Back Pain In Germany Research Articles

Work ability score as predictor of rehabilitation, disability pensions and death? A German cohort study among employees with back pain.

Sickness absence, disability pensions, and use of healthcare due to disabling back pain are a high economic burden in Germany. Assessment are needed to identify employees who are likely to need intensive support. The cohort study examined whether rehabilitation, disability pensions and death can be predicted by a simple self-reported rating of work ability in employees with back pain in Germany. Employees aged 45 to 59 years who reported back pain in the last 3 months completed the Work Ability Score in 2017 (0-10 points). Individual scores were categorized into poor (0-5 points), moderate (6-7) and at least good (8-10) work ability. Outcomes were extracted from administrative records covering the period until the end of 2018. Proportional hazard models were fitted to determine the prognostic benefit of the Work Ability Score. Data for 6,917 participants were included (57.8% women). The median follow-up time was 20 months. Of the participants, 52.1% had a good or excellent, 27.7% a moderate, and 20.2% a poor Work Ability Score. During follow-up, 548 persons were granted rehabilitation measures, 57 persons disability pensions, and 23 died. Fully adjusted analyses showed an increased risk of a rehabilitation measure (hazard ratio = 2.65; 95% CI 2.11; 3.34) and a disability pension (HR = 4.12; 95% CI 2.02; 8.39) in employees with poor work ability. A premature death was not associated with poor work ability. The Work Ability Score is a potential tool to identify individuals, reporting back pain, with an increased risk of health-related early retirement and work disability.

Most subjectively affected joints in patients with haemophilia - what has changed after 20 years in Germany?

In patients with haemophilia (PwH), most frequently affected joints are the ankle, knee and elbow. Due to improved factor therapy in the last decades, these previous findings have to be verified in Germany. The aim of this study is to detect the most affected joint, evaluate the significance of the source of pain and determine the point prevalence of back pain in Germany today. In a retrospective study, data of n=300 patients with severe moderate and mild haemophilia were evaluated regarding the most affected joint, the most common source of pain, and the point prevalence of back pain. An anamnesis questionnaire and the German Pain Questionnaire were used for this assessment. The most affected joint in German PwH is still the ankle (41%), followed by the knee (27%) and the elbow (11%). The most common source of pain is also the ankle joint (32%). Back pain was also identified as one of the most common sources of pain, which is comparable to the elbow (elbow:15%; back:13%). The point prevalence in PwH for back pain was significantly higher compared to the general German population (P=.031). Our data showed that the ankle is still the most affected joint and the most common source of pain in Germany. These results also showed the relevance of back pain as a pain source. The evaluations also demonstrated the high point prevalence of back pain in PwH. Future therapies should also focus on the spine because joint changes affect posture.

Barriers to applying for medical rehabilitation: a time-to-event analysis of employees with severe back pain in Germany.

ObjectiveLongitudinal studies on barriers to applying for rehabilitation in Germany are lacking in light of the suspected underutilization of rehabilitation services. The aim of this study was to examine application behaviour in persons with disabling back pain and to identify relevant predictors for making an application.DesignA prospective cohort study with randomized sampling of insurants in the German Pension Insurance, using a questionnaire at baseline and followup with linked administrative data for 1.5 years.Subjects/patientsEmployed persons (age range 45–59 years) with a high degree of limitations due to back pain and a self-reported risk of permanent work disability (not applied for disability pension, no medical rehabilitation within the last 4 years).MethodsMultivariable Cox regression was used to examine the influence of pre-selected variables on making an application in the follow-up period.ResultsOf 690 persons, only 12% applied for rehabilitation. Predictors for making an application were: support from physicians (hazard ratio (HR)=2.24; 95% confidence interval (95% CI) 1.32–3.80), family, and friends (HR=1.67; 95% CI 1.02–2.73), more pain-related disability days (HR=1.02; 95% CI 1.01–1.03), and worse work ability (HR=0.86; 95% CI 0.75–0.97). An intention to apply at baseline mediated the effect of family and physician support on the application.ConclusionThe low number of applications for rehabilitation despite disabling back pain indicates access barriers to, and underuse of, medical rehabilitation.LAY ABSTRACTMedical rehabilitation in Germany aims to enable participation and work ability in persons with chronic conditions, but requires an active decision to apply. This study included 690 persons with severe back pain and followed them for 1.5 years. The aim was to analyse applications for medical rehabilitation in this group and to determine the influencing factors. Only 12% of persons included in the study applied for rehabilitation, mostly after approximately 1 year. Factors making an application more likely were: more disability days and support of the application by their physician, family, and friends. Factors that made an application less likely were: better work ability and being more strained by household chores. The results show that only 1 out of 10 persons in need because of back pain actually end up in rehabilitation, and that possible barriers must be addressed.

