A randomized controlled component analysis of a behavioral medicine rehabilitation program for chronic spinal pain: are the effects dependent on gender?

The aim of the present study was to evaluate the outcome of a behavioral me dicine (BM) rehabilitation program and the outcome of its two main componen ts, compared to a 'treatment-as-usual' control group (CG). The study employ ed a 4 X 4 repeated-measures design with four groups and four assessment pe riods (pre-treatment, post-treatment, 6-month follow-up, and 18-month follo w-up). The group studied consisted of subjects on sick leave identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjec ts were randomized to one of four conditions, which were: (1) behavior-orie nted physical therapy (PT); (2) cognitive behavioral therapy (CBT); (3) BM rehabilitation consisting of PT + CBT (BM); (4) a 'treatment-as-usual' CG. The treatments were given over a period of 4 weeks, PT and CBT on a part-ti me basis and BM on a full-time basis. Outcome variables were sick leave, ea rly retirement, and health-related quality of life (measured using the Shor t Form Wealth Survey, SF36). The results showed that the risk of being gran ted full-time early retirement was significantly lower for females in PT an d CBT compared to the CG during the 18-month follow-up period. However, the total absence from work (sick listing plus early retirement) in days over the 18-month follow-up period was not significantly different in the CG com pared to the treatments. On the SF-36, women in CBT and BM reported a signi ficantly better health-related quality of life than women in the CG at the 18-month follow-up. No significant differences for men were found on the SF 36 scales. In conclusion, the results revealed gender differences in the ou tcome of the treatments and that the components of this BM program yielded as good results as the whole program. (C) 2001 International Association fo r the Study of Pain. Published by Elsevier Science B.V. All rights reserved .