Abstract
Objectives
Work-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.
Design
Nonrandomized controlled trial (cohort study).
Setting
Fifty-nine German rehabilitation centers.
Participants
Patients (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.
Interventions
Work-related medical rehabilitation in 2014 and medical rehabilitation in 2011.
Main Outcome Measures
Treatment dose of work-related therapies.
Results
The 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.
Conclusions
The 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.
Keywords
List of abbreviations:
CI (confidence interval), ICC (intraclass correlation coefficient), WMR (work-related medical rehabilitation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 06, 2018
Footnotes
Supported by the Federal German Pension Insurance.
Clinical Trial Registration No.: DRKS00009780.
The institutions of Matthias Bethge, Miriam Markus, Christian Gerlich, and Michael Schuler have received research grants from the Federal German Pension Insurance during the conduct of the study. Marco Streibelt is an employee of the Federal German Pension Insurance.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
