Work-related Medical Rehabilitation Research Articles

Development and initial evaluation of the usefulness of a question prompt list to promote patients' level of information about work-related medical rehabilitation: a pilot study.

The purpose of this study was to develop a question prompt list (QPL) to support patients undergoing work-related medical rehabilitation in obtaining relevant information and to explore how patients and physicians rate the QPL regarding its usefulness, practicability, and perceived (additional) effort. An initial item pool was assessed by rehabilitation patients (N = 3) in cognitive interviews, rated by physicians and other health professionals (N = 11), and then further modified. The final QPL version (16 items) was used by patients (N = 36) in medical admission interviews in an inpatient medical rehabilitation facility and then evaluated. Physicians evaluated the QPL after each interview with a study participant (N = 6; k = 39 interviews). The QPL was used by 50% of patients who rated its usefulness and comprehensibility positively. Neither the need for information nor satisfaction with the information received was correlated with QPL use. The physicians' assessment showed a positive evaluation regarding the provision of information and structuring of the conversation, but also a higher perceived time expenditure. While initial testing of the QPL in work-related medical rehabilitation as a tool to support patient-provider communication generally showed a favorable evaluation by patients using it and physicians, future research should address its validity and effectiveness.

Work-Related Medical Rehabilitation (WMR) Care in Psychosomatic Medicine in Comparison with Other Indications

So far, there is little data on the quality of work-related medical rehabilitation (WMR)-care in the routine, including from a user perspective. The best data are still available for orthopedic rehabilitation. For psychosomatic rehabilitation, a special need for WMR is known due to the long periods of inability to work and the frequent early retirements. It is unclear how precisely and to what extent WMR services are provided in routine care. In 2019, a representative sample (N=34.887) of employed insured persons up to 65 years old, stratified by indication, was surveyed by the German Pension Insurance fund six months after their rehabilitation with the self-assessment tool MBOR-R. In addition, standard data of the rehabilitation provider (RSD) were collected, from which WMR-related therapeutic offer data (KTL) could be taken. Rehabilitants were asked about their return to work as part of the catamnesis. The participation rate in the survey is 29%, complete survey and RSD data are available after exclusion of addiction rehabilitation and post-operative-procedures from a total of 6.128 rehabilitants, of which N=1.460 after psychosomatic rehabilitation. The comparison of indications shows that 37% of the rehabilitation patients need WMR, which is by far the highest rate. WMR care in psychosomatic rehabilitation is still the best developed and most targeted, but still far from the standards required by the pension insurance. More than 50% of the rehabilitants, even after WMR, rate their employment-related treatment offer as too low. These subjective rehabilitation assessments in the MBOR-R questionnaire prove to be a relevant factor for the prognosis of the return to work quotes, in contrast to the documented KTL services, in addition to the need indicators of WMR and the implementation of WMR. The results suggest that in the field of psychosomatic rehabilitation, too, increased efforts should be made in the future to offer and expand basic WMR services for all rehabilitants and core and special services for rehabilitants with poor work ability and an increased risk of permanent work disability (BBPL) in routine care. The scope and design of MBOR measures should also be quality-optimized from the user's perspective in order to achieve the greatest possible effects.Limitations of the results result from the restriction to rehabilitants of the German Federal Pension Insurance, to limited participation rates, Limitations of the interpretability of the therapy documentations and due to the study design with a one-point measurement and remembered pre-values.

Questionnaire to Assess the Work-Related Orientation of Medical Rehabilitation from the Perspective of the Rehabilitants (WMR-R): Cross-Sectional Study Comparing the Short and Long Versions

