Rehabilitation最新文献

The aim of this study was to examine how the COVID-19 pandemic affected return to work (RTW) after vocational rehabilitation. Particular attention was paid to whether pandemic-related changes in the likelihood of RTW could be observed overall and in relation to individual vulnerability characteristics.The study was based on administrative data from the German Pension Insurance (n=28,779; 2018-2021). Three cohorts were included in the analysis: a reference cohort (rehabilitation and RTW before the pandemic), pandemic cohort 1 (RTW during the pandemic), and pandemic cohort 2 (rehabilitation and RTW during the pandemic). The probability of RTW was analyzed first descriptively and then again using logistic regression models, with adjustments made for relevant covariates. Additionally, interactions between the cohort variable and vulnerability characteristics (i. e., previous receipt of unemployment benefits I or II) were examined.Descriptive results showed lower RTW rates in both pandemic cohorts compared to the reference cohort. After adjustment, the decline was less pronounced, indicating the importance of individual characteristics and contextual factors - particularly labor market conditions. In the adjusted model, no statistically significant difference remained for pandemic cohort 1 relative to the reference cohort, whereas the gap for pandemic cohort 2 was reduced but not fully eliminated. Interaction analyses further indicated that barriers to RTW were amplified under pandemic conditions: rehabilitees with prior unemployment saw a further decrease in predicted probabilities of RTW in pandemic cohort 2 compared to before the pandemic.Overall, pandemic-related conditions made the transition back to working life after vocational rehabilitation more difficult. Individuals with pre-existing labor market disadvantages were particularly affected, pointing to an intensification of social inequalities under crisis conditions. To counteract such effects in the future, stronger linkages between vocational rehabilitation and labor market integration should be established.

Older employees make up a large proportion of the labour force in Germany. Medical rehabilitation can help to keep them healthy in working life. The study examines the extent to which the utilisation of rehabilitation services by employees over the age of 50 differs depending on their occupational qualification.The data set consisted of 6,953 socially insured employees born in 1959, 1965 or 1971 from the fourth wave of the lidA cohort study ("leben in der Arbeit") 2022/2023. A cross-sectional analysis was conducted to determine whether they had utilised rehabilitation services in the last four years depending on their occupational qualification. In the multiple logistic regression analysis, adjustments were made for demographic characteristics, subjective health, work stress, physical workloads, work-privacy conflict and caregiving for relatives. Potential selection effects in recruitment and follow-up were addressed using combined longitudinal and cross-sectional weighting. In addition to odds ratios, average marginal effects were calculated.17.5% of older employees had undergone medical rehabilitation (13.1% inpatient, 4.4% outpatient). Low-skilled workers (OR: 1.28; 95% CI: 1.05-1.57) and medium-skilled workers (OR: 1.45; 95% CI: 1.19-1.77) had a higher chance of utilising rehabilitation services than high-skilled workers. High work stress (OR: 1.23; 95% CI: 1.04-1.46) and poor health (OR: 2.75; 95% CI: 2.40-3.16) were associated with a higher likelihood of utilising rehabilitation services, younger age (OR: 0.75; 95% CI: 0.63-0.89), female gender (OR: 0.81; 95% CI: 0.71-0.94) and a first-generation migration background (OR: 0.72; 95% CI: 0.58-0.90) were associated with a lower chance of utilising rehabilitation services.Rehabilitation utilisation depends on occupational qualification, as expected among the low-skilled. Subjective health explains a large part of the higher probability of utilisation of rehabilitation services in this group compared to the high-skilled. Compared to high-skilled individuals, medium-skilled and low-skilled older employees had a similarly high chance of utilising rehabilitation services. Future research should therefore examine the relationship between the need for and utilisation of medical rehabilitation services depending on the level of occupational qualification, taking other factors into account.

