[Changes in psychophysiologic status during inpatient rehabilitation in the orthopedics service--a preliminary study]

Assessment of non-operative treatment of orthopaedic diseases is sometimes considered difficult. The purpose of this retrospective longitudinal study on the one hand is to evaluate the formal quality of questionnaire data under routine conditions in an in-patient rehabilitation hospital and on the other hand to study the impact of additional psychologic treatment on the outcome of patients who received conservative treatment for chronic orthopaedic diseases.

During a 7-month period, a total of 900 patients received a standardized questionnaire at the beginning and the end of a 4-week inhouse treatment for chronic orthopaedic diseases. A questionnaire handed out to the patients at arrival includes 33 items of psychophysiologic interest. At discharge, a modified questionnaire was used, focussing on the course of complaints during the treatment period, and including additional control-questions for consistency. Return of the questionnaires was voluntary, no pressure was applied, no effort was made to correct inconsistent or missing data. The results presented here are based on 105 orthopaedic patients who returned both questionnaires complete with consistent data. Of these, 44 received additional psychologic treatment by a psychologist, while 61 did not. Participation or non-participation in the psychologic treatment was the grouping variable in this study.

For only 189/900 (21%) of the patients taking part in the study complete and consistent questionnaires were available for analysis. For the 105 orthopaedic patients, no significant score differences at arrival between the groups were detected (p = 0.38) using the Mann-Whitney U-test. At discharge, the mean rank sums for the psychological intervention group was 45.7, while it amounted to 58.3 in the control group, indicating significantly stronger improvement of symptoms in the intervention group (p = 0.04).

Under routine conditions without any arrangements to ensure data quality a great amount of incomplete and/or inconsistent data has to be expected. For subsequent studies, this fact has to be taken into account. Irrespective of this aspect, complementary psychologic treatment of certain orthopaedic diseases seems to lead to significantly better results of treatment, as assessed by a psychophysiological questionnaire.