The user perception of the work-related treatment is of great importance for the further development and success of work-related medical rehabilitation (WMR). The German Pension Insurance Fund (Deutsche Rentenversicherung DRV Bund) has therefore supported the development of the questionnaire WMR-R that can be used to assess the quality of the structure, process and results of work-related rehabilitation treatment from the patient's point of view. This paper presents a short version and compares it with the long version. Based on a representative sample stratified by indication, employed rehabilitants up to the age of 65 were randomly selected to be questioned 6 months after their rehabilitation with a long version (N=28276) or a short version (N=6611) of WMR-R. In addition, routine data of the German Pension Insurance Fund were included. 27 items each of the long version and 8 items of the short version are added up to a total score and compared with regard to test statistical quality criteria and sample sensitivity. Participation rates were slightly higher in the short version (31%, N=2115) than in the long version (28%, N=8019). The processing quality in both versions is comparable. The short and long versions correlate with each other at r=0.96 (p<0.01). Both versions have similar validity characteristics and separate well between WMR and standard rehabilitation. Both versions are robust to demographic, disease-related and socio-medical risk factors. Rehabilitants with addiction and psychosomatic as well as neurological diseases rate their rehabilitation as significantly more work-oriented compared to other indications, especially pneumology. Due to the low survey effort and the simple evaluation and interpretation, the short version is particularly suitable for routine surveys of WMR care quality. The long version allows a differentiated recording of the WMR offer of rehabilitation facilities in the sense of strength/weakness analyses.

Matching Perceived Physical Capacity and Work Demands: A New Classification of the Modified Spinal Function Sort (M-SFS).

Purpose The aims of this study were (1) to develop a new classification for the scores of the Modified Spinal Function Sort (M-SFS) which is related to the level of physical work demands and (2) to test the predictive value of the M-SFS classification. Methods The classification was carried out in 194 subjects with musculoskeletal disorders (MSD) attending a work-related medical rehabilitation from four rehabilitation centers. External criterion was a Functional Capacity Evaluation (FCE)-based work capacity estimation according to the classification used in Germany ("REFA") which differentiates between light, light to medium, medium and heavy work. The optimal cut-offs for the M-SFS were allocated using the Youden index. Logistic regression models were calculated based on 147 subjects who participated in the follow-up survey to evaluate the predictive validity of the M-SFS classification with regard to sustainable return to work (RTW; employment at the 3-month follow-up combined with a low level of sick leave). Results Cut-offs for M-SFS scores were 44 (light work), 54 (light to medium work), 62 (medium work) and 73 (heavy work). A match between the M-SFS category and the level of physical work demands was associated with a more than threefold higher RTW chance compared to subjects with a negative discrepancy. In case the M-SFS category was above the physical demand level the RTW-chance was more than 13-fold higher. Conclusions M-SFS scores can be classified into four levels of physical work demands. If the perceived work capacity matches or exceeds the level of physical work demands patients with MSD have a substantially higher probability to return to work after rehabilitation. More studies are needed to confirm or reject our findings and overcome some of the weaknesses of this study.

Work-related medical rehabilitation in patients with mental disorders: the protocol of a randomized controlled trial (WMR-P, DRKS00023175)

BackgroundVarious rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. To ensure that people with a high risk of not returning to work can participate in working life, the model of work-related medical rehabilitation was developed in Germany. The efficacy of these programs in patients with mental disorders has been tested in only a few trials with very specific intervention approaches. To date, there is no clear evidence of the effectiveness of work-related medical rehabilitation implemented in real-care practice.Methods/designOur randomized controlled trial will be conducted in six rehabilitation centers across Germany. Within 15 months, 1800 patients with mental disorders (300 per rehabilitation center) will be recruited and assigned one-to-one either to a work-related medical rehabilitation program or to a conventional psychosomatic rehabilitation program. Participants will be aged 18–60 years. The control group will receive a conventional psychosomatic rehabilitation program without additional work-related components. The intervention group will receive a work-related medical rehabilitation program that contains at least 11 h of work-related treatment modules. Follow-up data will be assessed at the end of the rehabilitation and 3 and 12 months after completing the rehabilitation program. The primary outcome is a stable return to work. Secondary outcomes cover several dimensions of health, functioning and coping strategies. Focus groups and individual interviews supplement our study with qualitative data.DiscussionThis study will determine the relative effectiveness of a complex and newly implemented work-related rehabilitation strategy for patients with mental disorders.Trial registrationGerman Clinical Trials Register (DRKS00023175, September 29 2020).

