Title: The Back to Life Project – Evaluating and changing a complex intervention Background: The Back to Life Project (BTL) is a small enterprise offering free rehabilitation services to persons with reduced level of functioning as a consequence of accident or disease. BTL aims to offer a better and more comprehensive rehabilitation service than what is currently provided by the Danish municipalities. To increase the availability of the service to a larger demographic, BTL is looking to secure stable funding. Currently the evidence for the BTL approach to rehabilitation is lacking which could be a barrier to further funding.
Aims: The aim of this thesis is to evaluate the effectiveness and cost-effectiveness of the BTL rehabilitation service. Due to uncertainty in the investigated evidence, we propose that BTL increase the level of documentation, to facilitate further documentations of costs and effects. This would furthermore be beneficial to subsequent evaluations.
Methods: This thesis is based on the MRC approach to developing and evaluating complex interventions. The use of a systematic review of literature and a health economic evaluation, is included in this thesis. The systematic review of literature contributes with evidence concerning the central elements of BTL. In order to investigate costs attributed to BTL and furthermore assess whether the intervention is a cost-effective alternative to the rehabilitation of individuals with reduced functioning, a cost-minimization and threshold analysis is used. To accommodate the uncertainty of the evidence underlying the two evaluations, a Context-Mechanism-Outcome approach is employed to investigate the most important mechanisms of the intervention, which ultimately results in a proposal to increase documentation within BTL.
Results: The review of literature finds limited evidence to indicate that the BTL approach is equal to or more beneficial than conventional approaches to rehabilitation. The health economic evaluation finds that the incremental costs per participant in BTL amounts to 5.881 DKK. As a result, BTL needs to produce an incremental effect of 0,024 QALY per participant to be considered cost-effective at a willingness-to-pay threshold of 250.000 DKK/QALY. As the true incremental effects of BTL has not been established, this thesis proposes to increase the level of documentation in BTL using A) the EQ-5D-3L health questionnaire alongside increased documentation of costs, and B) the ICF-classification coreset for musculoskeletal disease. Conclusion: At present there is insufficient evidence to recommend public funding and expansion of BTL, however increased documentation, using the ICF-classification and the EQ-5D-3L health questionnaire, might assist in addressing this issue.