Prevalence of and factors associated with long-term sick leave in working-age adults with chronic low back pain in Germany.

There are little data on the impact of chronic low back pain (CLBP) on long-term sick leave. Thus, the aim was to investigate the prevalence of and the factors associated with long-term sick leave in working-age adults with CLBP in Germany. This retrospective study included adults aged 18-65years diagnosed for the first time with CLBP in one of 1193 general practices in Germany between 2000 and 2019. CLBP was defined as the presence of two diagnoses of low back pain with > 90days between them. Long-term sick leave was assessed in the year following the first diagnosis of low back pain, and was defined as > 42days of absence from work for health-related reasons. In Germany, employees on sick leave lasting > 42days are not paid by the employer anymore but by the health insurance fund. Finally, an adjusted logistic regression model was used to assess the association between predefined variables (e.g., age, sex, and comorbidities) and long-term sick leave. A total of 59,269 working-age adults were included in this study [mean (SD) age 32.8 (11.5) years; 41.4% women]. The prevalence of long-term sick leave in the sample was 49.1%. Long-term sick leave was significantly associated with young age, male sex, and several physical and psychiatric comorbidities (e.g., reaction to severe stress and adjustment disorder, gastritis and duodenitis, and depression). Based on these results, public health measures are urgently needed to mitigate the deleterious effects of CLBP on work participation in Germany.

Digital Therapeutic Care Apps With Decision-Support Interventions for People With Low Back Pain in Germany: Cost-Effectiveness Analysis.

BackgroundDigital therapeutic care apps provide a new effective and scalable approach for people with nonspecific low back pain (LBP). Digital therapeutic care apps are also driven by personalized decision-support interventions that support the user in self-managing LBP, and may induce prolonged behavior change to reduce the frequency and intensity of pain episodes. However, these therapeutic apps are associated with high attrition rates, and the initial prescription cost is higher than that of face-to-face physiotherapy. In Germany, digital therapeutic care apps are now being reimbursed by statutory health insurance; however, price targets and cost-driving factors for the formation of the reimbursement rate remain unexplored.ObjectiveThe aim of this study was to evaluate the cost-effectiveness of a digital therapeutic care app compared to treatment as usual (TAU) in Germany. We further aimed to explore under which circumstances the reimbursement rate could be modified to consider value-based pricing.MethodsWe developed a state-transition Markov model based on a best-practice analysis of prior LBP-related decision-analytic models, and evaluated the cost utility of a digital therapeutic care app compared to TAU in Germany. Based on a 3-year time horizon, we simulated the incremental cost and quality-adjusted life years (QALYs) for people with nonacute LBP from the societal perspective. In the deterministic sensitivity and scenario analyses, we focused on diverging attrition rates and app cost to assess our model’s robustness and conditions for changing the reimbursement rate. All costs are reported in Euro (€1=US $1.12).ResultsOur base case results indicated that the digital therapeutic care strategy led to an incremental cost of €121.59, but also generated 0.0221 additional QALYs compared to the TAU strategy, with an estimated incremental cost-effectiveness ratio (ICER) of €5486 per QALY. The sensitivity analysis revealed that the reimbursement rate and the capability of digital therapeutic care to prevent reoccurring LBP episodes have a significant impact on the ICER. At the same time, the other parameters remained unaffected and thus supported the robustness of our model. In the scenario analysis, the different model time horizons and attrition rates strongly influenced the economic outcome. Reducing the cost of the app to €99 per 3 months or decreasing the app’s attrition rate resulted in digital therapeutic care being significantly less costly with more generated QALYs, and is thus considered to be the dominant strategy over TAU.ConclusionsThe current reimbursement rate for a digital therapeutic care app in the statutory health insurance can be considered a cost-effective measure compared to TAU. The app’s attrition rate and effect on the patient’s prolonged behavior change essentially influence the settlement of an appropriate reimbursement rate. Future value-based pricing targets should focus on additional outcome parameters besides pain intensity and functional disability by including attrition rates and the app’s long-term effect on quality of life.

