours indicates a preventive effect of the back school programme.

Motivation zur Prävention von Rückenschmerz — eine Studie zum transtheoretischen Modell Prochaskas

Zusammenfassung. Im Rahmen einer Querschnittsstudie wurden Hypothesen uberpruft, die aus dem transtheoretischen Modell fur den Bereich ruckenbewustes Verhalten abgeleitet wurden. Insbesondere waren dies Zusammenhange zwischen motivationalen Stufen und Ruckenschmerz, Wohlbefinden, Teilnahme an einer Ruckenschule sowie Verhaltensgewohnheiten, die zur Pravention von Ruckenschmerz beitragen sollen. Die Stichprobe bestand aus 160 Schulern (mittleres Alter 24.9 Jahre, SD = 7.3; 73 % weiblich) verschiedener Ausbildungsgange des Klinikums Marburg, die sich zu 25 % in Vor-Handlungsstufen, zu 20 % in der Handlungsstufe und zu 55 % in der Stufe der Aufrechterhaltung befanden. In die Analyse wurden nur Personen in den Stufen des Bewustwerdens, der Handlung oder der Aufrechterhaltung einbezogen. Schuler, die sich seit mindestens 6 Monaten ruckenbewust verhielten, berichteten der Tendenz nach seltener uber Ruckenschmerz als solche, die dieses Verhalten nicht oder erst seit kurzem zeigten (p = .052). Sie zeigten haufige...

Preventing pain attacks by low back school training.

