Effects of rehabilitation aftercare on work participation in patients with musculoskeletal disorders: a propensity score-matched analysis.

Meta-analyses of rehabilitation studies in chronic back pain patients in Germany showed a lack of sustainability of rehabilitation programs. The German Pension Insurance therefore developed an intensified aftercare program to support rehabilitation outcomes. The aim of this study was to compare disability pension rates, income from regular employment, and duration of welfare benefits in patients with and without rehabilitation aftercare. We used administrative data on finished rehabilitation services. Patients were included if they were aged 18-60 years, had musculoskeletal disorders, and attended an outpatient or an inpatient rehabilitation program during the first term of 2007. Patients were excluded if they received an old-age pension, started a disability pension before January 2008, or died during the follow-up period. Patients with rehabilitation aftercare were matched by propensity scores with patients without rehabilitation aftercare. Estimation of the propensity score considered 20 potential confounders. There were no differences in the cumulative probability of receiving a disability pension. Moreover, patients with and without aftercare did not differ in their income from regular employment and the duration of different types of welfare benefits during the follow-up period. However, stratified analyses found a positive effect of an aftercare program on income in patients who attended a postacute rehabilitation program and patients who were at least 3 months absent because of sickness during the year preceding the initial rehabilitation program. Only patients with strong impairments benefit from attending an aftercare program. Allocation to aftercare programs and the focus on exercise only have to be reconsidered and revised.