TY  - JOUR
A1  - Hüppe, Angelika
A1  - Zeuner, Christel
A1  - Karstens, Sven
A1  - Hochheim, Martin
A1  - Wunderlich, Max
A1  - Raspe, Heiner
T1  - Feasibility and long-term efficacy of a proactive health program in the treatment of chronic back pain: A randomized controlled trial
T2  - BMC Health Services Research
N2  - 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.
KW  - Rückenschmerz
KW  - Gesundheitswesen
KW  - Forschung
KW  - back pain
KW  - health services research
KW  - evaluation
KW  - patient-reported outcomes
Y1  - 2019
UR  - https://hst.opus.hbz-nrw.de/frontdoor/index/index/docId/132
UR  - https://nbn-resolving.org/urn:nbn:de:hbz:tr5-1321
VL  - 19
SP  - 1
EP  - 13
PB  - BMC
ER  -