Institute for Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany.
J Rehabil Med. 2022 Mar 22;54:jrm00274. doi: 10.2340/jrm.v53.1408.
Longitudinal studies on barriers to applying for rehabilitation in Germany are lacking in light of the suspected underutilization of rehabilitation services. The aim of this study was to examine application behaviour in persons with disabling back pain and to identify relevant predictors for making an application.
A prospective cohort study with randomized sampling of insurants in the German Pension Insurance, using a questionnaire at baseline and follow-up with linked administrative data for 1.5 years.
SUBJECTS/PATIENTS: Employed persons (age range 45-59 years) with a high degree of limitations due to back pain and a self-reported risk of permanent work disability (not applied for disability pension, no medical rehabilitation within the last 4 years).
Multivariable Cox regression was used to examine the influence of pre-selected variables on making an application in the follow-up period.
Of 690 persons, only 12% applied for rehabilitation. Predictors for making an application were: support from physicians (hazard ratio (HR)=2.24; 95% confidence interval (95% CI) 1.32-3.80), family, and friends (HR=1.67; 95% CI 1.02-2.73), more pain-related disability days (HR=1.02; 95% CI 1.01-1.03), and worse work ability (HR=0.86; 95% CI 0.75-0.97). An intention to apply at baseline mediated the effect of family and physician support on the application.
The low number of applications for rehabilitation despite disabling back pain indicates access barriers to, and underuse of, medical rehabilitation.
鉴于康复服务的疑似利用率不足，德国缺乏有关申请康复障碍的纵向研究。本研究的目的是研究有残疾腰痛的人的申请行为，并确定申请的相关预测因素。
一项前瞻性队列研究，对德国养老保险的参保人进行随机抽样，在基线和随访时使用问卷，并对 1.5 年进行链接的行政数据。
受试者/患者：因腰痛而高度受限且有永久性工作残疾风险的就业人员（年龄在 45-59 岁之间，过去 4 年内未申请残疾养恤金，未接受过医疗康复）。
使用多变量 Cox 回归分析，考察预先选择的变量对随访期间申请的影响。
在 690 人中，只有 12%的人申请了康复。申请康复的预测因素为：医生的支持（风险比（HR）=2.24；95%置信区间（95%CI）为 1.32-3.80）、家人和朋友的支持（HR=1.67；95%CI 为 1.02-2.73）、更多与疼痛相关的残疾天数（HR=1.02；95%CI 为 1.01-1.03）和更差的工作能力（HR=0.86；95%CI 为 0.75-0.97）。基线时的申请意向部分中介了家庭和医生支持对申请的影响。
尽管有残疾腰痛，但康复申请的数量很少，这表明医疗康复的准入障碍和利用率不足。
