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Background: Second opinion (SO) on spine surgery was recently implemented as a statutory right in Germany. Prior to this, one health insurer did offer SO to its policy holders including advice on additional conservative treatment options., Objectives: Which treatment recommendations did 522 patients receive in an interdisciplinary multimodal assessment (IMA) as part of a SO by 4 teams comprising physician, physio- and psychotherapist and what were the long-term consequences?, Methods: Second opinions under a selective contract between insurer and back pain centers were evaluated based on patient-related anamnesis and interdisciplinary multimodal clinical findings including treatment recommendations and patient reports after about 2 years., Results: Initially, spine surgery recommendation was confirmed in 15/522 (2.9%) patients (C-SS) versus 507 recommendations against. C‑SS patients were older, male, and had current high pain intensity more frequently, their well-being and quality of life were more often considerably impaired and from the perspective of the team morphological findings were stronger. Younger and female patients with higher pain grade and less previous surgery, but more visits to medical specialties received more often a recommendation of an interdisciplinary treatment option (ITO) versus standard care (SC). After 2 years, all 15 C-SS patients and 146 randomly selected patients were contacted. Of these 161 patients, 29 (18%) had undergone spine surgery. The long-term outcome was best in ITO patients without surgery, followed by the C‑SS after surgery and SC patients without surgery., Discussion: Most patients undergoing spine surgery make their decision based on the information that they are provided without requesting a SO. As in comparative studies, most patients with a confirmed surgical indication underwent surgery, while some did not. Some patients underwent surgery inspite of recommendations against-after considering conservative therapy recommendations by the IMA. In retrospect, sound advice and an intensive conservative therapy offer seem necessary and reasonable., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: There is no evidence of effectiveness for interdisciplinary second opinion procedures (ISOP) for recommended back surgery (BS). Since 2015, AOK Nordost has been offering the care program RückenSPEZIAL comprising a preliminary examination, ISOP, and optional interdisciplinary multimodal pain therapy (IMPT). The objective of this study is to determine the effectiveness of RückenSPEZIAL to reduce BS and back pain-related costs (BPRC) compared to patients who likewise received a recommendation for back surgery but not RückenSPEZIAL., Methods: Insured persons in the AOK Nordost consulted the AOK service center, presented a BS hospital admission slip and received advice to participate in RückenSPEZIAL. Following a 1:1 "matched pairs" selection, patients who participated in RückenSPEZIAL (intervention group [IG]) after this consultation (reference date) where compared with patients who did not participate after this consultation (comparison group [CG]). Patient characteristics, BS and BPRC were operationalised from AOK Nordost claims data., Results: Of 108 IG patients and 108 CG patients, 34 (42%) fewer IG patients had one or more BS in 365 following days (relative risk [RR] 0.58; p < 0.001). The subgroup analysis showed for 21 IG patients with ISOP and IMPT an RR of 0.13 (p < 0.001), and for 67 IG patients with solely ISOP without IMPT an RR of 0.59 (p < 0.001). The increase in RBC from the previous year to the following year was 50.2 percentage points lower for IG patients compared to CG patients (p = 0.088)., Discussion: The differences in BS were significant (p < 0.05) and in favor of RückenSPEZIAL. For the specific population it can be expected that mainly savings on BS can cover the intervention costs of RückenSPEZIAL (approximately significant, small case number). Bias due to self-selection needs to be assumed., (© 2022. The Author(s).)

Background: Back pain is prevalent in the population, sometimes recurrent and may result in everyday and work disabilities. It is often a reason for seeking healthcare support. Analyzing the need of treatment and chronification-risk tailored intervention is a particular demand in healthcare delivery., Objectives: Reducing downstream consequences of back pain (e. g. pain and disability) by using an interdisciplinary multimodal assessment followed by a risk-tailored intervention., Methods: Patients with back pain (n = 1638) underwent assessments based on the German Pain Questionnaire (GPQ) and the diagnostic assessment each by a team comprising a physician, a psychologist and a physiotherapist. They were assessed answering a follow-up questionnaire after 6 and/or 12 months (n = 832) for success criteria sensitive to change as pain, everyday and work disability., Results: Patients had on average 62.5 days of work disability and 53.3% had pain up to one year. After assessment, 1447 patients (88.3%) were assigned to receive an intensive interdisciplinary multimodal back pain intervention. Intervention groups were: 120 h of full-time treatment for 4 weeks (n = 1030) or 60 h (n = 224), 48 h part time treatment for 3 months (n = 87), and in-patient hospital treatment for about 17 days (n = 106). The effect sizes of success criteria were large to very large in all treatment groups., Conclusions: Tailored, interdisciplinary and intensive intervention is effective in reducing downstream consequences of back pain. The treatment assignment was based on patient reports (GPQ score) and multidisciplinary assessments (clinical evidence score). Tailored interventions should include sufficient intensity for highly disabled patients. Care integration such as timely communication between the health insurance system, back pain centers and usual healthcare services as well as patient- and process-related documentation are crucial for this intervention.

