Rehabilitation access and effectiveness cohort study for persons with back pain (REHAB-BP)

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In cases of limited work ability or when work ability is at risk, people can apply for medical rehabilitation services. The German Pension Insurance provides these services with the aim of improving or restoring the ability to work. Musculoskeletal disease, especially back pain, is the main reason for medical rehabilitation. The appropriate access to rehabilitation according the actual needs of patients is currently under critical discussion. Frequently, the need for rehabilitation does not lead to a rehabilitation request. Despite the maxim 'rehabilitation before pension', every second person who receives a disability pension did not participate in rehabilitation services before the pension was granted. However, there are no up-to-date studies that have examined rehabilitation barriers. Moreover, randomised controlled trials that compared persons with and without rehabilitation participation have generated contradictory findings regarding the efficacy of medical rehabilitation. However, the setting of these studies was restricted to single centres or particular regions. There is currently no evidence on the effectiveness of rehabilitation services under routine conditions. The aim of our cohort study is twofold: first, to address barriers to the access to medical rehabilitation services in Germany, and second, to examine the effectiveness of German medical rehabilitation services by a propensity score matched analysis (Rehabilitation access and effectiveness cohort study for persons with back pain, REHAB-BP). The samples will be drawn from the registers of two pension insurance agencies (German Pension Insurance North: n = 22,500; German Pension Insurance Central Germany: n = 22,500). We will include employed people aged 45 to 59 years (stratified for sex and duration of sickness benefits). Persons who requested or utilised medical rehabilitation services during the past four years and persons with requested or approved disability pensions will be excluded. The baseline survey will be conducted in 2016. The questionnaire will assess the three-month prevalence of back pain, and will include a grading of pain severity and chronicity (level 0, grades I to IV). Furthermore, potential barriers to rehabilitation utilisation as well as the baseline scores of primary and secondary outcomes will be assessed. Utilisation of medical rehabilitation in 2016 and 2017 will be extracted from administrative data from the cooperating pension insurance agencies. A follow-up survey will be sent to back pain patients (grades I to IV; n = 5,760) in 2018 in order to evaluate the effects of rehabilitation utilisation (primary outcome: pain disability; secondary outcomes: e.g. pain intensity, disability days, work ability). Additionally, secondary outcomes will be extracted from administrative data (days with sickness benefits, days in employment subject to compulsory social insurance, disability pensions).