Physical therapy for patients with low back pain in Germany: a survey of current practice

BackgroundLow back pain (LBP) is one of the most common musculoskeletal disorders worldwide. The National Disease Management Guideline (NVL) “Non-specific LBP” is a practical decision-making aid for both physicians and non-medical professionals in Germany to improve quality of health care. Although LBP is the most frequent diagnosis resulting in physical therapy treatment, information on the current management of patients with LBP and guideline adherence is limited. The objective of this study was to evaluate the current physical therapy management of patients with LBP in Germany, and to explore guideline adherence to the NVL “Non-specific LBP” recommendations.MethodsAn online survey among physical therapists working in Germany was conducted based on the recommendations given in the NVL “Non-specific LBP”. Participants were recruited using a snowball sampling approach and invited to complete the questionnaire. Guideline adherence was evaluated by comparing the survey findings with the recommendations of the NVL.ResultsIn total, 1361 physical therapists (41 years of age (SD 11); 839 female, 514 male; 16 years of clinical experience (SD 10)) completed the survey.Fifty percent (n = 675) of our respondents adhered to the recommendations of the NVL on the therapeutic diagnostic process, and 72% (n = 973) to the recommendations concerning treatment. The guideline adherence across the entire management process (i.e., both diagnosis and treatment) of LBP was 38% (n = 513). German physical therapists predominantly provide active interventions, e.g., exercise therapy, but also use interventions with low or conflicting evidence, respectively. Massage and Kinesio Taping were frequently used despite being not recommended. Less than one third of study participants (n = 400, 29%) answered to know the NVL or had dealt with its recommendations.ConclusionsIn the management of LBP, overall guideline adherence among German physical therapists was 38% with higher adherence in the treatment section than in the physical therapeutic diagnostic process. Widespread employment of implementation strategies and removal of existing barriers against the application of evidence-based guidelines could facilitate the transfer of scientific evidence into clinical practice and contribute to optimize the quality of health care.Trial registrationGerman Clinical Trials Register (DRKS00012607). Registered 04 October 2017.

Patients' Views on the Implementation Potential of a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study.

Stratified care for low back pain (LBP) has been shown to be clinically- and cost-effective in the UK, but its transferability to the German healthcare system is unknown. This study explores LBP patients’ perspectives regarding future implementation of stratified care, through in-depth interviews (n = 12). The STarT-Back-Tool was completed by participants prior to interviews. Interview data were analysed using Grounded Theory. The overarching theme identified from the data was ‘treatment-success’, with subthemes of ‘assessment and treatment planning’, ‘acceptance of the questionnaire’ and ‘contextual factors’. Patients identified the underlying cause of pain as being of great importance (whereas STarT-Back allocates treatment based on prognosis). The integration of the STarT-Back-Tool in consultations was considered helpful as long as it does not disrupt the therapeutic relationship, and was acceptable if tool results are handled confidentially. Results indicate that for patients to find STarT-Back acceptable, the shift from a focus on identifying a cause of pain and subsequent diagnosis, to prediction-orientated treatment planning, must be made clear. Patient ‘buy in’ is important for successful uptake of clinical interventions, and findings can help to inform future strategies for implementing STarT-Back in the Germany, as well as having potential implications for transferability to other similar healthcare systems.

Real-world prevalence and incidence of lower back pain in Germany

Real-world prevalence and incidence of lower back pain in Germany

Physiotherapists\u2019 views of implementing a stratified treatment approach for patients with low back pain in Germany: a qualitative study

BackgroundThe STarT-Back-Approach (STarT: Subgroups for Targeted Treatment) was developed in the UK and has demonstrated clinical and cost effectiveness. Based on the results of a brief questionnaire, patients with low back pain are stratified into three treatment groups. Since the organisation of physiotherapy differs between Germany and the UK, the aim of this study is to explore German physiotherapists’ views and perceptions about implementing the STarT-Back-Approach.MethodsThree two-hour think-tank workshops with physiotherapists were conducted. Focus groups, using a semi-structured interview guideline, followed a presentation of the STarT-Back-Approach, with discussions audio recorded, transcribed and qualitatively analysed using content analysis.ResultsNineteen physiotherapists participated (15 female, mean age 41.2 (SD 8.6) years). Three main themes emerged, each with multiple subthemes: 1) the intervention (15 subthemes), 2) the healthcare context (26 subthemes) and 3) individual characteristics (8 subthemes). Therapists’ perceptions of the extent to which the STarT-Back intervention would require changes to their normal clinical practice varied considerably. They felt that within their current healthcare context, there were significant financial disincentives that would discourage German physiotherapists from providing the STarT-Back treatment pathways, such as the early discharge of low-risk patients with supported self-management materials. They also discussed the need for appropriate standardised graduate and post-graduate skills training for German physiotherapists to treat high-risk patients with a combined physical and psychological approach (e.g., communication skills).ConclusionsWhilst many German physiotherapists are positive about the STarT-Back-Approach, there are a number of substantial barriers to implementing the matched treatment pathways in Germany. These include financial disincentives within the healthcare system to early discharge of low-risk patients. Therapists also highlighted the need for solutions in respect of scalable physiotherapy training to gain skills in combined physical and psychological approaches.

