Predictors of Participation in Medical Rehabilitation Follow-Up in Working Patients with Chronic Back Pain

Background and aim: Outpatient follow-up programmes aim to increase the sustainability of rehabilitation. However, the factors influencing participation in follow-up programmes are still unclear. The aim of this study was to examine participation in the MERENA follow-up programme of the Rhineland-Palatinate German Pension Fund. Method: The study was conducted in 12 outpatient rehabilitation centres with 192 working patients who were being treated for chronic back pain at the time the survey was conducted. Both patients and physicians completed a written survey at the outset of rehabilitation, on completion, and again (if applicable) at the end of the follow-up programme. The data collected mainly concerned the patients' health and factors related to their occupational situation (e.g. functional capacity, working capacity) and reasons for refusing to participate in the MERENA follow-up programme. Predictors for participation in the follow-up programme were determined using binary logistic regression analysis. Results: On completion of rehabilitation, nearly all patients were given the recommendation to participate in the follow-up programme. Half of these patients took advantage of the programme. The most frequently given reason for refusal to participate was that participation in the programme was not compatible with their duties at work. Low functional capacity and continued work disability increased the probability that a patient would take part in a follow-up programme after rehabilitation. In contrast, a longer commute to the centre was an obstacle to participation. Women were more likely to participate in the programme than men. Conclusions: The results indicate that participation in a follow-up programme is often not compatible with employment. We could not satisfactorily explain why women were more likely to participate in the programme. This result could have been related to women's more flexible time schedules. An improvement of the current situation could be achieved by having follow-up programmes closer to the home, by flexible follow-up offerings, alternative follow-up services (e.g. in certified physiotherapy centres and sport clubs) as well as by integrating companies in follow-up planning and implementation.