gms | German Medical Science

Background: The effectiveness of rehabilitation depends on the individual non return to work (RTW) risk. Therefore, a risk score (SIMBO) was developed to predict the future RTW chance supporting the referral management.

Aim: The aim of this paper is to summarise the evidence of the diagnostic accuracy of the screening instrument SIMBO in the German rehabilitation system.

Method: The data of 4 cohort studies including were integrated. In all these studies the SIMBO was measured at admission of the inpatient rehabilitation. The outcome was defined as the occurrence of problems in the return-to-work (RTW) process 3 months after rehabilitation. All results were weighted regarding gender and diagnosis group for the whole German rehabilitation population in 2015.

Results/findings: Data from 2,422 patients out of nine different disease groups were included. In these groups between 9% and 47% reported critical RTW events in the follow-up (total: 35.2%). The area under curve (AUC) criteria laid between .844 and .899 (total: .891). The standardised mean differences in the SIMBO score between patients with and without a critical RTW event was 1.22 to 1.48 (total: 1.43).

Sensitivity and specificity rates varied depending on the chosen threshold. Using optimal thresholds they ranged from 74% to 93% as well as 72% to 87%. The identification of critical RTW events could be increased threefold due to the SIMBO.

Discussion and conclusions: Up to now, this is the strongest evidence regarding the diagnostic accuracy of a screening instrument to detect RTW problems after rehabilitation. Based on this the SIMBO can be used as generic screening identifying patients having a need for an intensified rehabilitation strategy.