Utilization of Outpatient Physical and Occupational Therapy in People With Spinal Cord Injury in Germany: Results of the German Spinal Cord Injury Survey.

OBJECTIVE: The aim of the study was to assess factors determining the utilization of physical and occupational therapy in people with spinal cord injury. DESIGN: Data from the German Spinal Cord Injury study conducted in 2017 were analyzed. The 12-mo prevalence of physical therapy and occupational therapy utilization was determined. To identify underlying determinants, multivariable logistic regression was used. RESULTS: Of 1479 participants (response = 26.4%), 72.9% were male, with a mean (SD) age of 55.3 (14.6) yrs and a mean (SD) time since injury of 14.0 (12.0) yrs; 51.2% were people with paraplegia and 66.3% had an incomplete spinal cord injury. In the past 12 mos, 78.1% received physical and 29.3% occupational therapy. Physical therapy and occupational therapy were significantly associated with time since spinal cord injury occurrence, participation in lifelong care programs, and electric wheelchair dependency. Spinal cord injury characteristics, level of impairment, and time since spinal cord injury had a greater impact on occupational therapy than on physical therapy utilization. CONCLUSIONS: The use of physical therapy and occupational therapy is much higher in Germans with spinal cord injury than in the general population and in people with similar neurological conditions. Further research should focus on the frequency of use and the types of interventions. Guidelines for lifelong care should include recommendations on physical therapy and occupational therapy.

Comorbidity of chronic back pain and depression in Germany: Results from the GEDA study, 2009 and 2010.

BACKGROUND: Depression and chronic back pain are two common disabling diseases. Studies suggest an association of both conditions. We aimed to determine sex- and age-specific prevalences of depression, chronic back pain and the combination of both. Furthermore, influencing factors and resulting consequences were analyzed. METHODS: Data was derived by pooling two representative cross-sectional telephone surveys "German Health Update (GEDA)" 2009 and 2010 including 43,312 adults. Self-reported physician-diagnosed chronic somatic diseases including diagnosed depression and chronic back pain in the past 12 months were assessed. Age- and sex-specific prevalence was calculated. Logistic regression was used to examine their association and identify influencing factors. Sick days, missed workdays and doctor visits were compared for single disease vs. comorbidity. RESULTS: 12-month prevalence for diagnosed depression was 6.7 %, for chronic back pain 21.1 %, and the comorbidity of both was 3.0 %. An association of depression and chronic back pain was found for both sexes and all age groups. The characteristics "female sex", "being 50-64 years of age", "low socioeconomic status" and "low social support" increased the likelihood of comorbid depression and chronic back pain. Comorbid depression and chronic back pain increased the number of sick days, missed workdays and doctor visits significantly. CONCLUSION: The results show a strong association of depression and chronic back pain. The direction of association cannot be determined due to the cross-sectional design of the study. Identifying patients at risk for comorbid depression and chronic back pain early on might improve treatment and reduce the economic impact.