RESUMO
PURPOSE: Social inequality in medical rehabilitation is receiving increasing attention. The present study examined the impact of the social status on the long-term effectiveness of the pain competence and depression prevention training "Debora" among patients with chronic low back pain (CLBP) in an inpatient multidisciplinary rehabilitation. METHODS: The control group study with cluster-block randomization investigated the long-term changes in pain self-efficacy, psychological burden, functional capacity, and subjective work ability among 394 patients with non-specific CLBP depending on the condition (control group, CG: pain competence training vs. intervention group, IG: additional depression prevention training) and the social status (lower, middle vs. upper class; according to Deck [1]). The data were collected at five sample points: pre (t0), post (t1), 6-(t2), 12-(t3) and 24-month follow-up (t4). Multi- or univariate repeated-measures analyses of variance were conducted per protocol (pp). In a second step, results should be confirmed by multiple imputations (MI; N=1089). RESULTS: In general, patients of the lower class showed significantly worse values in depressive symptoms, functional capacity, and subjective work ability compared to the upper class. In addition, positive long-term effects could not be found among patients of the lower class. In contrast, patients of the middle and upper class improved, especially in the IG. Furthermore, only the IG showed long-term improvements in subjective work capacity. CONCLUSION: This study confirms the influence of the social status on the psychophysical health. Moreover, social inequality in long-term success of rehabilitation of CLBP was suggested, which could be mediated by health literacy. Therefore, these aspects should be taken into account already in the conception and especially in the application of psychological group trainings in inpatient rehabilitation.
