EFFECTIVENESS OF BEHAVIOURAL MEDICAL REHABILITATION UNDER REALLIFE CONDITIONS IN GERMANY: A PROPENSITY-SCORE MATCHED ANALYSIS

Abstract

ObjectivesIn Germany, behavioural medical rehabilitation programmes have been implemented for patients with musculoskeletal disorders and additional mental health comorbidity. The aim of this cohort study is to assess the relative effectiveness of behavioural medical rehabilitation under real-life conditions.DesignParticipants received either a common or behavioural medical rehabilitation programme. Propensity score matching was used to provide balanced samples of both groups (German Clinical Trials Register: DRKS00016404).ParticipantsA total of 360 patients treated in behavioural medical rehabilitation were compared with 360 matched controls. The mean age of study participants was approximately 53.5 years (standard deviation (SD)=7.0 years) and 74.0% were women.ResultsNo significant and clinical meaningful differences were found in return to work, applications for disability pension, and the number of patients receiving social security benefits in the year after rehabilitation. However, participants in behavioural medical rehabilitation reported better self-rated work ability, physical functioning and self-management skills, and decreased pain disability and fear-avoidance beliefs 10 months after rehabilitation. Standardized effect sizes were between 0.13 and 0.22.ConclusionBehavioural medical rehabilitation had no clinical meaningful effect on maintaining and restoring work ability. However, behavioural medical rehabilitation affected pain and disease management skills 10 months after completing the rehabilitation programme.LAY ABSTRACTMental health comorbidity increases the risk for patients with musculoskeletal disorders to receive a disability pension despite participating in a multimodal rehabilitation programme. In Germany, behavioural medical rehabilitation programmes were therefore developed for people who are affected from both musculoskeletal and mental health disorders. These programmes integrate additional psychological treatment into the standard multimodal rehabilitation approach. To test whether these programmes are more effective in enabling a stable return to work and improving self-rated health, this study compared 360 patients treated in behavioural medical rehabilitation with 360 comparable controls treated in conventional medical rehabilitation. The results indicate that participants could benefit more from a behavioural medical rehabilitation programme. Patients did not return to work significantly more often. However, they reported better self-rated work ability, better pain and health-related outcomes, and fewer days with unemployment benefits. In conclusion, more consistent implementation of the programme offers the opportunity to further improve these outcomes.