Evaluation of Inpatient Conservative Management of Acute, Subacute, and Chronic Back Pain

Abstract

Backache is very common in the German population. It is a common reason for people to seek medical advice and specific back pain programs have been developed. The intention of this study is to evaluate the short and long term effects of conservative management of back pain in a German general hospital. Outcomes of interest were pain intensity, interference in daily functions, physical functioning and health related quality of life. We examined 1010 patients with acute, subacute and chronic back pain, admitted to inpatient nonsurgical interventional therapy in a German hospital between July 2013 and July 2015. Outcomes were assessed at the end of the inpatient treatment and at 3, 6 and 12 months follow-up, using Numerical Rating Scales (NRS) for pain and daily function, the Hannover Ability Questionnaire for Measuring Back Pain-Related Functional Limitations (FFbH - R) and the German Version of the EuroQol Questionnaire (EQ-5D) for measuring health-related quality of life. The baseline questionnaire also included questions on the risk of developing long-term disability following back pain (HKF-R 10) for acute and subacute cases and the Mainz Pain Staging System (MPSS) for patients with chronic back pain. The return rate was 54% after 3 months, 38% after 6 months and 27% at 12 months follow-up. The results from the follow-up measurements (T2 - T5) were compared to the pre-treatment results (T1). Because of missing or insufficiently normal distributions nonparametric paired Wilcoxon tests were used to test differences over time for each variable. Level of significance was adjusted for multiple testing. In addition, effect sizes were computed to estimate the clinical relevance of statistically significant results. Pain intensity and impact of pain on daily function were significantly lower at the end of the inpatient treatment (T2). The results remained largely stable at the 3, 6 and 12 month follow-ups. Significant improvements were found in physical functioning and health-related quality of life. These improvements were maintained equally at the 3, 6 and 12 month follow-ups. In consequence, working ability increased during the follow-up period. Calculated effect sizes showed large effects for pain intensity, interference and quality of life (r = 0.51 to 0.85) and predominately moderate effects (r = 0.45 to 0.62) for physical functioning at all measurement points. The percentage of patients who had an operation due to continuing back pain after conservative treatment was 7.8, 9.9, and 12.3 at the 3, 6, and 12 month follow-ups, respectively. Persistent effects of inpatient conservative treatment of back pain were found for all outcome variables. The specific approach appears to be effective in conservative treatment programs of back pain. In the end, it's not about the alternative of surgery or conservative treatment for back pain. Treatment has to be coordinated with the patient in terms of participative decisions.