General Practitioner Centered Rehabilitation Aftercare for Chronic Back Pain

Abstract

Background Back pain is one of the most common and costly health disorders in Germany. Rehabilitation measures for back pain often show a lack of long-term effects after rehabilitation treatment. The Neues Credo aftercare concept has proven to be promising in increasing the long-term effects. In the current study, it was piloted and evaluated in general practitioners' practices. Methods A prospective observational study was carried out. Nine orthopedic rehabilitation clinics and N=178 general practitioners were involved in the aftercare. The intervention was evaluated by means of written surveys of 85 rehabilitation patients with chronic back pain at 3 points in time. The outcomes were functional capacity and participation; the secondary outcomes were subjective health and physical activity. The long-term effects were evaluated by analyses of variance with repeated measurements. Results At the end of the rehabilitation, the main outcome functional capacity shows a significant improvement of small magnitude, all secondary outcomes show significant medium to large effects. During the follow-up period, the participants were able to significantly increase their physical activity. Especially with respect to endurance training and workout. Twelve months after rehabilitation, significant improvements can still be seen in all outcomes. The range of parameters describing effect size are below the usual thresholds for clinically important changes. Conclusion Rehabilitation aftercare like the program Neues Credo shows similar lasting effects when supported by the general practitioner instead of the rehabilitation clinic. The successes decrease somewhat 12 months after the rehabilitation, but we still see significant differences in all outcomes compared to baseline. There is a high satisfaction with the program by rehabilitants and general practitioners. Since general practitioners are the first contact after rehabilitation a transfer of the program into routine care would be promising.