Work-Related Medical Rehabilitation in Patients with Musculoskeletal Disorders: a Propensity-Score-Analysis

Work-related medical rehabilitation is a multimodal interdisciplinary approach to reduce health-related discrepancies between work capacity and job demands in order to achieve work participation, especially for patients with severely more restricted work ability. The study tested the effects of a work-related medical rehabilitation program, implemented in routine care, compared with common medical rehabilitation in patients with musculoskeletal disorders. Data were assessed in 2014 and 2015 and were analyzed by an as-treated analysis. By means of propensity-score-matching, participants of work-related medical rehabilitation (intervention group, IG) were compared with similar participants of common medical rehabilitation (control group, CG). The primary outcome was a positive work status one year after discharge of rehabilitation. Treatment effects were analyzed by logistic regressions and absolute risk reductions (ARR) were calculated. 312 patients (156 in the IG) were included in the analysis one year after rehabilitation. Propensity-score-matching achieved balanced sample characteristics. Work-related medical rehabilitation increased a positive work status by 11 points (ARR=0.11; 95% CI: 0.02, 0.20; p=0.020) compared to common medical rehabilitation. Work-related medical rehabilitation leads to better work participation outcomes after one year compared with common medical rehabilitation.

Effects of nationwide implementation of work-related medical rehabilitation in Germany: propensity score matched analysis

ObjectivesSince 2014, the Federal German Pension Insurance has approved several departments to implement work-related medical rehabilitation programmes across Germany. Our cohort study was launched to assess the effects of work-related...

Work-Related Medical Rehabilitation in Cancer: A Cluster-Randomized Multicenter Study.

Current guidelines recommend rehabilitative measures to alleviate dis- turbances resulting from cancer and its treatment. To give cancer survivors further assistance in getting back to work, work-related medical rehabilitation is currently being tested in Germany. In this cluster-randomized, multicenter trial, we studied the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation (trial no. DRKS00007770 in the German Clinical Trials Registry). A total of 484 cancer survivors of working age who were candidates for rehabilitation were recruited and assigned at random to either the intervention group (IG; work-related medical rehabilitation) or the control group (CG). The primary end- point was self-assessed function in a role one year after the end of rehabilitation, as evaluated with the health-related quality of life questionnaire of the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30). Further endpoints included symptom and function scales, subjective ability to work, coping with illness, and return to work. Neither the medical personnel nor the subjects were blinded. One year after the end of rehabilitation, data from 379 subjects who par- ticipated in the last follow-up survey were evaluated. The intervention and control groups did not differ significantly either in the primary endpoint of role function (IG = 60.8 vs. CG = 57.6 out of a maximum of 100 points; p = 0.204) or in any of the secondary endpoints. A last observation carried forward analysis yielded com- parable results. At 12 months, 28.5% of the subjects in the IG and 25.3% of those in the CG were still unable to work. This study did not reveal any significant clinically relevant advantage of work-related medical rehabilitation at one year. Future studies should determine whether a second period of rehabilitation might be helpful and whether selected subjects might benefit from the assistance of case managers beyond the period of rehabilitation.

Work-related medical rehabilitation in patients with cancer-Postrehabilitation results from a cluster-randomized multicenter trial.

Effective multidisciplinary rehabilitation programs supporting the return to work have become increasingly relevant for cancer survivors. In Germany, inpatient work-related medical rehabilitation programs consider treatment modules of work-related diagnostics, work-related functional capacity training, psychosocial groups, and intensified social counseling. The authors tested the effectiveness of a work-related medical rehabilitation program compared with conventional medical rehabilitation using a cluster-randomized multicenter trial (German Clinical Trial Register: DRKS00007770). In total, 484 patients with cancer were recruited at 4 rehabilitation centers. Patients at a center who started their rehabilitation in the same week represented a cluster. These clusters were randomly assigned using computer-generated randomization schedules either to an intervention group (IG) or to a control group (CG). The primary outcome was role functioning. Secondary outcomes were other quality-of-life domains and the return to work. In total, 425 patients (210 in the IG) were included in the analysis at the 3-month follow-up. There was no significant difference between the IG and CG in role functioning (b=3.55; 95% CI, -1.18 to 8.29; P=.142). Participants in the IG reported better physical functioning (b=5.99; 95% CI, 3.33-8.65; P<.001), less physical fatigue (b=-5.09; 95% CI, -9.62 to -0.56; P=.028), and less pain (b=-6.24; 95% CI, -11.24 to -1.23; P=.015). Work-related medical rehabilitation had no effect on the primary outcome compared with conventional medical rehabilitation but may enhance physical functioning and reduce physical fatigue and pain.

