[A comparison of multimodal programmes of patient education in the rehabilitation of chronic low back pain]

There is growing evidence for the effectiveness of multimodal intervention concepts for chronic low back pain in the international literature, and accordingly several German rehabilitation programmes for the treatment of chronic low back pain patients have been developed. Focus of this paper is to describe and compare frequently used German multimodal intervention programmes for in- and outpatient rehabilitation of patients with chronic low back pain. Programmes were chosen by searching the most relevant online resources as well as the online pages of Deutsche Rentenversicherung and Zentrum Patientenschulung during September 2008. Keywords guiding the search were: Patientenschulung, Rückenschmerzen, Manual, psychologische multimodale Interventionskonzepte, Rehabilitationsprogramm, psychology, intervention, low back pain, manual and therapy. By this means, six manually supported multimodal rehabilitation programmes for the in- and outpatient therapy of patients with chronic back pain could be identified: Göttinger Rücken-Intensiv-Programm (GRIP), the psychological programme for chronic head- and low back pain, the Münchner Rücken-Intensiv-Programm (MRIP), Back to Balance, Arbeiten und Leben--Back to Balance (ALEBABA) und Rückenfit: Lebenslust statt Krankheitsfrust. These programmes are depicted and compared with regard to their potentials and limitations in supporting the rehabilitation process of patients with chronic low back pain. While comparing the programmes, a number of similarities between them can be detected, as well as pronounced differences, e. g., regarding settings and complexity. In most programmes, lack of appropriate evaluation studies and lack of aftercare turn out to be critical aspects.

[Control beliefs and patient compliance: an empirical study exemplified by adolescents with diabetes mellitus, bronchial asthma and alopecia areata]

The present paper focuses on the relation between control beliefs and the compliance of adolescents suffering from chronical diseases. It is assumed that the compliance will be high when the own behavior is regarded as most important for the improvement during illness (internal locus of control). A high compliance is also expected when the own state of health is seen as dependent from other persons, who are engaged in the therapeutic process (powerful others locus of control). Little compliance is expected when the state of health is regarded as dependent from fate or chance influences (chance locus of control). Thereover, it is assumed that the control beliefs are influenced by the specific disease of a patient, since diseases are controllable by the patients in different degrees and therefore should result in specific control beliefs. The theoretical assumptions were proved in an empirical study with 80 patients suffering from different diseases (Diabetes mellitus, Asthma bronchiale, Alopecia areata) and 366 healthy adolescents and adults. The results show a clear dependency of the control beliefs from the kind of disease of the patients. However, the relations between control beliefs and compliance are discrepant to the expectations which is shown mainly by null or negative correlations between internality and compliance. The empirical relations are explained by the self-reliant behavior of the internal patients which perhaps shows little compatibility to traditional concepts of compliance. The implications of the present results for the enhancement of compliance and for the definition of the compliance-concept are elaborated and discussed.