Transition from medical to vocational rehabilitation not only mark the change from one institution or programme to the next, but are also biographically significant and vulnerable phases for the rehabilitants. The organisation of this transition is therefore of great importance. The present study analyses transitions from medical to vocational rehabilitation from the perspective of four research projects. The article addresses key hurdles, control mechanisms and subjective experiences in the transition process.The data basis comprises qualitative interviews, focus groups, document analyses, as well as standardised and open questionnaire surveys in various vocational rehabilitation institutions (BFW and BTZ) and medical rehabilitation institutions. The evaluation was conducted using a combination of qualitative content analysis (Kuckartz, Mayring), grounded theory (Glaser & Strauss), and descriptive statistical methods.The results can be grouped into four thematic focus areas that chronologically describe the transition process: 1) the path to vocational rehabilitation, 2) information and support for vocational rehabilitation, 3) access to and referral to vocational rehabilitation, and 4) the start of and arrival in vocational rehabilitation. It became evident that the transitions were characterized by institutional fragmentation, information deficits and unclear responsibilities. It was often the case that individuals seeking vocational rehabilitation services did so on an opportunistic basis, or through their own personal initiative. The coordination of counselling services was suboptimal, and the formal referral processes appeared to lack transparency and were sometimes arbitrary. Vulnerable groups, such as those grappling with addictions or other mental health problems, were particularly susceptible to the impact of these barriers. However, there were documented instances of successful transitions, particularly when early, continuous counselling was provided, and individual circumstances were given due consideration.Successful transition management requires clear responsibilities, standards for counselling and referral, and better integration of medical and vocational rehabilitation. It is crucial to integrate institutional routines within the rehabilitants' biographies.

Patients covered by the German Pension Insurance Braunschweig-Hannover (DRV BS-H) are offered participation in a case management program after completing medical rehabiliation. The aim of the present study was to compare and identify differences along several parameters between those who took up the offer of CM and those who refused participation in this program.For this cross-sectional study, between 2021 and 2023, members of the DRV BS-H with a recommendation for CM were included in a retrospective survey, that contained items on their disease burden, professional situation and work ability as well as on the evaluation of the medical rehabilitation undergone and the CM. Non-participants were also asked about the reasons for their refusal to particpate. In addition, administrative data of the DRV BS-H were used as a supplement. Group comparison was executed with t-test, Chi²-tests and Mann-Whitney U tests. Predictors were determined using binary logistic regression. Satisfaction with the CM and the reasons for refusal were evaluated descriptively.In many aspects, significant differences were found between participants and non-participants although the effects were mainly small. Non-participants were more likely to suffer from mental illness. They generally considered themselves to be in poorer health, were less likely to be employed and had a poorer prognosis regarding work ability. Participants experienced better outcomes from the retrospective evaluation of medical rehabilitation than non-participants. The evaluation of the CM was consistently positive. The most common reason for rejecting participation in CM was a wish to find a solution themselves. A performance level of less than six hours during the last professional activity increased the probability of participation in CM; however, the regression model had a very low explanatory power.The CM of DRV BS-H is an offer taken up by patients with diverse diagnoses after completing medical rehabilitation, and can be considered as a suitable service for members with complex support needs.

Returning to the workplace after inpatient medical rehabilitation poses significant challenges for many rehabilitants. When conventional rehabilitation aftercare is not available, internet-based aftercare offers an effective alternative to support rehabilitants in incorporating action and coping strategies developed during rehabilitation into daily personal and professional life. This paper presents the development and pilot testing of the internet-based self-help intervention "marena" (My Work-Related Rehabilitation Aftercare), which was designed to support rehabilitants during this complex transition.The intervention was developed in an agile, iterative process based on comprehensive literature research and expert interviews. Its features and content were continuously refined through expert feedback loops. Rehabilitants were actively involved in order to identify potential usability problems and evaluate usability and user experience.Marena includes, among other elements, task planning with pre-designed aftercare plans, a knowledge base with frequently asked questions, and established rehabilitation strategies and exercises. Marena promotes key behaviour change techniques by providing information and supporting self-monitoring and setting aftercare goals. The pilot study included n=7 participants. Usability was rated as good, achieving a System Usability Score of 75.33 (SD=6.97). User experience was assessed in the User Experience Questionnaire with an overall score of 1.02 (SD=1.07), indicating an average rating. A total of 38 usability issues were identified, with the most frequent and severe problems occurring in the areas of design and functionality.Despite some limitations, the pilot study provides valuable insights into user interactions with the intervention. The investigation identified key usability issues, which led to specific optimizations of the application. The results highlight the importance of pilot-testing internet-based interventions with future users for identifying usability-problems early on. The intervention is currently undergoing evaluation for effectiveness in a randomized controlled trial.

