Effects of a back school programme initiated by a statutory sickness body on the development of a life-duality/health relationship and incapacity to work

The statutory sickness fund AOK Lower Saxony developed a specific course pr ogram for a target group of up to 55-year old employees with common back pa in in the early stage of chronification. Comparative evaluation of effects in study participants and controls was achieved by quality of life and perf ormance data, i.e. days of sick leave (DSL). Medium and long-term change in quality of life (6 and 12 months after the c ourse) was assessed by means of the SF-36 dimensions for cases and controls and compared in bivariate and multivariate tests. 92 of 197 baseline parti cipants (or 127 participants who completed the programme) and 483 controls were included in the medium term effect analysis. Significant medium and lo ng-term net effects could only be shown for pain dimensions. Anonymised DSL data for all 5409 insured persons who were initially selecte d as potential participants for the regionally restricted course programme in the second quarter of 1997 were available for the period from 01-01-1996 to 30-06-1999. For controlling any selection bias and potential regional d ifferences, the initial DSL trends of the 197 baseline course participants were compared with two control groups, namely other insured from the progra mme region and control regions. DSL trends in the three groups prior to the course program were identical. Subsequently DSL due to ICD-9 Codes 710-739 were reduced more substantially in course participants than in controls: 25.5 versus 33 or 32 days respect ively. A covariance analysis model that also considered socio-economic fact ors and pre-intervention DSL levels yielded a 14-day reduction in DSL (p va lue 0.023). This is a clear effect on DSL trends that may be utilised for net savings f or AOK. This is also the first proof of a back-pain programme outside compa ny settings that permits net savings.