Barriers to applying for medical rehabilitation: a time-to-event analysis of employees with severe back pain in Germany.
Julia-Marie Zimmer, David Fauser, André Golla and 4 others
PMID 35019995WHAT IT FOUND
Only 81 of 690 employees with disabling back pain had an approved rehabilitation application over a mean 580 days.
Intention to apply, physician support and more disability days were associated with applications; household strain was associated with fewer.
Key findings
01Only 81 of 690 employees with disabling back pain had an approved rehabilitation application during a mean 580 day follow-up.
02Intention to apply, physician support and more disability days were associated with a higher chance of application, while higher household work strain and a better work ability score were associated with a lower chance.
03Family and friends' support appeared to work mainly through forming an intention to apply, while physician support also had a direct association.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is an observational cohort, so it cannot show that any factor caused an application. The outcome was only an approved application, not whether rehabilitation was needed, effective or completed. Denied applications were excluded because their diagnoses were not recorded. Listwise deletion reduced the number of cases available for the regression models by 10%. Several variables could not be tested in the main model because they did not meet the model's statistical assumption. The application process is specific to the German pension and rehabilitation system, although the analysed factors are mainly individual. The sample was selected for severe limiting back pain and risk of permanent work disability, so it says little about milder back pain.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that physician encouragement or a rehabilitation application improves health. It is an observational study of applications, and the low application rate could reflect barriers, other treatment effects, or the German system rather than a treatment effect.