[Comparison of three outpatient therapy forms for treatment of chronic low back pain-- findings of a multicentre, cluster randomized study]

Abstract

The AOK Baden-Württemberg health insurance fund initiated a study on the outpatient rehabilitation of patients with chronic low back pain, aimed at improving the treatment concept for its insurees with chronic low back pain (START). This model project was scientifically guided by the Hochrhein-Institute in Bad Säckingen. The paper compares the effectiveness of Enhanced Outpatient Physiotherapy (Erweiterte Ambulante Physiotherapie, EAP), Outpatient Rehabilitation (Ambulante Rehabilitation, AR) and Medical Training Therapy (Medizinische Trainingstherapie, MTT) in patients with low back pain. In seven regions in Baden-Württemberg, one of these three intervention forms was provided to the patients. A total of 1,274 patients were included in the study. The AOK Baden-Württemberg patients receiving treatment in one of the three intervention forms were seriously restricted in both the physical dimension of their health status and in their physical mobility in everyday life and at the workplace. Besides, they frequently reported considerable psychosocial strain. The three interventions led to significant and relevant decreases in pain intensity and to an improved health-related quality of life. There were no significant differences between the various treatments in terms of effectiveness. The patients shared an equally high satisfaction with the treatment received. In MTT, the total therapy length of 15 weeks was by far longer than in AR and EAP (about 5 and 8 weeks). Unlike AR and, in parts, EAP, patients may continue to work while participating in MTT. Therefore an immediate therapy start within a week was more likely possible in MTT (59 %) than in AR (10 %) or EAP (23 %). In evaluating the results a number of restrictions have to be considered. Nevertheless, based on our research findings, the following can be concluded: MTT is a suitable therapy concept in patients with low back pain characterized by a rapid start and-- compared to the other two concepts-- by lower therapy costs. MTT might represent a meaningful therapy element also in new forms of provision such as integrated services. Patients showing severe psychosocial strain should be assigned to an interdisciplinary therapy as it is provided by inpatient and outpatient rehabilitation facilities. For effective differential assignment to the various programmes, realization of a standardized rehab assessment is an important precondition.