Development and implementation of work-related medical rehabilitation in cancer patients using organizational ethnography and action research methodology.

To develop a work-related medical rehabilitation (WMR) program for cancer patients based on the best available evidence, the expertise of rehabilitation professionals and the perspective of the patients, to ensure the fidelity of its implementation and to prepare its subsequent outcome evaluation. The implementation study was based on organizational ethnography and action research, and followed a multimethod, participatory and iterative approach to data collection and analysis. The authors carried out observations in 4 rehabilitation centers and conducted focus groups with rehabilitation professionals and patients. The obtained data were subjected to qualitative content analysis. All findings were discussed promptly with the rehabilitation centers at feedback meetings that contributed to the further development of the program. The following WMR modules were defined based on the findings: additional work-related diagnostics, multi-professional team meetings, an introductory session, work-related functional capacity training, work-related psychological groups and intensified social counseling. Process descriptions for the subsequent evaluation of the program via a cluster-randomized trial were also developed, containing, e.g., instructions for patient information and recruitment. Implementation studies can help to prepare for valid trials as they facilitate ensuring the feasibility, acceptability and fidelity of program implementation and evaluation. Organizational ethnography and action research are suitable methods for carrying out such studies. Int J Occup Med Environ Health. 2019;32(2):217-28.

Work-related medical rehabilitation (WMR) in Neurology requires individualised rehabilitant identification

To increase the rate of successful return-to-work (RTW) after acute or chronic diseases, the German Pension Insurance established the concept of work-related medical rehabilitation (WMR) as a strategic advancement of conventional medical rehabilitation. Although in some indications, the WMR is demonstrably superior to conventional medical rehabilitation in terms of occupational reintegration, this has not yet been proven for neurology so far. Current studies on neurological WMR point to the complexity of clinical anamnestic characteristics of the target group, which makes it difficult to define severe restrictions of work ability (SRWA) as a prerequisite for access to the neurological WMR. In addition, the heterogeneous functional disabilities, multiple comorbidities and the different types of rehabilitation services (follow-up, medical treatment) significantly influence SRWA identification. Standardized SRWA screening instruments with a focus on socio-medical criteria identify SRWA less adequately than individual history taking. In neurology, an individualized SRWA screening is recommended at the beginning of WMR despite additional expense.

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

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.

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

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.

Effectiveness and implementation of work-related medical rehabilitation in cancer patients: Results from a cluster randomized multicenter trial

Work is a central resource for cancer survivors impacting health and quality of life. Effective rehabilitation programs supporting return to work become increasingly relevant for cancer survivors. In Germany, such programs were established as work-related medical rehabilitation, comprising work-related diagnostics, functional capacity training, psychosocial groups and intensified social counseling. The study investigated the effectiveness of work-related medical rehabilitation compared to conventional medical rehabilitation. We conducted a cluster randomized multicenter trial. 484 cancer patients aged 18 to 60 years were recruited in four inpatient rehabilitation centers. Patients of a center starting their rehabilitation in the same week represented a cluster. These clusters were randomly assigned with computer-generated randomization schedules to intervention (IG) or control group (CG). The primary outcome was the role functioning scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire as assessed at the 12-month follow-up. Secondary outcomes were other quality of life domains, disease coping and return to work. Effects were estimated using random effects models. The study was registered in the German Clinical Trials Register (DRKS00007770). Analysis of delivered dose of treatments indicated a successful implementation of work-related medical rehabilitation. 379 patients, 197 in IG, were included in the analysis of the 12-month follow-up. There was no significant difference between IG and CG in role functioning ( b = 3.69; 95% CI: −2.01;9.39; P = 0.204) and any secondary outcome. Results indicate effects in favor of those patients with a high risk for early retirement in IG regarding role functioning ( b = 10.54; 95% CI: 1.68–19.40; P = 0.020) and physical functioning ( b = 7.84; 95% CI: 2.60–13.08; P = 0.003). Work-related medical rehabilitation had no significant effects on primary and secondary outcomes compared to conventional medical rehabilitation. However, participants with an increased risk for health-related early retirement may benefit from a work-related medical rehabilitation program.

