Prognostic factors for pain relief and functional improvement in chronic pain after inpatient rehabilitation.

OBJECTIVE: To determine the factors associated with pain relief and improved physical functioning in chronic pain patients during outpatient management in the first 5 months immediately after a standardized inpatient pain management program. METHODS: Prospective cohort study using standardized questionnaires on sociodemographic data, disease outcome, psychosocial factors, change in behavior, and outpatient therapies on discharge from inpatient rehabilitation and during the 5-month follow-up at home (observation period). Stepwise forward multivariate linear regression analysis examined the correlation of these factors with change in pain severity and change in physical functioning. RESULTS: The study included 80.1% female patients, 90.0% had at least 1 comorbidity and 62.9% had chronic pain for≥5 years. On average, pain intensity and depression worsened slightly during the observation period, but the other outcomes remained almost stable. Relief from anxiety (20.7% explained variance) and low baseline depression (5.5%) were the most important predictors for pain relief. Relief from anxiety (13.3%) and low baseline depression (7.1%) were most strongly associated with functional improvement. CONCLUSIONS: This study found a strong association of change in pain severity and physical functioning with change in baseline level of affective health and coping during the first outpatient management period after inpatient rehabilitation. As a consequence, it may be possible to improve the treatment of chronic pain by therapy of mood and coping.

Working conditions and Work-Family Conflict in German hospital physicians: psychosocial and organisational predictors and consequences.

BACKGROUND: Germany currently experiences a situation of major physician attrition. The incompatibility between work and family has been discussed as one of the major reasons for the increasing departure of German physicians for non-clinical occupations or abroad. This study investigates predictors for one particular direction of Work-Family Conflict--namely work interfering with family conflict (WIF)--which are located within the psychosocial work environment or work organisation of hospital physicians. Furthermore, effects of WIF on the individual physicians' physical and mental health were examined. Analyses were performed with an emphasis on gender differences. Comparisons with the general German population were made. METHODS: Data were collected by questionnaires as part of a study on Psychosocial work hazards and strains of German hospital physicians during April-July 2005. Two hundred and ninety-six hospital physicians (response rate 38.9%) participated in the survey. The Copenhagen Psychosocial Questionnaire (COPSOQ), work interfering with family conflict scale (WIF), and hospital-specific single items on work organisation were used to assess WIF, its predictors, and consequences. RESULTS: German hospital physicians reported elevated levels of WIF (mean = 74) compared to the general German population (mean = 45, p < .01). No significant gender difference was found. Predictors for the WIF were lower age, high quantitative demands at work, elevated number of days at work despite own illness, and consequences of short-notice changes in the duty roster. Good sense of community at work was a protective factor. Compared to the general German population, we observed a significant higher level of quantitative work demands among hospital physicians (mean = 73 vs. mean = 57, p < .01). High values of WIF were significantly correlated to higher rates of personal burnout, behavioural and cognitive stress symptoms, and the intention to leave the job. In contrast, low levels of WIF predicted higher job satisfaction, better self-judged general health status, better work ability, and higher satisfaction with life in general. Compared to the German general population, physicians showed significantly higher levels of individual stress and quality of life as well as lower levels for well-being. This has to be judged as an alerting finding regarding the state of physicians' health. CONCLUSION: In our study, work interfering with family conflict (WIF) as part of Work-Family Conflict (WFC) was highly prevalent among German hospital physicians. Factors of work organisation as well as factors of interpersonal relations at work were identified as significant predictors for WIF. Some of these predictors are accessible to alteration by improving work organisation in hospitals.