[The role of psychosocial factors in a chronic course after injuries of the lower spine].

Clinical experience has often demonstrated the inadequate relationship between degree of injury and rehabilitation outcome. The aim of this study is to investigate the importance of different psychosocial factors in coping behaviour after lower back injury. 194 patients of three nationalities (Swiss, Italian, Yugoslavian) were examined, 70 in an acute and 124 in a chronic phase of injury. A semistructured interview, followed by a physical examination, was used to gather the needed information; a follow-up examination was done one year afterwards. Factors shown to contribute to poor outcome were: reduced sense of wellbeing, pessimistic self-prognosis of outcome, poor job security, migration, social status, insufficient doctor-patient relationship, lack of social support and limitations in certain physical parameters. The most reliable predictor for poor outcome was the patients evaluation of job security. In addition to diagnosis of existing chronification, resumption of work "for therapeutic purposes" after thorough preparation of the patient and conclusion of cases within the shortest possible time with definitive settlement of insurance payments were proposed as concluding steps.