ZusammenfassungDie Rückenschule “Rücken stärken” zielt hin auf ein Prävention der Chronifizierung von Rückenschmerz und ist für den betrieblichen Bereich entwickelt worden. Sie orientiert sich an psychologischen Konzepten der Chronifizierung von Schmerz sowie an den von Brügger entwickelten Methoden eines Trainings von haltung und Bewegung. Folgende Bausteine sind enthalten: Ergonomische Analyse des Arbeitsplatzes, Training von Entspannung, Förderung der aktiven Aufrechthaltung sowie der damit verbundenen Aktivitäten des täglichen Lebens, Übung von Dehnfähigkeit, Kraft und Beweglichkeit, Es werden 12 im Regelfall 2stündige Sitzungen nach einem standardisierten Manual durch zuvor geschulte Krankengymnastinnen durchgeführt. Es findet routinemäßig eine wissenschaftliche Begleitforschung statt. Vollständige Daten aus 31 Kursen von 283 Personen (77% der Teilnehmer) zeigen im Prä-post-Vergleich eine Reduktion des Rückenschmerzes, eine Verbesserung von Gesundheitszustand und Befinden und eine gute Umsetzbarkeit des trainierten Verhaltens am Arbeitsplatz. Mit einer Teilstichprobe von 74 Mitarbeitern des Klinikums Marburg wurde eine kontrollierte Studie durchgeführt. Kontrollpersonen wurden nach den Kriterien Geschlecht, Alter und Arbeitsplatz parallelisiert. Datenerhebungen fanden jeweils prä, post und zum 9-Monats-Follow-Up statt. Neben Fragebogenangaben wurden videogestützte Verhaltensbeobachtungen von Haltung und Bewegungsmustern vorgenommen (Inter-Rater-Reliabilitätr=0,91). Varianzanalytische methoden belegen eine deutliche, auch langfristig vorhandene, Verbesserung des Verhaltens ausschließlich in der Versuchsgruppe. Unter der Annahme, das gegenwärtige Verhalten stehe in einem Zusammenhang mit zukünftigen Rückenbeschwerden, muß diesem Befund unter präventiven Gesichtspunkten große Bedeutung zugesprochen werden. Während die aktive Aufrechthaltung sowie auch die Durchführung der Dehn- und Kräftigungsübungen im alltäglichen Handeln gut umsetzbar erscheinen, können nur etwa 50% der Kursteilnehmer auch die Empfehlungen zur Veränderung des Arbeitsplatzes realisieren. Dieser Sachverhalt läßt es als sinnvoll erscheinen, das verhaltensorientierte Übungsprogramm durch solche Gesundheitsförderungsmaßnahmen im Betrieb zu ergänzen, die der Veränderung der Arbeitsverhältnisse dienen.AbstractIntroductionOur knowledge of the risk factors involved in the process by which acute pain becomes chronic has improved. Psychological conceptualizations of chronic pain presently include (1) the pain-tension cycle, with special reference to a diathesis-stress model, (2) the operant conditioning model, and (3) the interrelationship between vulnerability to pain attacks on the one hand and body posture, gait and activities of daily living on the other. With reference to these conceptualizations and to psychological procedures for the enhancement of self-management strategies, a low back school was implemented at the worksite as a preventive measure.The target population is characterized by (1) rare but recurrent pain episodes, (2) mild pain that has had little impact on daily activities, and (3) pain contingent on particular activities or situations.Low back schoolA low back school called “Turn your back on backache” consists of the following elements: (1) analysis of labour conditions and adaptation of the worksite to the person, (2) relaxation and stress management, (3) training of posture, gait, and activities of daily living, and (4) stretching and stengthening of the muscles involved.The programme comprises 12 2-h sessions and is conducted by a physiotherapist according to a manual, after an introduction to self-management procedures including behavioural training for working with groups. For homework, participants are asked to practise the exercises demonstrated.Method and resultsIn a preventive context, pain ratings should be of minor importance as an outcome measure. Assuming that future pain is interrelated with present behaviour, changes in behaviour should be the predominant criteria applied to assess the effects of the training. Therefore, as well as assessments of pain episodes and wellbeing, a behavioural observation method based on video-taped behavioural assessment in a standardized situation was used. Course members had to demonstrate a sequence of different activities, including standing and walking, lifting and bending. Each sequence was rated on a four-point scale reflecting the degree to which adequate posture and gait were achieved. The final scale consists of 13 items with an inter-rater-reliability of 0.91 (Cronbach Alpha). The data for 283 persons attending in 31 courses in different industrial and administrative settings was used to evaluate the outcome. A marked decrease in pain episodes and an increase in health status and wellbeing were reported. Behaviour that was learned in the course had been incorporated into everyday activities at the worksite. The behavioural observation method was utilized in a subgroup of this sample who were on the staff of a university hospital. The study used a 2×2 repeated-measures design with the between-subject factor of treatment condition (training vs nontraining) and the within-subject factor of assessment period (pre-treatment=t1, post-treatment=12, 9-month follow-up=t3) allowing for analyses of variance (AN-OVA). Following a matched-pair design, for every person that participated in the training a control person was included in the study to allow control for gender, age, and occupation. This sample consists of 74 pairs and comprises nurses, administration personnel, physicians and physical therapists. Most (80%) are female. So far only 28 pairs have been reassessed at t3. A comparison of the overall scores obtained with the above items before and after treatment demonstrates an extremely significant interaction effect, indicating an increase of adequate behaviours in the treatment group. At the follow-up assessment, the observed effect was maintained.Conclusions(1) A back school training for the worksite results in a decreased frequency of back pain episodes and an increase in reported health status and wellbeing. (2) The effects of behavioural training of posture, gait, and activities of daily living in hospital staff are clearly demonstrated by observational methods. (3) Assuming that present posture, gait, and daily activities are interrelated with future pain conditions, an increase in the exercise of adequate behaviours indicates a preventive effect of the back school programme.

Rücken stärken—Konzept und Evaluation einer Rückenschule für den Arbeitsplatz@@@Preventing pain attacks by low back school training