Work-Related Medical Rehabilitation in Cancer Rehabilitation - Short-Term Results from a Cluster-Randomized Multicenter-Trial

Rehabilitation programs that support return to work become increasingly relevant for cancer survivors. In Germany, such programs were established as work-related medical rehabilitation (WMR). The study investigated whether WMR leads to better results compared to medical rehabilitation (MR). We report effects on secondary outcomes when the rehabilitation program was completed. Clusters of participants were randomly assigned to WMR or MR. Patients of working age and an elevated risk of not returning to work were included. The grade of implementation was assessed by dose delivered and dose received. Study outcomes were assessed using scales measuring functioning and symptoms, coping with illness as well as self-reported work ability. Treatment effects were estimated using mixed linear models. From 232 planned randomized intervention groups, 165 (71%) were realized. In total, 476 patients were included. Mean age of participants was 50.7 years (SD=7.3). Most frequent primary diagnoses were malignant neoplasms of the breast. Participants in the WMR program reported significantly better outcomes regarding quality of life (SMD=0.17-0.25), fatigue (SMD=0.18-0.27), coping with illness (SMD=0.17-0.22), and self-reported work-ability (SMD=0.16) compared to participants in MR program (all p<0.05). The results indicate a positive effect in favor of WMR for cancer patients with an elevated risk of not returning to work at the end of their treatment.

Facilitating Processes of Disintegration instead of Occupational Reintegration: A Qualitative Study on Employer-Involvement in Rehabilitation

Purpose To explore the patient's perspective on the involvement of employers into rehabilitation. Methods 8 participants of a work-related medical rehabilitation were interviewed by telephone 4 weeks after discharge. Qualitative content analysis was used to analyze generated data. Results Beside a poor employer-involvement, the interviews revealed that the process of returning to work was characterized and hampered by unused measures of supporting vocational reintegration during rehabilitation, intersection problems in the health care and social security system, and a strategy of waiting by all involved actors. Conclusion Beside an improved employer-involvement, systematic intersection management and full usage of existing measures are demanded to support vocational reintegration.

The Prognostic Validity of the Functional Capacity Evaluation ELA in Work-Related Medical Rehabilitation

The aim of the study was to determine the ability of FCE (Functional Capacity Evaluation) to predict sustained return-to-work (RTW). A multicentric prospective cohort study was conducted in cooperation with 4 outpatient rehabilitation clinics. The sample consisted of 198 patients. Sustained RTW was defined as a combination of employment at 3-month follow-up with a low level of sick leave (dependent variable 1) resp. with a moderate or better rating of the current work ability with respect to the physical demands at work (dependent variable 2). Based on questionnaires and FCE information, logistic regression models were calculated to predict sustained RTW. The FCE-information at discharge predicted sustained RTW after adjusting for assessors (Odds Ratio - OR=17.2 [95% CI: 6.2-57.8] resp. OR 12.8 [95% CI: 5.1-32.1]) as well as after adjusting for additional RTW predictors (OR 14.6 [95% CI: 4.8-44.9] resp. OR 10.1 [95% CI: 3.5-29.4]). Concerning dependent variable 1 and the FCE-information at admission there was a gain of information towards a model based on patient self-reports (OR 2.6 [95% CI: 1.1-6.0]). The study supports the predictive validity of crude and adjusted FCE-information. The gain of information towards patient self-reports is unclear.

Work-Related Medical Rehabilitation

Work-related medical rehabilitation (WMR) is a strategy to improve work participation in patients with poor work ability. This review summarizes the state of knowledge on WMR. The prevalence of poor work ability and corresponding need for WMR is high (musculoskeletal disorders: 43%; mental disorders: 57%). The meta-analysis of randomized controlled trials in patients with musculoskeletal disorders shows better return to work outcomes after one year in favor of WMR patients than compared to patients participating in usual medical rehabilitation. The amount of work-related measures in rehabilitation was clearly increased during recent years. A direct involvement of the workplace and a closer cooperation with employers and occupational health physicians may further improve the outcomes of WMR.