Health-care utilization of patients with chronic back pain before and after rehabilitation

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.

General Practitioners Views of Implementing a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study.

Background and ObjectiveThe STarT Back stratified primary care approach has demonstrated clinical and cost effectiveness in the UK, and is commonly used by General Practitioners (GPs). However, it remains unknown how this approach could be implemented into the German healthcare system. The aim of this study was therefore to explore the views and perceptions of German GPs in respect to using a stratified primary care for low back pain (LBP).MethodsA 90-minute think-tank workshop was conducted with 14 male and five female GPs, during which the STarT-Back-Screening-Tool (SBST) and related research evidence was presented. This was followed by two focus groups, based on a semi-structured interview guideline to identify potential implementation barriers and opportunities. Discussions were audiotaped, transcribed and coded using a content analysis approach.ResultsFor the three deductively developed main themes, 15 subthemes emerged: (1) application of the SBST, with the following subthemes: which health profession should administer it, patients known to the GP practice, the reason for the GP consultation, scoring the tool, the tool format, and the anticipated impact on GP practice; (2) psychologically informed physiotherapy, with subthemes including: provision by a physiotherapist, anticipated impact, the skills of physiotherapists, management of patients with severe psychosocial problems, referral and remuneration; (3) the management of low-risk patients, with subthemes including: concern about the appropriate advising health professional, information and media, length of consultation, and local exercise venues.ConclusionsThe attitudes of GPs towards stratified primary care for LBP indicated positive support for pilot-testing in Germany. However, there were mixed reactions to the ability of German physiotherapists to manage high-risk patients and handle their complex clinical needs. GPs also mentioned practical difficulties in providing extended advice to low-risk patients, which nevertheless could be addressed by involvement of specifically trained medical assistants.

PSY72 - Utilization Patterns for Treatment with Strong Opioids for Chronic Back Pain in Germany

PSY72 - Utilization Patterns for Treatment with Strong Opioids for Chronic Back Pain in Germany

Intermediate and Long-term Effects of a Standardized Back School for Inpatient Orthopedic Rehabilitation on Illness Knowledge and Self-management Behaviors

A back school is a mandatory part of the multimodal rehabilitation program for patients with chronic low back pain in Germany. However, no standardized and evaluated back school program has been available for routine use. In this study, we report the evaluation of a new back school that was developed based on theories of health behavior, treatment evidence, practice guidelines, and quality criteria for patient education. Randomized controlled trial of patients with low back pain (n=360) in inpatient orthopedic rehabilitation clinic in Germany. Intervention patients received the new back school, whereas control patients a traditional back school (usual care). Illness knowledge (primary outcome) and secondary behavioral and health outcomes were assessed at admission, discharge, and 6 and 12 months follow-up. Results showed a significant medium between-group treatment effect in patients' knowledge about back pain at discharge (η²=0.081), after 6 (η²=0.056), and 12 months (η²=0.026). Furthermore, small-to-medium effects were observed among the secondary self-management behaviors, such as physical activity, back exercises, back posture habits, and coping with pain, after 6 and 12 months. The superior effectiveness of the back school based on a biopsychosocial approach was demonstrated with regard to illness knowledge and self-management behaviors up to 1 year. Thus, the program may be recommended for dissemination within medical rehabilitation.

