Implementing the German Model of Work-Related Medical Rehabilitation: Did the Delivered Dose of Work-Related Treatment Components Increase?

Abstract

ObjectivesWork-related components are an essential part of rehabilitation programs 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. The aim of our study was to explore the state of implementation of the guideline’s recommendations by describing the change in the delivered dose of work-related treatments. DesignNonrandomized controlled trial (cohort study). SettingFifty-nine German rehabilitation centers. ParticipantsPatients (N=9046) with musculoskeletal disorders were treated in work-related medical rehabilitation or common medical rehabilitation. Patients were matched one-to-one by propensity scores. InterventionsWork-related medical rehabilitation in 2014 and medical rehabilitation in 2011. Main Outcome MeasuresTreatment dose of work-related therapies. ResultsThe mean dose of work-related therapies increased from 2.2 hours (95% confidence interval [CI], 1.6-2.8) to 8.9 hours (95% CI, 7.7-10.1). The mean dose of social counseling increased from 51 to 84 minutes, the mean dose of psychosocial work-related groups from 39 to 216 minutes, and the mean dose 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. ConclusionsThe delivered dose of work-related components was increased. However, there were discrepancies between the guideline’s recommendations and the actual dose delivered in at least half of the centers. It is very likely that this will affect the effectiveness of work-related medical rehabilitation in practice.