Zugangsbarrieren zu und Wirksamkeit medizinischer Rehabilitation bei Rückenschmerz: Aktueller Stand einer Kohortenstudie mit Versicherten der Deutschen Rentenversicherung Nord und Mitteldeutschland

Background Musculoskeletal disorders, especially chronic back pain, are the second most common reason for disability pensions in Germany. However, despite the principle Rehabilitation before pension, only half of the persons receiving a disability pension because of back pain had previously participated in a medical rehabilitation programme. This may indicate an underutilization of rehabilitation services and raises the question which barriers affect access to rehabilitation services. However, studies on barriers for using medical rehabilitation are rare. Furthermore, it is not clear that a preceding rehabilitation would have prevented the disability leading to a pension, as the few analyses of the effectiveness of medical rehabilitation due to back pain in Germany showed inconclusive results so far. Research goals The present study has 2 major goals: First, to analyze the barriers to using rehabilitation services for persons with back pain, and second, to examine the effectiveness of medical rehabilitation in the population reached. Methods For this prospective observational study, a random sample of 45,000 persons was drawn equally from the registers of the German Pension Insurance (GPI) North and the GPI Central Germany. Inclusion criteria men and women aged 45-59 years, currently employed, neither utilization of rehabilitation services during the last 4 years nor application for a disability pension ever before. After the first survey in 2017 (t1), only respondents with reported back pain in t1 will be sent a second questionnaire in 2019 (t2). The questionnaire data will be linked with the administrative data of the GPI (i. e., application and utilization of rehabilitation services, application of disability pensions, and days with sickness absence benefits). To examine the effectiveness of rehabilitation services, propensity score matched samples of rehabilitation participants and non-participants will be compared at t2. Current state The first survey is completed. Currently, the questionnaire data is prepared for identifying persons with back pain for the follow-up survey and for linking them to the administrative data of the GPI. Conclusions This cohort study prospectively identifies barriers to using medical rehabilitation services for persons with back pain, and provides results on the effectiveness of these services in this target group. The findings may improve the evidence-based treatment of persons with back pain in Germany.