Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 68

Effects of multimodal back exercise
Table IV. BE and ST compared before study start (pre)
Criteria BE ST
Age, years, mean (SD)
Females, %
Education, % 46.6 (12.5)
64.0
  47.6 (12.2)
58.6

18.9 20.9
68.8
1.1
4.7
2.4
4.1

4.3 (2.2)
5.1 (2.0) 67.6
1.0
3.7
3.4
3.4

4.5 (2.6)
4.9 (2.3)
6.9 (2.0)
3.8 (2.3)
86.7 (62.6)
31.3
30.9
24.3
13.5
2.2 (1.0)

3,215 (5,998)
571 (1,686)
2,711 (5,362)
895 (2,760) 6.4 (2.4)
3.7 (2.6)
87.6 (67.5)
35.6
28.9
17.4
18.2
2.2 (1.1)

3,343 (4,329)
564 (1,424)
2,845 (5,323)
967 (3,798)
Secondary school/compl. 10 th grade, no
vocational training
Secondary school/compl. 10 th grade,
vocational training
Abitur without vocational training
Abitur with vocational training
Technical college degree
University degree
Back pain
Current back pain (0–10), mean (SD)
Mean back pain (0–10), mean (SD)
Severest back pain – last half year (0–10),
mean (SD)
Impairment of daily activities (0–10), mean (SD)
Days with pain, mean (SD) – last half year
GCPS 1, %
GCPS 2, %
GCPS 3, %
GCPS 4, %
GCPS, mean (SD)
Medical costs, EUR, mean (SD)
Direct hospital costs
Direct back medical costs
Indirect medical costs
Indirect back medical costs
65
(pre- 35.6%, post- 26.6%), while for BE the reduction
remained approximately unchanged at 56% (Table IX).
Overall, therapeutic effects run ahead of cost-effects,
because the exercise costs are frontloaded during the
intervention year (Fig. 2).
The therapeutic and economic efficacy of back exer-
cise increases with the starting level of the back problem
(GCPS). The interaction time*treatment*GCPS (pre-)
for both the direct medical costs (F 7, 2,316 = 5.096;
p <0.001) and for GCPS (F 7, 1,176 = 94.27; p < 0.001)
is significant (Fig. 3).
Only for grade 4 GCPS do direct medical cost
savings occur and are the exercise programme costs
more than compensated for (Table X). Conversely, for
none of the grades do the BE costs significantly exceed
the ST costs and therapeutic effects of exercising are
achieved across all back pain grades. For the indirect
medical costs (including exercise costs) also, the cost
difference between BE and ST is significant only with
grade 4 (mean –5,076 EUR, 95% CI –8,394 EUR to
–1,757 EUR, p = 0.003). Exercising represents a do-
minant strategy for grade 4 GCPS, since therapeutic
SD: standard deviation.BE: back exercise; ST: standard treatment.
Fig. 2. Therapeutic effects (right: Graded Chronic Pain Status scale (GCPS), pre: before intervention (t0), 1 st year post-: after 1 year (t2), 2 nd year
post- after 2 years (t4)) and economic impacts (left: direct medical cost per insured in EUR/year) of multimodal back exercise (BE) (treatment
groups BE: green; standard treatment (ST): blue). Direct medical costs for all measurement points: BE n  = 1,829, ST n  = 495; GCPS pre-: BE
n  = 1,829; ST n  = 495, 1 st year post-: BE n  = 1,075, ST n  = 276, 2 nd year post-: BE n  = 928, ST n  = 256.
Table V. Calculating the Graded Chronic Pain Status (GCPS) and exemplary study results (mean values) from the pre-measurement
Grade
Grade 0 – no pain***
Back pain
severity *
Calculation from scores Mean (SD)
Pain intensity = 0 and
function impairment = 0
Grade 1 – low pain intensity Function impairment < 3
and pain intensity > 0< 50
Grade 2 – high pain intensity Function impairment < 3
and pain intensity ≥ 50
Grad 3 – moderate
Function impairment
functional impairment
ranks between 3 and 4
Grade 4 – severe functional Function impairment
impairment
ranks between 5 and 6
Impairment of daily Direct medical
activity*
costs (EUR)**
Mean (SD)
Mean (SD) Indirect medical Total sick days/days
costs (EUR)** with back pain**
Mean (SD)
Mean (SD)
– – – – –
3.0 (1.2) 1.9 (1.6) 2,391 (4,329) 1,830 (3,925) 20.0 (42.9)/4.6 (20.8)
5.5 (1.3) 3.4 (1.8) 2,868 (4,629) 2,235 (4,417) 24.4 (48.3)/4.6 (15.5)
5.9 (1.7) 5.0 (1.7) 3,629 (7,677) 2,959 (5,055) 32.3 (55.2)/11.7 (27.7)
7.1 (1.7) 6.8 (1.6) 5,310 (6,093) 5,471 (8,520) 59.7 (92.9)/29.9 (58.4)
*in the past 6 months, 0 to 10 max. pain/impairment. **costs/days within two years pre. ***Not available pre-study. SD: standard deviation.
J Rehabil Med 50, 2018