Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 64
J Rehabil Med 2019; 51: 61–70
ORIGINAL REPORT
THERAPEUTIC AND ECONOMIC EFFECTS OF MULTIMODAL BACK EXERCISE: A
CONTROLLED MULTICENTRE STUDY
Gerhard MÜLLER, PhD 1 , Manuela PFINDER, PhD 2,3 , Michael CLEMENT, Dipl. 3 , Andreas KAISERAUER, Dipl. 3 , Guido DEIS,
Dipl. 4 , Timm WABER, MSc, MA 5 , Stefanie RIEGER 6 , Dana SCHWARZ, Dipl. FH 6 , Monika HEINZEL-GUTENBRUNNER,
PhD 7 , Michael STRAIF, PhD 8 , Klaus BÖS, PhD 9 and Thomas KOHLMANN, PhD 10
From the 1 Department of Product Management, AOK Baden-Wuerttemberg, Bruchsal, 2 Department of General Practice and Health
Services Research, Heidelberg University Hospital, Heidelberg, 3 Department of Health Promotion/Occupational Health Management, AOK
Baden-Wuerttemberg, Stuttgart, 4 Department of Health Promotion, AOK-Baden-Wuerttemberg, Heidenheim, 5 Department of Health
Promotion, AOK-Baden-Wuerttemberg, Ulm, 6 Business Unit 5 – Servicemanagement, ITSCare – ITServices for the Health Care Market
GbR, Stuttgart, 7 MH Statistics Consulting, Marburg, Germany, 8 Business Analytics BI plus GmbH, Vienna, Austria, 9 Institute for Sport
and Sport Science, Karlsruhe Institute of Technology, Karlsruhe, and 10 Methods in Community Medicine, Ernst-Moritz-Arndt-University
Greifswald, Greifswald, Germany
Objective: To compare the cost-effectiveness of a
multimodal back exercise programme for non-speci-
fic back pain with that of standard treatment. Medi-
cal costs were measured in euros (EUR) and effec-
tiveness was measured using Graded Chronic Pain
Status (GCPS).
Design: A controlled multicentre study (39 sites)
with a 6-month intervention phase and follow-up at
6, 12 and 18 months.
Subjects: The study included 1,829 participants in an
intervention group and 495 individuals in a control
group.
Methods: The multimodal back exercise programme
comprises 36 exercise sessions for optimizing the
spine stabilizing muscles and everyday motor func
tions. The patients were given a home training pro-
gramme at the end of the intervention programme.
Results: The back exercise programme resulted in
a significant reduction, of 0.4, in back pain grade
on the GCPS after 2 years, compared with standard
treatment, and reduced medical costs by 763 EUR.
The exercise programme was therapeutically effecti-
ve for GCPS back pain grades 1–4 and produced cost
savings in the case of grade 4 GCPS.
Conclusion: The multimodal back exercise program-
me was therapeutically effective for back pain (gra-
des 1–2) and pain-related functional impairment
(grades 3–4). It resulted in reduced costs for chro-
nic back pain causing high pain-induced functional
impairment (grade 4). The therapeutic and econo-
mic effects of the programme increase with the gra-
de of back pain.
Key words: cost-benefit analysis; back pain; exercise.
Accepted Sep 18, 2018; Epub ahead of print Nov 8, 2018
J Rehabil Med 2019; 51: 61–70
Correspondence address: Gerhard Müller, Department of Product Ma-
nagement, AOK Baden-Wuerttemberg, Bahnhofstrasse 12, DE-76646
Bruchsal, Germany. E-mail: [email protected]
B
ack pain is the cause of more years lived with
disability (YLDs) than any other disorder (1).
LAY ABSTRACT
This study compared the cost-effectiveness of a back
exercise programme for different levels of back pain
with standard treatment. The back exercise programme
resulted in a reduction in back pain after 2 years com-
pared with standard treatment. Moreover, the exercise
programme resulted in reduced medical costs. The back
exercise programme was found to be therapeutically ef-
fective and cost-efficient. The therapeutic and econo-
mic effects of the programme increased with severity
of back pain.
With a monthly prevalence of 23% worldwide (2)
and a lifetime prevalence in Western industrial nations
exceeding 70% (3, 4), back pain incurs high direct and
indirect medical costs (5–7).
In 80–90% of cases, back pain progresses favour
ably, and patients return to work within 6–8 weeks.
Sixty percent of patients are pain free within the first
4 weeks. The 8–10% of patients who develop chronic
back pain significantly increase the direct and indi-
rect costs (8, 9). The high socioeconomic importance
of back pain contrasts noticeably with a lack of
knowledge about the cost-effectiveness of different
interventions, and it does so against a background of
tightening healthcare resources. Exercise is one of
the interventions viewed as effective against chronic
back pain. However, what we know about it is very
general in nature: no one type of exercise is regarded
as superior (10). Despite years of research, we do not
yet know which exercise to favour, with how many
exercise sessions, and with what intensity. Specifically,
we do not know if the therapeutic and economic effects
also vary with the severity of the back problem (11).
AOK Baden-Wuerttemberg, a major German sta-
tutory health insurer, since 2005 has provided insured
individuals who experience back pain with a multimo-
dal (strength/mobility and ergonomic) back exercise
programme. Approximately 30,000 patients enrol in
this programme annually. The goal of the present study
was to determine how the benefit from this exercise
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977
doi: 10.2340/16501977-2497