From evidence to practice: Improving work participation outcomes by work-related medical rehabilitation in patients with chronic musculoskeletal diseases

Abstract

In Germany, work-related medical rehabilitation programs were developed for patients with musculoskeletal disorders to improve work participation outcomes. Randomized controlled trials have shown that return-to-work rates can be increased by about 20 points compared to common medical rehabilitation programs. Since 2014, the Federal German Pension Insurance has approved several work-related rehabilitation departments to implement these new rehabilitation programs. Our study was launched to assess the effects of work-related medical rehabilitation under real-life conditions. Participants received either a common or a work-related medical rehabilitation program. Propensity score matching was used to identify controls that were comparable to work-related medical rehabilitation patients. Effects were assessed by patient-reported outcome measures 10 months after completing the rehabilitation program. We included 1282 patients (mean age: 52.4 years; 75.3% women). Work-related medical rehabilitation increased stable return-to-work (OR = 1.42; 95% CI: 1.02 to 1.96) and self-rated work ability ( b = 0.38; 95% CI: 0.05 to 0.72) compared to common medical rehabilitation. Participants of work-related medical rehabilitation had also less depressive symptoms and fear of movement, and they reported better self-management skills. Subgroup analyses showed that the effect on stable return-to-work depended on the prior risk of not returning to work and the dose received as rated by the participants. Only persons with a high initial risk of not returning to work and a high dose received benefited from work-related medical rehabilitation. In this subgroup, i.e. high risk and high dose received, the absolute risk difference was about 20 points in favor of work-related medical rehabilitation. Implementation of work-related medical rehabilitation in German rehabilitation centers affected work participation outcomes. Our effectiveness study showed that the results from randomized controlled trials can be also achieved under real-life conditions. However, effectiveness is moderated by the population reached and the dose received.