ZusammenfassungDie Rückenschule “Rücken stärken” zielt hin auf ein Prävention der Chronifizierung von Rückenschmerz und ist für den betrieblichen Bereich entwickelt worden. Sie orientiert sich an psychologischen Konzepten der Chronifizierung von Schmerz sowie an den von Brügger entwickelten Methoden eines Trainings von haltung und Bewegung. Folgende Bausteine sind enthalten: Ergonomische Analyse des Arbeitsplatzes, Training von Entspannung, Förderung der aktiven Aufrechthaltung sowie der damit verbundenen Aktivitäten des täglichen Lebens, Übung von Dehnfähigkeit, Kraft und Beweglichkeit, Es werden 12 im Regelfall 2stündige Sitzungen nach einem standardisierten Manual durch zuvor geschulte Krankengymnastinnen durchgeführt. Es findet routinemäßig eine wissenschaftliche Begleitforschung statt. Vollständige Daten aus 31 Kursen von 283 Personen (77% der Teilnehmer) zeigen im Prä-post-Vergleich eine Reduktion des Rückenschmerzes, eine Verbesserung von Gesundheitszustand und Befinden und eine gute Umsetzbarkeit des trainierten Verhaltens am Arbeitsplatz. Mit einer Teilstichprobe von 74 Mitarbeitern des Klinikums Marburg wurde eine kontrollierte Studie durchgeführt. Kontrollpersonen wurden nach den Kriterien Geschlecht, Alter und Arbeitsplatz parallelisiert. Datenerhebungen fanden jeweils prä, post und zum 9-Monats-Follow-Up statt. Neben Fragebogenangaben wurden videogestützte Verhaltensbeobachtungen von Haltung und Bewegungsmustern vorgenommen (Inter-Rater-Reliabilitätr=0,91). Varianzanalytische methoden belegen eine deutliche, auch langfristig vorhandene, Verbesserung des Verhaltens ausschließlich in der Versuchsgruppe. Unter der Annahme, das gegenwärtige Verhalten stehe in einem Zusammenhang mit zukünftigen Rückenbeschwerden, muß diesem Befund unter präventiven Gesichtspunkten große Bedeutung zugesprochen werden. Während die aktive Aufrechthaltung sowie auch die Durchführung der Dehn- und Kräftigungsübungen im alltäglichen Handeln gut umsetzbar erscheinen, können nur etwa 50% der Kursteilnehmer auch die Empfehlungen zur Veränderung des Arbeitsplatzes realisieren. Dieser Sachverhalt läßt es als sinnvoll erscheinen, das verhaltensorientierte Übungsprogramm durch solche Gesundheitsförderungsmaßnahmen im Betrieb zu ergänzen, die der Veränderung der Arbeitsverhältnisse dienen.AbstractIntroductionOur knowledge of the risk factors involved in the process by which acute pain becomes chronic has improved. Psychological conceptualizations of chronic pain presently include (1) the pain-tension cycle, with special reference to a diathesis-stress model, (2) the operant conditioning model, and (3) the interrelationship between vulnerability to pain attacks on the one hand and body posture, gait and activities of daily living on the other. With reference to these conceptualizations and to psychological procedures for the enhancement of self-management strategies, a low back school was implemented at the worksite as a preventive measure.The target population is characterized by (1) rare but recurrent pain episodes, (2) mild pain that has had little impact on daily activities, and (3) pain contingent on particular activities or situations.Low back schoolA low back school called “Turn your back on backache” consists of the following elements: (1) analysis of labour conditions and adaptation of the worksite to the person, (2) relaxation and stress management, (3) training of posture, gait, and activities of daily living, and (4) stretching and stengthening of the muscles involved.The programme comprises 12 2-h sessions and is conducted by a physiotherapist according to a manual, after an introduction to self-management procedures including behavioural training for working with groups. For homework, participants are asked to practise the exercises demonstrated.Method and resultsIn a preventive context, pain ratings should be of minor importance as an outcome measure. Assuming that future pain is interrelated with present behaviour, changes in behaviour should be the predominant criteria applied to assess the effects of the training. Therefore, as well as assessments of pain episodes and wellbeing, a behavioural observation method based on video-taped behavioural assessment in a standardized situation was used. Course members had to demonstrate a sequence of different activities, including standing and walking, lifting and bending. Each sequence was rated on a four-point scale reflecting the degree to which adequate posture and gait were achieved. The final scale consists of 13 items with an inter-rater-reliability of 0.91 (Cronbach Alpha). The data for 283 persons attending in 31 courses in different industrial and administrative settings was used to evaluate the outcome. A marked decrease in pain episodes and an increase in health status and wellbeing were reported. Behaviour that was learned in the course had been incorporated into everyday activities at the worksite. The behavioural observation method was utilized in a subgroup of this sample who were on the staff of a university hospital. The study used a 2×2 repeated-measures design with the between-subject factor of treatment condition (training vs nontraining) and the within-subject factor of assessment period (pre-treatment=t1, post-treatment=12, 9-month follow-up=t3) allowing for analyses of variance (AN-OVA). Following a matched-pair design, for every person that participated in the training a control person was included in the study to allow control for gender, age, and occupation. This sample consists of 74 pairs and comprises nurses, administration personnel, physicians and physical therapists. Most (80%) are female. So far only 28 pairs have been reassessed at t3. A comparison of the overall scores obtained with the above items before and after treatment demonstrates an extremely significant interaction effect, indicating an increase of adequate behaviours in the treatment group. At the follow-up assessment, the observed effect was maintained.Conclusions(1) A back school training for the worksite results in a decreased frequency of back pain episodes and an increase in reported health status and wellbeing. (2) The effects of behavioural training of posture, gait, and activities of daily living in hospital staff are clearly demonstrated by observational methods. (3) Assuming that present posture, gait, and daily activities are interrelated with future pain conditions, an increase in the exercise of adequate behaviours indicates a preventive effect of the back school programme.

