[Can routine data on in-patient rehabilitation of musculoskeletal diseases replace the physicians' judgement in quality management? --an investigation on 12,014 observations]. / Ist das arztliche Urteil in der Qualitätssicherung stationärer Rehabilitation bei Patienten mit Erkran- kungen des Bewegungs- apparates durch Routine- parameter zu ersetzen? Eine Untersuchung an 12 014 Beobachtungen.

The acceptance of quality management is strongly influenced by the additional work-load necessary to obtain data. "Quality management questionnaire? Do we really need it? In rehabilitation, we must deliver a long and detailed discharge report anyway...". This frequent comment from the physician side has prompted us to investigate whether compilation of quality-management questionnaires really provides new information, or if a prediction model (for example similar to that predicting early retirement based on routine data in a discharge report) could be used to replace the physician judgement. If the prediction accuracy of the model is sufficiently high, the compilation of quality-management questionnaires might become obsolete, sparing the paperwork load of the physician. A central issue in the quality-management system of the LVA Baden-Wuerttemberg (a regional pension insurance institute) is the mutual agreement on a certain rehabilitation goal by patient and physician at the beginning of therapy. At the end of the rehabilitation program, the achievement of the goal is discussed with the patient in a discharge interview. In addition, patient and physician fill out a structured questionnaire with specification on three rehabilitation dimensions (WHO standard ICF: Body function and structure, activity, and participation). However, the results of multivariate modelling of 10 routinely observed parameters on more than 12,000 observations in patients with musculoskeletal diseases demonstrate that the agreement between the prediction model and the physician judgement of rehabilitation success is far away from optimal values. Thus, in this case the physician judgement can not be replaced by a forecast model solely based on routine data. Accordingly, the evaluation of rehabilitation success within the framework of a quality-management system based on currently valid standards must directly rely on the physician judgement.

A German version of the Extended Aberdeen Back Pain Scale: development and evaluation.

STUDY DESIGN: Psychometric testing of translated, culturally adapted questionnaire. OBJECTIVES: Cross-cultural adaptation of the German version of the Extended Aberdeen Back Pain Scale (EABPS, three questionnaires), and to evaluate its use for assessing back pain related health status and disability in German patients. SUMMARY OF BACKGROUND DATA: The EABPS can be used as one questionnaire for the whole spine or three questionnaires for the three parts of the spine: neck, upper back, and lower back. It was shown to be valid, reliable, and responsive. No German version was available. METHODS: The EABPS was translated and adapted. The three questionnaires were evaluated separately. A total of 158 outpatients with neck pain, upper back pain, and/or low back pain were assessed by the EABPS-G at admission, 148 patients 1 day later for retest. For testing responsiveness, the standardized response mean (SRM) was chosen and for criterion validity a generic and cLBP-specific measure (SF-36 and FFbH-R). RESULTS: Between the first and second questionnaire, high correlations (from 0.93 to 0.95) represent a very high level of test-retest reliability. Criterion validity showed high (negative) correlations between the questionnaires for the three spinal areas on the one side and the FFbH-R and the SF-36 on the other. The SRM for the three questionnaires indicated remarkable changes ranging from 1.36 to 1.96. CONCLUSIONS: The EABPS-G is a valid, reliable, and responsive questionnaire for assessing health status and disability influenced by pain in one or more area of the spine and allows intercultural comparisons with the original English version. It could be used for assessment of current state as well as measurement for change.

Effectiveness and cost-effectiveness of adding a cognitive behavioral treatment to the rehabilitation of chronic low back pain.

OBJECTIVE: To investigate return to work and cost-effectiveness of the addition of cognitive-behavioral treatment to standard therapy compared to standard 3-week inpatient rehabilitation for patients with chronic low back pain. METHODS: A prospective economic evaluation alongside a randomized controlled trial was performed. Outcomes included days off work due to spinal complaints, health-related quality of life, and direct and indirect disease-related costs. RESULTS: A total of 409 patients with chronic low back pain, who were admitted to a 3-week inpatient rehabilitation, were randomly assigned to usual care or usual care plus cognitive behavioral treatment. Average incremental costs for psychological treatment during rehabilitation were Euros 127 (95% CI 125.6, 130.9; p < 0.001). Six months after rehabilitation, patients in the intervention group were absent from work an average of 5.4 (95% CI -1.4, 12.1; p = 0.12) days less than patients receiving usual treatment. Between groups, there were no significant differences in quality-adjusted life-years gained or in direct medical or nonmedical costs. The cognitive behavioral treatment showed lower indirect costs: Euros 751 (95% CI -145, 1641; p = 0.097). CONCLUSION: Adding a cognitive behavioral component to standard therapy may reduce work days lost and thus decrease indirect costs. From a societal perspective, the cost of the psychological treatment was compensated by lower indirect costs.