Abstract
Background: To facilitate access to evidence-based care for back pain, a German private medical insurance offered a health program proactively to their members. Feasibility and long-term efficacy of this approach were evaluated. Methods: Using Zelen's design, adult members of the health insurance with chronic back pain according to billing data were randomized to the intervention (IG) or the control group (CG). Participants allocated to the IG were invited to participate in the comprehensive health program comprising medical exercise therapy and life style coaching, and those allocated to the CG to a longitudinal back pain survey. Primary outcomes were back pain severity (Korff's Chronic Pain Grade Questionnaire) as well as health-related quality of life (SF-12) assessed by identical online questionnaires at baseline and 2-year follow-up in both study arms. In addition to analyses of covariance, a subgroup analysis explored the heterogeneity of treatment effects among different risks of back pain chronification (STarT Back Tool). Results: Out of 3462 persons selected, randomized and thereafter contacted, 552 agreed to participate. At the 24-month follow-up, data on 189 of 258 (73.3%) of the IG were available, in the CG on 255 of 294 (86.7%). Significant, small beneficial effects were seen in primary outcomes: Compared to the CG, the IG reported less disability (1.6 vs 2.0; p = 0.025; d = 0.24) and scored better at the SF-12 physical health scale (43.3 vs 41.0; p < 0.007; d = 0.26). No effect was seen in back pain intensity and in the SF-12 mental health scale. Persons with medium or high risk of back pain chronification at baseline responded better to the health program in all primary outcomes than the subgroup with low risk at baseline. Conclusions: After 2 years, the proactive health program resulted in small positive long-term improvements. Using risk screening prior to inclusion in the health program might increase the percentage of participants deriving benefits from it.
| Original language | English |
|---|---|
| Article number | 714 |
| Journal | BMC Health Services Research |
| Volume | 19 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 21.10.2019 |
Funding
This study is contract research funded by the German Private Health Insurance Central, a member of the Generali Group. Central payed a grant for the scientific evaluation of the initiative.back by the researchers of the university of Lübeck. The funders took over the case identification of the eligible persons, the invitation to participate in the evaluation study as well as the organization of the health program activities in the intervention group. The funders did not have access to the patient related outcomes and were not involved in the data collection or evaluation.
Research Areas and Centers
- Research Area: Center for Population Medicine and Public Health (ZBV)