The entry bonus (ESP) is an innovative benefit designed to promote participation in working life, which has been trialled as part of the rehapro support programme. Its main objective is to facilitate the rapid and self-directed reintegration of people with long-term health impairments into the labour market. The ESP is offered as an alternative to the integration subsidy (EGZ) and provides employees with monthly support of up to €400 over a period of six months, as well as a one-time success bonus after twelve months of employment. The measure is intended to motivate people to take up employment, facilitate their transition into working life and improve their chances of participating in social life.In the cohort study, rehabilitation statistics data (RSD) from insured persons of the pension insurance institutions Mitteldeutschland and Braunschweig-Hannover who received the ESP or EGZ were evaluated. The main target parameter was the reintegration rate six, 13 and 15 months after the start of the measure and a cost comparison. Secondary parameters such as the sectors of employment were analysed for both groups using descriptive analyses. In addition, a binary logistic regression analysis was performed to investigate predictors of 15 months of employment.During the intervention period, 485 persons received ESP. The RSD analysis showed a higher employment rate for the group receiving ESP for the periods of 6 months, 13 months and 15 months after the start of the measure (91.3% for 6 months, 83.7% for 13 months and 81.2% for 15 months after the start of the measure). The employment rate for the EGZ group was 89.3% after 6 months, 68.7% after 13 months and 63.4% after 15 months after the start of the programme. ESP recipients had 2.4 times higher odds to be in employment after 15 months than EGZ recipients. The measure costs per case were 2.8 times higher in the EGZ group than in the ESP group.Reintegration rate and economic analysis of the ESP show a positive outcome of the pilot project. The benefit reaches a target group that has long-term health restrictions and, in some cases, has been unemployed for a long-term period. KEY MESSAGE: : The entry bonus is a non-purpose-tied benefit for employees. Compared to payments to employers, ESP is an alternative option and achieves a better integration rate at lower costs than the EGZ.

The aim of this study was to examine whether rehabilitation outcomes for back pain, operationalized as pre-post changes, in Germany have improved since 1990 and whether they have reached clinically relevant thresholds.Studies reporting changes in pain intensity, depression, catastrophizing, vitality, functional capacity, and days of incapacity for work across at least two measurement points were included. Meta-analyses using standardized mean differences were performed according to the random-effects model, distinguishing between short-, medium-, and long-term effects. Additionally, mean differences were standardized to the scale widths of the respective instruments and combined meta-analytically. A threshold of 15% of the scale width was used to define clinically relevant change. Subgroup analyses explored whether studies published after 2004 demonstrated better rehabilitation outcomes than earlier studies. Meta-regressions with publication year as a moderator variable pursued a similar aim.A total of 80 studies involving 19,844 participants were included, of which 57% were controlled studies and 5 used usual care as the control group. Meta-analyses showed mild to moderate improvements with high heterogeneity and medium study quality, but - except for a short-term increase in vitality - without achieving clinical relevance. More recent studies reported significantly better short-term improvements in functional capacity compared to older studies (0.21 vs. 0.38, p=0.014). Meta-regressions confirmed this finding. The heterogeneity of the results was considerable and could not be explained by characteristics of the studies, such as baseline status, the age of participants, or the number of study centres. The inconsistency introduces substantial uncertainty into the findings. Furthermore, it points to a deficiency in the uniformity of rehabilitation delivery.Despite substantial efforts to enhance structural and procedural quality, there is no evidence that the effectiveness of back pain rehabilitation in Germany has improved beyond marginal levels since 1990. Outcomes remain predominantly below the threshold of clinical relevance. There is a persistent lack of robust randomized controlled trials (RCTs) evaluating the absolute effectiveness of these programs.

Our study analyzed whether self-reported functional capacity is more realistic after a functional capacity evaluation has been carried out, i. e. whether the second self-reported functional capacity after testing corresponds more closely to the tester-observed judgement during the test than the first self-reported functional capacity before testing.Patients with orthopedic trauma were referred for functional capacity evaluation at the end of an inpatient rehabilitation program in Austria and were consecutively recruited for a diagnostic before-after study. We assessed self-reported functional capacity before and after completion of functional capacity evaluation as patient-reported outcome and compared it with tester-observed functional capacity when performing the functional capacity evaluation, i. e. our diagnostic procedure. Self-reported functional capacity was assessed with the Spinal Function Sort.In 523 patients, self-reported functional capacity assessed by the Spinal Function Sort increased significantly by 15.4 points after the functional capacity evaluation. This change corresponded to slightly more than 40% of the baseline standard deviation. The frequencies of self-reported moderate and heavy or very heavy work functional capacity increased from 22.2% to 30.4% and 13.6% to 23.5%, respectively, while the frequency of self-reported sedentary functional capacity decreased from 35.2% to 18.9%. The number of patients whose self-reported functional capacity matched the tester-observed functional capacity increased from 19.3% to 34.2% after completion of the functional capacity evaluation.After completion of the functional capacity evaluation, the number of patients significantly increased whose rating of functional capacity matched their tester-observed functional capacity.