Background: Persons insured by AOK Nordost statutory health insurance (SHI) and on sick leave underwent a 20-day program of interdisciplinary multimodal pain therapy (IMST) following an initial assessment (IA). We evaluated its effectiveness regarding sick leave, utilization/costs of SHI services, and patient-reported characteristics of pain., Materials and Methods: Participants with >14 days of IMST in 2013-2015 and with data necessary for comparison (intervention group, IG) were matched 1:1 in 2 steps. From AOK Nordost data, we identified a comparison group (CG) having characteristics matching exactly and by propensity score. Starting on the IA (IG) or a comparable reference day (CG), we analyzed utilization/costs of services related to back pain for 365 days. Participants' characteristics of pain were surveyed on the IA day and within 183-365 days., Results: The 86 IG patients had on average 44.33 (median 12) days of sick leave less than the CG after their initial sick leave starting at the IA (significant, p <0.05). Fewer IG patients had ≥1 hospitalization (OR 0.33; 95%CI 0.12-0.88), ≥1 prescription of physiotherapy (OR 0.35; 95%CI 0.24-0.82), and ≥1 specialist visit (OR 0.39; 95%CI 0.10-0.52) related to back pain. More IG patients had "lasting absence of treatment" (OR 4.06; 95%CI 1.09-15.1). Follow-up interviews were available for 56 IG patients, showing less pain intensity, impairment by pain, and pain severity (significant). Regarding the SHI perspective, cost savings per patient nearly covered the IA and IMST costs., Discussion: For a selected comparable population treated by protocol, IA and IMST was associated with reduction or "lasting absence" of treatment, pain relief, and major savings on sickness benefits. Other than in previous studies we found coverage of IA and IMST costs without consideration of productivity loss.

Background and Purpose: Previous stroke performance measures consider aspects of postacute treatment, but there are only few specific quality indicators or standards for poststroke rehabilitation. The purpose of this study was to develop a set of indicators for measuring the quality of postacute stroke rehabilitation in inpatient and outpatient facilities using a standardized evidence-based approach., Methods: Quality indicators were developed between January 2009 and February 2010 by an interdisciplinary board of healthcare professionals from rehabilitation centers cooperating in the Berlin Stroke Alliance. The Berlin Stroke Alliance is a regional network of >40 providers of acute treatment, rehabilitation, and aftercare aiming to improve stroke services within Berlin and Brandenburg. The indicators were developed according to published international recommendations and predefined methodological requirements. The applied standards included a systematic literature review, a rating of published evidence, an external peer review, and the evaluation in a pilot study before implementation., Results: Of an initial list of 33 indicators, 20 indicators were rated as being appropriate. After completion of the pilot phase, we agreed on a set of 18 indicators. The indicators measure processes (9 indicators), outcomes (5 indicators), and structures (4 indicators) in the following domains of stroke rehabilitation: completion of diagnostics; secondary prevention; cognition and affect; speech and swallowing; management of complications; sensorimotor functions and mobility; discharge status; and aftercare., Conclusions: Documentation of evidence-based quality indicators for stroke rehabilitation in clinical routine is feasible and can serve as a first step toward implementing standardized cross-institutional quality assurance programs for stroke rehabilitation.

Introduction: The results of conventional chronic back pain therapy are unsatisfactory. Deconditioning, psychosocial disorders and prolonged disability are common sequelae., Material and Methods: The health insurance fund Deutsche Angestellten Krankenkasse (DAK) offers an interdisciplinary assessment by the Berlin-Brandenburg back pain network (BBR) to its members with ongoing work disability on account of back pain. After medical, physiotherapeutic and psychological exploration one of the following four options is suggested: further diagnostics, outpatient monomodal treatment, day-care pain management program of two intensities or inpatient pain treatment. The data of 394 patients with the leading diagnostic group of back pain (M54, ICD 10, 65.7%) and disability for 92.7 days (mean) are presented., Results: The patients were severely impaired in physical and psychosocial aspects. The chronification was moderate (stage II-III of Mainz Staging System, MPSS). The success of treatment was evaluated 6 months after the initial assessment. All groups showed a significant reduction of pain, anxiety and depression whereas the wellbeing and daily activities improved, but best in the day-care pain management groups., Conclusion: Patient selection by a health fund, interdisciplinary assessment and severity adapted treatment resulted in significant reduction in pain and functional improvement in disabled back pain patients.