Healthcare utilization of back pain patients: results of a claims data analysis

Objectives:The high life-time prevalence of chronic back pain (25–30% according to surveys in small samples) suggests that it may be a major source of healthcare cost and that prevention of chronic back pain may be both ethically and economically recommendable. To obtain valid economic data on the cost of back pain in Germany, a retrospective claims data analysis was performed.Methods:Using data from 2006 of 5.2 million beneficiaries of a German statutory health insurance fund (DAK Unternehmen Leben) covering ∼7% of the German population, mean value analyses report on key healthcare utilization figures from a sickness funds’ perspective. In contrast to other studies, cost data are primary data and not extrapolated, but clinical characteristics include surrogate markers as no clinical case descriptions were available.Results:Based on previously investigated diagnosis patterns three types of back pain could be identified: (other) specific back pain (n = 211,216), pain due to spinal disk disease (n = 195,712), and non-specific back pain (n = 534,272). Of all back pain patients, 25.8% were identified as at risk to develop chronic pain, where only 2.6% were detected as patients with chronic back pain. Mean resource utilization and related healthcare costs were significantly higher for beneficiaries with indicators for chronic back pain than for beneficiaries with only risk factors for developing chronic back pain. This especially holds for outpatient analgesic prescriptions (p < 0.05), for in-hospital multimodal pain therapy (p < 0.05), for in-hospital care in general (p < 0.05), as well as for direct cost of care (p < 0.05).Conclusion:The results show the potential that could be made accessible by an early detection of back pain patients who bear a risk of pain becoming chronic, both in terms of quality-of-life as well as in financial terms.

The epidemiology, economic burden, and pharmacological treatment of chronic low back pain in France, Germany, Italy, Spain and the UK: a literature-based review

Objective: This study's objective was to review the literature on the epidemiological and economic burden and treatment of chronic low back pain (CLBP) in France, Germany, Italy, Spain and the UK. Methods: A literature search was conducted for 1997 – 2007, focusing on CLBP burden and treatment in the countries of interest. Results: The literature search yielded 1552 articles; 23 sources were included in this review. General population prevalence estimates for CLBP were available for two countries: 5.91% (Italy) and 6.3 – 11.1% (UK). Resource utilization estimates were available for Germany, Italy, Spain and the UK. Patients visited general practitioners and osteopaths. Annual direct costs of low back pain were available only for Germany: > € 7000 per person. Work absenteeism accounted for 75% of the total per-patient cost of low back pain in Germany. The five identified treatment guidelines recommended a multimodal approach. Recommended pharmacotherapies included NSAIDs, muscle relaxants, analgesics and anesthetics, and opioids. Conclusions: Prevalence estimates varied, possibly owing to differences in diagnostic criteria and populations studied. Little is known about CLBP's economic burden. Treatment guidelines recommended multimodal treatment.

Costs of back pain in Germany

With 12-month prevalence rates of more than 70%, back pain is currently one of the major health problems for German adults and entails major economic consequences. The aim of this study was to estimate back pain-related costs from a societal perspective and to determine the impact of sociodemographic variables on costs. Based on back pain-related survey data of a large German adult sample (9267 respondents, response rate 60%), costs were assessed using a prevalence-based bottom-up approach. Direct costs caused by utilisation of healthcare services, as well as indirect costs due to back pain-related production losses were considered. All prices are expressed in 2005 Euros. Average total back pain costs per patient were estimated to be €1322 (95% CI [1173–1487]) per year. These costs are split between direct (46%) and indirect (54%) costs. Bivariate analysis showed considerable differences in total costs between the Von Korff back pain grades (GCPS Group I: Mean 414.4, 95% CI [333.2–506.3]; II: 783.6 [574.5–1044.4]; III: 3017.2 [2392.9–3708.6]; IV: 7115.7 [5418.5–9006.5]). Male gender, increasing age, single status, low education, unemployment, and increasing back pain grade had a significant positive impact on the cost magnitude in multivariate analysis. Despite several limitations, this study provides important information concerning the relevance of back pain as a health problem and its socioeconomic consequences. The information may be of value for decision-making and allocation of research fund resources.

Is the occurrence of back pain in Germany decreasing? Two regional postal surveys a decade apart

Back pain is often perceived as an epidemic disorder with an ever-increasing prevalence. The objective of this paper is to estimate and compare point and period prevalence rates of back pain from two highly comparable postal surveys, a decade apart within a single regional population in the north of Germany. In 1991/1992 and 2003 two systematic random samples of German residents of Lübeck aged 25-74 years were independently drawn from the municipal population registry. They received a short postal questionnaire with maximally two reminders. All data were directly standardised on the age, sex, and educational distribution of the merged samples. A sharp decrease in response rates from 81% in the early 1990s to 60% in 2003 required complex considerations of non-response bias. Both the overall and gender-specific point and 1 year prevalence rates of back pain remained fairly stable as well as the rate of severe disabling back pain. The overall prevalence (adjusted for age, sex, and education) of 'back pain today' was 39.2% (1991/92) and 38.2% (2003), the 1 year prevalence was 75.3% (1991/92) and 73.8% (2003), and the prevalence of severe pain was 9.9% (1991/92) and 10.2% (2003). The data do not support the widespread public notion of a growing epidemic of back pain in Germany.

