Abstract
BackgroundPatients with chronic back pain show an increased use of health-care services leading to high direct costs. Multidisciplinary rehabilitation reduces pain intensity, depression, disability and work inability. The study aims to investigate whether health-care utilization in patients with chronic back pain is lower after rehabilitation than before rehabilitation and if, in addition to sociodemographic, medical and psychological characteristics, changes in these characteristics immediately after rehabilitation can predict health-care utilization.MethodsN = 688 patients with chronic back pain were asked about their overall health-care services use and the use of general practitioners, specialists, physiotherapy, psychotherapy, complementary therapist, massages, and admission to hospital both 6 months before and 6 months after rehabilitation. In addition, various sociodemographic, medical and psychological variables were assessed. To measure changes due to rehabilitation, differences in pain intensity, disability, impairment and coping, quality of life, and days on sick leave before and after rehabilitation were calculated. Dependent t-tests and hierarchical regression analyses were used to analyse the data.ResultsHealth-care utilization 6 months after rehabilitation was, except for physiotherapy and psychotherapy, significantly lower than before. The effect sizes were rather small (Cohens’d =. 01–.34). After rehabilitation between 15.2% and 39.9% of the variance of health-care utilization could be explained. The baseline values of health-care utilization explained between 3.2% and 15.9% of the incremental variances. The changes in psychological impairment and coping as well as in sick leave after rehabilitation could explain between 0.8% and 2.9% of the variance of health-care utilization after rehabilitation. Its influence was significant for the general use of health-care services, general practitioners and specialists.ConclusionsThe results indicate that use of health-care services after rehabilitation in the present study is slightly lower than before, which has an impact on direct costs due to chronic back pain in Germany. The predictors show the importance in terms of health-care utilization of improving work ability and psychological impairment.
Highlights
Patients with chronic back pain show an increased use of health-care services leading to high direct costs
Due to the lack of specific studies concerning the German health-care system, this study aims to investigate whether there is a difference in health-care utilization before and after a multidisciplinary rehabilitation in patients with chronic back pain in Germany and whether, in addition to sociodemographic, medical and psychological characteristics, changes due to rehabilitation determine health-care utilization after rehabilitation
The means of utilization of physiotherapy and psychotherapy were lower after rehabilitation than before, but the differences were not significant
Summary
Patients with chronic back pain show an increased use of health-care services leading to high direct costs. If duration of back pain exceeds 3 months, it is classified as chronic with a reported lifetime prevalence of between 10% and 27% [2]. Patients with chronic back pain use more health-care services than the average population [4]. Health-care utilization represents a complex pattern of individual and contextual characteristics, which are described in the widely used Behavioral Model of Health Services Use [5]. In this model, the characteristics are determined by predisposing, enabling and need factors.
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