Prognose des Erfolges von Operationen an der Bandscheibe@@@Predicting the outcome of diskectomy: Eine Untersuchung an Patienten mit Schmerzen nach einem lumbalen Bandscheibenvorfall

The outcome of disk surgery in 40 consecutive patients was predicted by pre-treatment assessments of sociodemographic and psychological variables and findings in a standardised orthopaedic and neurological examination. The pre-surgery variables that proved to be associated with outcome criteria six months post surgery by means of a multiple stepwise regression procedure were selected for discriminant analyses, using three outcome criteria: functional status, patient evaluation of the outcome, and vocational rehabilitation. The correct classification rate was 85%, 77.5%, and 90%, respectively. No prediction was possible for postoperative pain behaviour and postoperative orthopaedic and neurological status. Significant predictors were time off work before surgery, active search for information about disease and surgery, presence of conditions that reinforce pain behaviour, and cognitive variables indicating helplessness.The outcome of disk surgery in 40 consecutive patients was predicted by pre-treatment assessments of sociodemographic and psychological variables and findings in a standardised orthopaedic and neurological examination. The pre-surgery variables that proved to be associated with outcome criteria six months post surgery by means of a multiple stepwise regression procedure were selected for discriminant analyses, using three outcome criteria: functional status, patient evaluation of the outcome, and vocational rehabilitation. The correct classification rate was 85%, 77.5%, and 90%, respectively. No prediction was possible for postoperative pain behaviour and postoperative orthopaedic and neurological status. Significant predictors were time off work before surgery, active search for information about disease and surgery, presence of conditions that reinforce pain behaviour, and cognitive variables indicating helplessness.ZusammenfassungVierzig konsekutive für eine Nukleotomie vorgesehene Patienten wurden daraufhin untersucht, ob der Operationserfolg neben orthopädisch-neurologischen Indikatoren auch durch psychologische Indikatoren vorhergesagt werden kann. Die psychologischen Indikatoren werden begründet durch verhaltensmedizinische Konzepte, die zur Chronifizierung von Schmerzen vorgelegt wurden. Der Operationserfolg wurde 1/2 Jahr postoperativ gemessen über die Schmerzintensität, den Funktionsstatus, die berufliche Rehabilitation, das Patientenrating des Erfolges und das Ergebnis der orthopädisch-neurologischen Untersuchung. Für die durch schrittweise multiple Regression aufgefundenen Prädiktorvariablen wurden Diskriminanzanalysen berechnet. Die Trefferquoten betrugen für den funktionellen Status 85%, für das Patientenrating des Operationserfolges 77,5% und für die berufliche Rehabilitation 90%. Postoperatives Schmerzverhalten und postoperativer orthopädisch-neurologischer Befund konnten nicht vorhergesagt werden. Bedeutsame Prädiktorvariablen sind die Dauer der Arbeitsunfähigkeit vor der Operation, die aktive Suche nach Information über die Erkrankung und die Operation, die Verstärkungsbedingungen des Schmerzverhaltens sowie Gedanken der Hilflosigkeit.