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Objective: To examine the effect of a case manager–assisted rehabilitation programme as an add-on to usual physical rehabilitation in patients undergoing lumbar spinal fusion. Design: A randomized controlled trial with a two-year follow-up. Settings: Outpatient clinics of a university hospital and a general hospital. Subjects: In total, 82 patients undergoing lumbar spinal fusion. Interventions: The patients were randomized one-to-one to case manager–assisted rehabilitation (case manager group) or no case manager–assisted rehabilitation (control group). Both groups received usual physical rehabilitation. The case manager–assisted rehabilitation programme included a preoperative meeting with a case manager to determine a rehabilitation plan, postsurgical meetings, phone meetings, and voluntary workplace visits or roundtable meetings. Main measures: Primary outcome was the Oswestry Disability Index. Secondary outcomes were back pain, leg pain, and return to work. Results: Of the 41 patients in the case manager group, 49% were men, with the mean age of 46.1 (±8.7 years). In the control group, 51% were male, with the mean age of 47.4 (±8.9 years). No statistically significant between-group differences were found regarding any outcomes. An overall group effect of 4.1 points (95% confidence interval (CI): –1.8; 9.9) was found on the Oswestry Disability Index, favouring the control group. After two years, the relative risk of return to work was 1.18 (95% CI: 0.8; 1.7), favouring the case manager group. Conclusion: The case manager–assisted rehabilitation programme had no effect on the patients’ functional disability or back and leg pain compared to usual physical rehabilitation. The study lacked power to evaluate the impact on return to work.

Objective: To examine the cost-effectiveness of case manager–assisted rehabilitation as an add-on to usual physical rehabilitation after lumbar spinal fusion, given the lack of any clinical benefits found on analysing the clinical data. Design: Economic evaluation alongside a randomized controlled trial with two-year follow-up. Setting: Patients from the outpatient clinics of a university hospital and a general hospital. Subjects: A total of 82 lumbar spinal fusion patients. Interventions: Patients were randomized one-to-one to case manager–assisted rehabilitation programme as an add-on to usual physical rehabilitation or to usual physical rehabilitation. Main measures: Oswestry Disability Index and EuroQol 5-dimension. Danish preference weights were used to estimate quality-adjusted life years. Costs were estimated from micro costing and national registries. Multiple imputation was used to handle missing data. Costs and effects were presented with means (95% confidence interval (CI)). The incremental net benefit was estimated for a range of hypothetical values of willingness to pay per gain in effects. Results: No impact of case manager–assisted rehabilitation on the Oswestry Disability Index or estimate quality-adjusted life years was observed. Intervention cost was Euros 3984 (3468; 4499), which was outweighed by average reductions in inpatient resource use and sickness leave. A cost reduction of Euros 1716 (–16,651; 20,084) was found in the case manager group. Overall, the probability for the case manager–assisted rehabilitation programme being cost-effective did not exceed a probability of 56%, regardless of willingness to pay. Sensitivity analysis did not change the conclusion. Conclusion: This case manager–assisted rehabilitation programme was unlikely to be cost-effective.