Comparisons in Muscle Function and Training Rehabilitation Outcomes Between Avoidance-Endurance Model Subgroups.

Objective
To determine if the avoidance-endurance model subgroups, fear-avoiders (FAR), distress-endurers (DER), eustress-endurers (EER), and adaptive responders (AR), in chronic low back pain differ in physical measures and outcomes after training therapy.

Methods
6-month training intervention with 10 devices for the back muscles, abdominal muscles, and hip adductors, abductors with real time training monitoring from device screens. Training was based on initial test results, resistance increase every 4 weeks. Mean training frequency 1 x week. Assessment pre and post intervention.

Outcome measures: maximum isometric strength (G110, G120, G130), ROM, flexion-relaxation tests, AEQ, RMDQ, PDI, SF-36, IPAQ, VAS.

Outcome
Post training, significant improvements were detected in all subgroups in back-related health. However, the DER and the FAR were found to be more impaired before and after the intervention compared with EER and AR, as indicated by a higher pain intensity, higher disability levels, lower quality of life, and inferior working capacity. even though groups did not differ in physical measures and activity levels at baseline. The results underline the importance of AEM-subgroup-specific interventions.

Fehrmann E, Tuechler K, Kienbacher T, Mair P, Spreitzer J, Fischer L et al. Comparisons in Muscle Function and Training Rehabilitation Outcomes Between Avoidance-Endurance Model Subgroups. The Clinical Journal of Pain 2017;33(10):912-920.

Cost / benefit analysis of a scientifically supported training for health insurance participants with back problems. The example of the Gothaer Krankenversicherung AG.

Objective
To reduce the high costs of back pain patients through the back training program “integrated functional back pain therapy” implemented according to the FPZ (Research and Prevention Centre / Forschungs- und Präventionszentrum) concept.

Methods
Using the criterion: “spinal column syndrome with major symptoms”, 400 insured parties from the period 2001–2003 were analyzed from which 94 entered the treatment program.

The intervention group underwent 24 training session with David Spine Concept (with initial and outcome analysis).

The services rendered were subjected to a comparative test according to business management criteria with return on investment (ROI).

Outcome
Savings in the intervention group were 5544 EUR on average. Calculated over the period of 4 years from 2000-2003, savings were 1390 EUR per patient per year.

When divided into specific cost criteria, results where more diversified. Between the years 2000-2003 the costs for the insurance company per patient were 17.489,78 EUR in the control group and 11.647,24 EUR in the intervention group. The costs for the back training with 1:1 therapist: patient ratio were 1247,55 EURO.

This shows that over the period of 4 years for total costs a ROI of 4,7:1 was achieved. This means that for every EUR invested into active back training a benefit of 4,7 EUR compared to the control group could be achieved.

Daschner T, Tschubar F. Cost/benefit analysis of a scientifically supported training for health insurance participants with back problems. The example of the Gothaer Krankenversicherung AG. Manuelle Medizin 2006;44(4):308-312.