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15th Congress of the European Forum for Research in Rehabilitation (EFRR)

15.04. - 17.04.2019, Berlin

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Implementing the German model of work-related medical rehabilitation: Did the dose delivered of work-related treatment components increase?

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  • author presenting/speaker Uwe Egner - German Federal Pension Insurance, Berlin, Germany
  • corresponding author Marco Streibelt - German Federal Pension Insurance, Berlin, Germany
  • Michael Schuler - University of Würzburg, Würzburg, Germany
  • Matthias Bethge - Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany

15th Congress of the European Forum for Research in Rehabilitation (EFRR). Berlin, 15.-17.04.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. Doc050

doi: 10.3205/19efrr050, urn:nbn:de:0183-19efrr0500

Published: April 16, 2019

© 2019 Egner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Background: Work-related treatment components are an essential part of rehabilitation in order to support return to work of patients with musculoskeletal disorders. In Germany, a guideline for work-related medical rehabilitation was developed to increase work-related treatment components. In addition, new departments were approved to implement work-related medical rehabilitation programs.

Aim: The aim of our study was to explore the state of implementation of the guideline’s recommendations by describing the change in the dose delivered of work-related treatments.

Method: The treatment dose of work-related therapies was compared for two patient cohorts with musculoskeletal disorders. The first cohort participated in a common medical rehabilitation program in the second half of 2011. The second cohort joined a work-related medical rehabilitation program in the second half of 2014 after the implementation of the new departments. Patients were matched one-to-one by propensity scores.

Results/findings: We included data of 9,046 patients. The mean dose of work-related therapies increased from 2.2 hours (95% CI: 1.6–2.8) to 8.9 hours (95% CI: 7.7–10.1). The mean dose of social counselling increased from 51 to 84 minutes, of psychosocial work-related groups from 39 to 216 minutes, and of functional capacity training from 39 to 234 minutes. The intraclass correlation of 0.67 (95% CI: 0.58–0.75) for the total dose of work-related therapies indicated that the variance explained by centers was high.

Discussion and conclusions: Dose delivered of work-related components was increased. However, there was a discrepancy between the guideline’s recommendations and the dose delivered in at least half of the centers. It is very likely that this will affect the effectiveness of work-related medical rehabilitation.