Interdisciplinary multimodal assessment and risk-tailored pathways for patients with back pain : Prospective evaluation of an integrated healthcare delivery project

Abstract

Back pain is prevalent in the population, sometimes recurrent and may result in everyday and work disabilities. It is often areason for seeking healthcare support. Analyzing the need of treatment and chronification-risk tailored intervention is aparticular demand in healthcare delivery. Reducing downstream consequences of back pain (e. g. pain and disability) by using an interdisciplinary multimodal assessment followed by arisk-tailored intervention. Patients with back pain (n = 1638) underwent assessments based on the German Pain Questionnaire (GPQ) and the diagnostic assessment each by ateam comprising aphysician, apsychologist and aphysiotherapist. They were assessed answering afollow-up questionnaire after 6and/or 12months (n = 832) for success criteria sensitive to change as pain, everyday and work disability. Patients had on average 62.5 days of work disability and 53.3% had pain up to one year. After assessment, 1447 patients (88.3%) were assigned to receive an intensive interdisciplinary multimodal back pain intervention. Intervention groups were: 120 h of full-time treatment for 4weeks (n = 1030) or 60 h (n = 224), 48 h part time treatment for 3months (n = 87), and in-patient hospital treatment for about 17days (n = 106). The effect sizes of success criteria were large to very large in all treatment groups. Tailored, interdisciplinary and intensive intervention is effective in reducing downstream consequences of back pain. The treatment assignment was based on patient reports (GPQ score) and multidisciplinary assessments (clinical evidence score). Tailored interventions should include sufficient intensity for highly disabled patients. Care integration such as timely communication between the health insurance system, back pain centers and usual healthcare services as well as patient- and process-related documentation are crucial for this intervention.