[Intervertebral disk surgery and postoperative rehabilitation treatment: effect on health status]. / Bandscheibenoperation und Anschlussheilbehandlung: Einfluss auf den Gesundheitszustand.

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.

[Problems in implementing a pain management program for rheumatoid patients and studies of its effectiveness]. / Probleme bei der Durchführung eines Schmerzbewältigungsprogrammes bei Rheumapatienten und Untersuchungen zu seiner Effektivität.

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.

Assessing health in musculoskeletal disorders--the appropriateness of a German version of the Sickness Impact Profile.

The Sickness Impact Profile (SIP) is gaining increasing popularity in clinical and epidemiological studies, assessing health status or the impact of therapeutic interventions. The SIP was created as a global measure, assessing generic dimensions of health. As there were only a few such methods available in our country, we decided in 1990 to validate a German version of the SIP and to test its appropriateness in patients with musculoskeletal disorders. Due to the up-to-dateness of our results, we decided to publish now the data of this German version of the SIP. Reliability, validity and sensitivity to change of the German version of the SIP were tested in 299 patients with musculoskeletal disorders. The test-retest correlation was high for the overall score (r = 0.81), as well as for Cronbach's alpha (r = 0.83). Results for categories were significantly lower. Validity was tested by comparing the SIP to the Keitel Index (r = 0.6) and to the Measurement of Patient Outcome Scale (r = 0.72), as well as to a control group, which showed significant differences in all categories and in the overall score. Furthermore, the SIP was able to demonstrate therapy-related improvements in health in all our patients. We concluded that the german version of the SIP fulfilled statistical test criteria. The results were comparable to those achieved in the original American version. A cross-cultural comparison using the SIP is justified for at least those patients with musculoskeletal disorders.

[Measuring physical disability and psychosocial consequences of chronic backache]. / Messung der körperlichen Beeinträchtigung und der psychosozialen Konsequenzen bei chronischen Kreuzschmerzen.

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.

Assessing health status after inpatient rehabilitation in rheumatoid arthritis.

Evaluation of different therapy programmes, e.g. inpatient rehabilitation, in rheumatoid arthritis requires valid, reliable and sensitive instruments describing patient health status. Traditional measurements such as ESR, joint count or radiographic findings do not suffice for this purpose, particularly because they neglect the psychosocial dimensions of impairment. We report upon a questionnaire, MOPO scales, a German adaptation of the Arthritis Impact Measurement Scales. We found the questionnaire to be valid, reliable and sensitive to change. The main application of MOPO scales is in multidimensional measurement of patient health status and in detection and documentation of therapeutically induced change.

[Assessment of the effectiveness of inpatient rehabilitation measures in patients with chronic low back pain: a prospective, randomized, controlled study]. / Uberprüfung der Wirksamkeit stationärer Rehabilitationsmassnahmen bei Patienten mit chronischen Kreuzschmerzen: eine prospektive, randomisierte, kontrollierte Studie.

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.

[Epidemiology of rheumatic complaints in Germany. Data on the prevalence and physical and psychosocial disability]. / Epidemiologie rheumatischer Beschwerden in der Bundesrepublik Deutschland. Daten zur Prävalenz und zur körperlichen und psychosozialen Beeinträchtigung.

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.

[Importance and value of roentgen studies as outcome criteria in rheumatoid arthritis]. / Wertigkeit und Aussagefähigkeit von Röntgenuntersuchungen als Outcome-Kriterium bei rheumatoider Arthritis.

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.