Abstract
BackgroundBack pain is one of the most common chronic diseases in Germany and has a major impact on work ability and social participation. The German Pension Insurance (GPI) is the main provider of medical rehabilitation to improve work ability and prevent disability pensions in Germany. However, over half of the persons granted a disability pension have never used a medical rehabilitation service. Furthermore, evidence on the effects of medical rehabilitation in Germany is inconclusive. Consequently, this study has two aims: first, to determine barriers to using rehabilitation services, and second, to examine the effectiveness of medical rehabilitation in German residents with chronic back pain.MethodsIn 2017 a postal questionnaire will be sent to 45,000 persons aged 45 to 59 years whose pension insurance contributions are managed by the GPI North or the GPI Central Germany. In 2019 respondents who report back pain in the first survey (n = 5760 expected) will be sent a second questionnaire. Individuals will be eligible for the first survey if they are employed, have neither used nor applied for a rehabilitation programme during the last 4 years and neither received nor applied for a disability pension. The sample will be drawn randomly from the registers of the GPI North (n = 22,500) and the GPI Central Germany (n = 22,500) and stratified by sex and duration of sickness absence benefits. Barriers to rehabilitation services will be related to socio-demographic and social characteristics, pain and attitudes to pain, health and health behaviour, healthcare utilisation, experiences and cognitions about rehabilitation services and job conditions. Propensity score matched analyses will be used to examine the effectiveness of rehabilitation services. Data on use of medical rehabilitation will be extracted from administrative records. The primary outcome is pain disability. Secondary outcomes are pain intensity and days of disability, pain self-efficacy, fear avoidance beliefs, self-rated health, depression, healthcare utilisation, self-rated work ability and subjective prognosis of employability, sickness absence benefits, and disability pensions.DiscussionThis study identifies barriers to use of rehabilitation services and determines the effectiveness of medical rehabilitation for patients with chronic back pain.Trial registrationGerman Clinical Trials Register (DRKS00011554, January 26, 2017).
Highlights
Back pain is one of the most common chronic diseases in Germany and has a major impact on work ability and social participation
The main predictor of rehabilitation utilisation appears to be impaired health, manifested as poor subjective health [8, 11, 14,15,16,17], functional impairment or impairment in activities of everyday life [11, 19], chronic conditions [11, 19], poor work ability [11, 18], long sickness absence [8, 11, 14, 19], and greater use of medical care services [11, 14]. Though these findings indicate that use of medical rehabilitation services is linked to substantial health problems affecting work ability, they do not give insight into the barriers to using rehabilitation services
Back pain patients who complete a medical rehabilitation will be compared with back pain patients who do not participate in a medical rehabilitation programme
Summary
Study design The study is designed as a cohort study. Persons with back pain will be identified via a preliminary survey and followed up. COPSOQ Copenhagen Psychosocial Questionnaire, CPQ Chronic Pain Grade Questionnaire, FABQ Fear-Avoidance Beliefs Questionnaire, GPI German Pension Insurance, FEBA Fragebogen zur subjektiven Einschätzung der Belastungen am Arbeitsplatz (questionnaire on job demands), PSEQ Pain Self-Efficacy Questionnaire, PHQ-8 Patient Health Questionnaire (8-item version), SCQ Self-Administered Comorbidity Questionnaire, SPE subjective prognosis of employment status, WAS work ability score deal with the extent to which pain interferes with important life domains, including daily living, leisure time and work Because it includes the work domain this measure covers work ability, which is the primary focus of GPI-approved rehabilitation services. Sickness absence benefits and disability pensions Data on days in receipt of sickness absence benefits, days in regular employment, applications for and granting of a disability pension will be extracted from the GPI registers during the third year of the study These variables are the secondary outcomes in our analyses of the effectiveness of medical rehabilitation. Moderators will be tested in order to identify the patients who would benefit most from medical rehabilitation
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