Rehabilitation access and effectiveness cohort study for persons with back pain (REHAB-BP)
Final Report Abstract
This study identified barriers to the use of rehabilitation services and examined the effectiveness of medical rehabilitation for persons with chronic back pain. Of 45,000 members of the compulsory German Pension Insurance, 11,193 (24%) completed the baseline questionnaire in 2017. 6,940 individuals with back pain were followed up and received a second questionnaire in 2019. During the observation period 200 persons (3%) were treated in a medical rehabilitation programme due to musculoskeletal disorders including back pain. Barriers to access were directly addressed in the questionnaire. The health status and associated limitations played a major role in the perception of a personal wish for rehabilitation. However, a considerable proportion of persons reported a lack of knowledge about medical rehabilitation services. The preliminary stage for submitting an application, i.e. developing an intention to apply, is mainly determined by contextual factors, particularly family and work-related barriers. In general, social support seems to be an important factor for preparing an application. A concrete intention to apply at baseline and aspects indicating restriction of participation were identified as determinants of the actual application. Even in a subgroup of 590 persons with severe back pain only 8.6% utilised a rehabilitation programme due to musculoskeletal disorders during the observation period. For analysing the effectiveness of medical rehabilitation services, 200 persons treated in a medical rehabilitation programme were compared to 200 similar persons without rehabilitation. In the follow-up survey pain, health and work ability were reported more favourably by persons without rehabilitation. At first sight, the data suggest that rehabilitation was ineffective among employed persons with back pain. However, a very long mean period of more than 340 days was observed between the baseline survey and the start of the rehabilitation programme. In the meantime persons with rehabilitation may have experienced a health-related deterioration that led to their actual use of rehabilitation. Since the available data did not allow clarifying this point, we do not know if the sample characteristics at baseline reflect the characteristics of the treated persons at the beginning of their rehabilitation programme. Therefore, the non-suitability of the methodological approach in the study for analysing the effectiveness of medical rehabilitation became apparent during the course of the project. These findings make an important contribution to the current scientific discussion on methodological approaches to testing the effectiveness of medical rehabilitation. In addition, new findings on barriers in the access to rehabilitation services enhance the existing data.
Publications
- Rehabilitation access and effectiveness for persons with back pain: the protocol of a cohort study (REHAB-BP, DRKS00011554). BMC Public Health 2018; 18: 22
Bethge M, Mattukat K, Fauser D, Mau W
(See online at https://doi.org/10.1186/s12889-017-4588-x) - Zugangsbarrieren zu und Wirksamkeit medizinischer Rehabilitation bei Rückenschmerz: Aktueller Stand einer Kohortenstudie mit Versicherten der Deutschen Rentenversicherung Nord und Mitteldeutschland. Physikalische Medizin, Rehabilitation, Kurortmedizin 2018; 28(06): 372-382
Mattukat K, Fauser D, Schmitt N, Bethge M, Mau W
(See online at https://doi.org/10.1055/a-0626-7167) - Propensity-Score-Methoden zur Schätzung von Behandlungseffekten: Eine Chance für die rehabilitative Versorgungsforschung. Die Rehabilitation 2019, 58(01): 50-58
Fauser D, Bethge M.
(See online at https://doi.org/10.1055/a-0781-8967) - Rehabilitationszugang und -nutzen bei Rückenschmerz: Aktueller Stand und Stichprobe einer Kohortenstudie mit Versicherten der Deutschen Rentenversicherung Nord und Mitteldeutschland. In: 28. Rehabilitationswissenschaftliches Kolloquium (Tagungsband) 2019, DRV-Schriften (117), S. 148-150
Fauser D, Mattukat K, Schmitt N, Schmidt S, Krüger JM, Bethge M, Mau W
- Erfahrungen und Einstellungen bezüglich der medizinischen Rehabilitation als Prädiktoren des subjektiven Rehabilitationsbedürfnisses bei Personen mit Rückenschmerzen. In: 29. Rehabilitationswissenschaftliches Kolloquium (Tagungsband) 2020, D RV-Schriften (120), S. 79-81
Schmitt N, Fauser D, Golla A, Bethge M, Mau W
- Subjektive Erwerbsprognose und Determinanten der Reha - Antragsintention bei Erwerbstätigen mit Rückenschmerzen. 19. DKVF Digital, Berlin 2020
Fauser D, Schmitt N, Golla A, Zimmer JM, Mau W, Bethge M
- Subjektive Erwerbsprognose und Reha -Antragsintention bei Erwerbstätigen mit Rückenschmerzen. In: 29. Rehabilitationswissenschaftliches Kolloquium (Tagungsband) 2020, DRV-Schriften (120), S. 84-87
Fauser D, Schmitt N, Golla, A, Mau, W, Bethge, M
- Warum wird kein Rehabilitationsantrag gestellt? Individuelle Gründe aus der Perspektive von Personen mit Rückenschmerzen und subjektivem Rehabilitationsbedürfnis. 19. DKVF Digital, Berlin 2020)
Zimmer JM, Fauser D, Golla A, Schmitt N, Bethge M, Mau W
- Zugang zur medizinischen Rehabilitation bei Rückenschmerzen - Einflussfaktoren auf das subjektive Rehabilitationsbedürfnis und die Intention zur Antragsstellung. 19. DKVF Digital, Berlin 2020
Schmitt N, Fauser, D, Golla A, Zimmer, JM, Bethge M, Mau W