Integriertes Orthopädisch-Psychosomatisches Konzept zur medizinischen Rehabilitation von Patienten mit chronischen Schmerzen des Bewegungsapparates - Langfristige Effekte und Nachhaltigkeit eines multimodalen Programmes zur Aktivierung und beruflichen Umorientierung

According to a recent review by Hüppe and Raspe effects of multidisciplinary treatment programs for patients with chronic low back pain in Germany seem to be rather weak and not to have persisting effects. Factors which could counteract possible benefits of treatment are, among others, psychic and job-related stresses and strains persisting after treatment. A multidisciplinary, in-patient treatment program for patients with chronic low back pain, therefore, was amended by multidisciplinary diagnosis and assignment and measures to support vocational solutions. To evaluate the effects of the multidisciplinary program in comparison to a control group with the usual care, a prospective longitudinal study was conducted. 307 patients were assigned to the multidisciplinary in-patient treatment program, whereas 176 patients with comparable complaints had the standard rehabilitation program. Besides the full sample, we analyzed a subgroup of patients with chronic low back pain. We found positive moderate and strong effects in the intervention group concerning function, pain, psychic strains as well as the number of sick days and return to work rates 10 months after discharge. Effects in the intervention group exceeded the effects achieved in the control group. Beside the full sample, we analyzed a subgroup of patients with chronic low back pain, who received an intense activating group treatment. Also in this subgroup we found moderate and strong effects of treatment superior to those in the control group for function, psychic strains and sick days. We attribute these persisting and superior effects in the treatment group to an efficient treatment of occupational and psychic problems as well as to more homogeneous treatment groups attained by a multidisciplinary diagnosis and team-based assignment. They also show the significance of in-patient-treatment which is effective, when -- based on multidisciplinary diagnosis -- differential treatment groups can be formed.

Preaching to the converted: Über- und Unterversorgung in der Schmerzprävention am Beispiel bundesdeutscher Rückenschulen

In response to the growing incidence of back pain, increasing emphasis is being placed on individualized preventive measures. The purpose of the present study was to investigate representative data for back pain, participation rates of back care programs, and their correlates in the German general population. The first National Health Survey was carried out in the Federal Republic of Germany in the period from October 1997 to March 1999. It comprised a representative, cross-sectional study of the population with a total sample of 6235 participants between the ages of 18 and 79. The 7-day prevalence for back pain in Germany was found to be 36%, and 7% of all Germans had participated in a back care program within the past year. The 1-year participation rate was significantly lower in persons with higher risk for back pain (men, full-time workers, unmarried people, and those with an unhealthy lifestyle). The user profile for back care programs indicates that genuine needs are not being met and the target group is not being reached. A "preaching to the converted" phenomenon is evident, as indicated by the fact that the user group is made up of individuals who already have a healthy lifestyle and few risks while the population group most likely to develop back pain is significantly less likely to participate in preventive back care programs.

Chronische Rückenschmerzen in der Allgemeinbevölkerung in Deutschland 2002/2003: Prävalenz und besonders betroffene Bevölkerungsgruppen

Back pain is one of the most common complaints in the general population and chronic back pain is a major Public Health burden. However, the prevalence of chronic back pain in Germany is not known. The aim of our study was to determine the prevalence of chronic back pain in the general adult population in Germany and to identify highly affected population groups. A nation-wide computer-assisted telephone interview (CATI) survey was conducted with 8,318 men and women aged 18 years and older residing in German households. Participants were selected using the Gabler-Häder telephone sampling method and the next-birthday method. The one-year prevalence of chronic back pain defined as daily or almost daily back pain over a period of three months was 16 % in men and 22 % in women, the lifetime prevalence 24 % in men and 30 % in women. The 12-months prevalence of any back pain was 66 % in women and 58 % in men. Back pain on the day preceding the interview was reported by 18 % of men and 27 % of women and had a median intensity on a 1 - 10 point scale of 5 in women and 4 in men. Factors independently associated with chronic back pain in the past 12 months were age, female sex, a history of arthritis, self-reported depression, lower educational level, current unemployment, overweight or obesity, no sports, smoking and living with a partner. In conclusion, chronic back pain is a highly prevalent complaint in the general population in Germany. The association not only with bone and joint diseases but also with depression, a lower level of education and with certain lifestyle behaviours emphasises that back pain should not be viewed only in the context of the spine.