Untersuchungen zur Optimierung der Zuweisung von Patienten zur stationären klassisch-orthopädischen oder verhaltensmedizinisch-orthopädischen Rehabilitation

Chronic low back pain has become a health care problem of considerable importance. It is one of the most disabling causes of long-term disability in Western Europe. In Germany, patients with chronic orthopedic diseases are assigned to either traditional or behavior-medical rehabilitation by consultant physicians of the rehabilitation department within the Deutsche Rentenversicherung Bund (German annuity insurance association). Within a randomized controlled trial, we evaluated the clinical relevance of this assignment at the Rehazentrum Bad Pyrmont - Klinik Weser. In a sample of 363 patients, we found the procedure applied so far for assigning patients to either traditional or multidisciplinary rehabilitation is not sufficiently valid. As psychiatric comorbidity frequently is taken into consideration as a decision-making criterion within the assignment, we further examined whether orthopedic patients with versus without a psychiatric comorbidity profit from rehabilitation in the same degree. Within traditional or behavior-medical rehabilitation, we also investigated whether there are differential treatment effects. In some aspects, patients with a mental disorder benefited more from the treatment than patients without psychiatric comorbidity. Differential treatment effects were found only in patients with a mental disorder; their improvements were higher in behavior-medical than in traditional rehabilitation. Since psychiatric comorbidity as a single criterion would be too poor, we therefore tried to find more objective criteria for improving the assignment of patients. We found sick leave days prior to treatment to be an approach-specific predictor for outcome in traditional rehabilitation, whereas general self-efficacy was an approach-specific predictor for behavior-medical rehabilitation. In general, the previous procedure of assigning patients to either traditional or behavior-medical rehabilitation is not sufficiently valid so far. The results of this work indicate that it might be reasonable to assign people with longer sick-leave days and patients with a comorbid mental disorder to behavior-medical rehabilitation. People with low self-efficacy should be assigned to traditional rehabilitation. Further implications of the findings are discussed. Since lots of our results are based on correlational data, further research is necessary to improve the assignment of orthopedic patients.