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

在工作能力有限或工作能力受到威胁的情况下，人们可以申请医疗康复服务。德国养老金保险提供这些服务，目的是改善或恢复工作能力。肌肉骨骼疾病，特别是背部疼痛，是医疗康复的主要原因。根据患者的实际需要适当地获得康复服务目前正在进行关键的讨论。通常，康复的需要不会导致康复请求。尽管有“先康复后领取养老金”的格言，但每两个领取残疾养恤金的人在养老金发放前并未参加康复服务。然而，目前还没有研究过康复障碍的最新研究。此外，对参与康复和不参与康复的人进行比较的随机对照试验，在医疗康复的效果方面得出了相互矛盾的结论。然而，这些研究的背景仅限于单一中心或特定区域。目前没有证据表明在常规情况下康复服务的有效性。我们队列研究的目的有两个：第一，解决德国获得医疗康复服务的障碍，第二，通过倾向得分匹配分析(针对背痛患者的康复机会和有效性队列研究，rehab-BP)来检查德国医疗康复服务的有效性。样本将从两家养老保险机构的登记簿中抽取(德国北方养老保险公司：n=22,500人；德国中部养老保险公司：n=22,500人)。我们将包括45岁至59岁的就业人员(按性别和疾病津贴期限分层)。在过去四年内要求或使用医疗康复服务的人以及要求或批准领取伤残抚恤金的人将被排除在外。基准调查将于2016年进行。该问卷将评估三个月来背部疼痛的患病率，并将包括疼痛严重程度和慢性程度的分级(0级，I至IV级)。此外，还将评估康复利用的潜在障碍以及主要和次要结果的基线分数。2016年和2017年医疗康复的使用情况将从合作的养老保险机构的行政数据中提取。2018年将向背痛患者(I级至IV级；n=5,760人)发送一份跟踪调查，以评估康复使用的效果(主要结果：疼痛残疾；次要结果：例如疼痛强度、残疾天数、工作能力)。此外，次要结果将从行政数据中提取(领取疾病津贴的天数、必须缴纳强制性社会保险的就业天数、残疾养老金)。

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).