Work-related medical rehabilitation in patients with musculoskeletal disorders: the protocol of a propensity score matched effectiveness study (EVA-WMR, DRKS00009780).

BackgroundMusculoskeletal disorders are one of the most important causes of work disability. Various rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. As the effects of conventional medical rehabilitation programs on sickness absence duration were shown to be slight, work-related medical rehabilitation programs have been developed and tested. While such studies proved the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation in well-conducted randomized controlled trials, its effectiveness under real-life conditions has yet to be proved.Methods/DesignThe cohort study will be performed under real-life conditions with two parallel groups. Participants will receive either a conventional or a work-related medical rehabilitation program. Propensity score matching will be used to identify controls that are comparable to treated work-related medical rehabilitation patients. Over a period of three months, about 18,000 insured patients with permission to undergo a musculoskeletal rehabilitation program will be contacted. Of these, 15,000 will receive a conventional and 3,000 a work-related medical rehabilitation. We expect a participation rate of 40 % at baseline. Patients will be aged 18 to 65 years and have chronic musculoskeletal disorders, usually back pain. The control group will receive a conventional medical rehabilitation program without any explicit focus on work, work ability and return to work in diagnostics and therapy. The intervention group will receive a work-related medical rehabilitation program that in addition to common rehabilitation treatments contains 11 to 25 h of work-related treatment modules. Follow-up data will be assessed three and ten months after patients’ discharge from the rehabilitation center. Additionally, department characteristics will be assessed and administrative data records used. The primary outcomes are sick leave duration, stable return to work and subjective work ability. Secondary outcomes cover several dimensions of health, functioning and coping strategies.DiscussionThis study will determine the relative effectiveness of a complex, newly implemented work-related rehabilitation strategy for patients with musculoskeletal disorders.Trial registrationGerman Clinical Trials Register (DRKS00009780, February 10, 2016).

Effectiveness of work-related medical rehabilitation in cancer patients: study protocol of a cluster-randomized multicenter trial.

BackgroundWork is a central resource for cancer survivors as it not only provides income but also impacts health and quality of life. Additionally, work helps survivors to cope with the perceived critical life event. The German Pension Insurance provides medical rehabilitation for working-age patients with chronic diseases to improve and restore their work ability, and support returning to or staying at work, and thus tries to sustainably avoid health-related early retirement. Past research showed that conventional medical rehabilitation programs do not support returning to work sufficiently and that work-related medical rehabilitation programs report higher return-to-work rates across several health conditions, when compared to medical rehabilitation. Therefore, the current study protocol outlines an effectiveness study of such a program for cancer survivors.MethodsTo evaluate the effectiveness of work-related medical rehabilitation in cancer patients we conduct a cluster-randomized multicenter trial. In total, 504 rehabilitation patients between 18 and 60 years with a Karnofsky Performance Status of ≥70 %, a preliminary positive social-medical prognosis of employability for at least 3 h/day within the next 6 months and an elevated risk of not returning to work will be recruited in four inpatient rehabilitation centers. Patients are randomized to the work-related medical rehabilitation program or the conventional medical rehabilitation program based on their week of arrival at each rehabilitation center. The work-related medical rehabilitation program comprises additional work-related diagnostics, multi-professional team meetings, an introductory session as well as work-related functional capacity training, work-related psychological groups, and social counseling. All additional components are aimed at the adjustment of the patients’ capacity in relation to their individual job demands. Role functioning defines the main study outcome and will be assessed with the EORTC-QLQ30. Secondary outcome measures are the remaining scales of the EORTC-QLQ30, fatigue, self-rated work ability, disease coping, participation in working life, realization of work-related goals and therapies during rehabilitation, and treatment satisfaction.DiscussionA positive evaluation of work-related medical rehabilitation in cancer patients is expected due to the promising findings on the effectiveness of such programs for patients with other health conditions. Results may support the dissemination of work-related medical rehabilitation programs in German cancer rehabilitation.Trial registrationGerman Clinical Trials Register DRKS00007770. Registered 13 May 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2563-z) contains supplementary material, which is available to authorized users.