Sequences of vocational rehabilitation services in Germany: a cohort study.

BACKGROUND: This study aimed to describe sequences of vocational rehabilitation services among individuals with approved vocational rehabilitation in Germany and to identify typical service sequences. METHODS: We used administrative data on vocational rehabilitation services and questionnaire data on health and work ability to describe frequencies and sequences of vocational rehabilitation services financed by the Federal German Pension Insurance. Through sequence analysis, we were able to map the service sequences. We did cluster analyses to identify typical different service sequences. RESULTS: Our sample included 1,652 individuals with 2,584 services. Integration services and two-year vocational retraining were the most common services. We could identify three different service clusters around integration services: shorter ones, followed by employer benefits and without employer benefits. We found two different clusters around two-year vocational retraining: shorter and longer clusters. Two-year vocational retraining was more often initiated by preparatory services and followed by employer benefits than integration services. Longer services in both clusters were associated with better baseline data for physical health, work ability, risk of future work disability, and younger age than shorter services. People in two-year-vocational retraining reported at baseline better general health, better work ability, low risk of future work disability, and less mental illness compared to people in integration services. CONCLUSIONS: Multiple services, that is, sequences of services, were more likely to occur among individuals with more complex services like two-year vocational retraining. Utilization of complex services and longer services was influenced by health, age, risk of future work disability, and education. TRIAL REGISTRATION: German Clinical Trials Register DRKS00009910, registration 25/01/2016.

[Facilitating and Hindering Factors in the Implementation of Medical Rehabilitation of Adolescents with Scoliosis before and during the SARS-CoV-2 Pandemic: A Qualitative Study]. / Förderliche und hinderliche Faktoren für die Durchführung der medizinischen Rehabilitation bei Jugendlichen mit Skoliose vor und während der SARS-CoV-2-Pandemie: Eine qualitative Studie.

PURPOSE: Based on the experience during the SARS-CoV-2 pandemic, the study aimed to derive facilitating and hindering factors in the implementation of medical rehabilitation during future pandemics in adolescents with scoliosis. METHODS: A qualitative study design with guided expert interviews was chosen. Twelve interviews with adolescents and seven interviews with physiotherapists were conducted. The evaluation was carried out using qualitative content analysis according to Mayring and inductive categorization. RESULTS: For 83.3% of the adolescents a therapy considering individual patient needs was a facilitator. Good information management (91.7%), continued availability of leisure activities (66.7%), and a high perception of safety (100%) were facilitating. 71.4% favoured outdoor therapy. The increased exertion caused by wearing a mask (91.7%) and the shortened therapy times (66.7%) were seen as barriers. For 75.0% of the adolescents, social contacts were more difficult. All therapists stated that communication between patients and therapists was more difficult. CONCLUSION: For successful rehabilitation during the SARS-CoV-2 pandemic, depending on weather conditions, therapy should be outside, as there is no need to wear mouth-nose protection outdoors. In addition, the physiotherapeutic treatment (Schroth therapy) should be carried out without mask due to the intensity of the exercise. Social contacts among all adolescents should be supported as much as possible. The leisure activities should provide a wide choice and enough free places. Continuation of certain hygienic measures could help to reduce the incidence of illnesses (e. g., gastrointestinal infections) in the future. These were barely noticed in rehabilitation facilities during the pandemic.

A Mega-Ethnography of Qualitative Meta-Syntheses on Return to Work in People with Chronic Health Conditions.

PURPOSE: The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies. METHODS: We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings. RESULTS: Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model. CONCLUSIONS: RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.

[Impact of the SARS-CoV-2 Pandemic on the Utilization of Cancer Rehabilitation: a Difference-in-Differences Analysis]. / Auswirkungen der SARS-CoV-2-Pandemie auf die Inanspruchnahme der onkologischen Rehabilitation: eine Difference-in-Differences-Analyse.

PURPOSE: Restricted access to rehabilitative care due to the SARS-CoV-2 pandemic may affect the participation of cancer survivors and risks progression of the underlying disease. The aim of our analyses was to examined the extent to which cancer rehabilitations in Germany decreased due to the SARS-CoV-2 pandemic. METHODS: Data were retrieved from the German Pension Insurance which is the main provider for medical rehabilitation in Germany. We used monthly cross-sectional data on the utilization of cancer rehabilitation (Ca-rehab-services according to section 15 for working-aged people or section 31 social security code VI for pensioners) in 2019 and 2020. We used a difference-in-differences model to determine the reduction in rehabilitation utilization attributable to the pandemic and reported incidence rate ratios (IRR). RESULTS: We included 146,924 cancer rehabilitations in 2019 and 113,117 cancer rehabilitations in 2020. Compared to the previous year, the nationwide decline in cancer rehabilitations was greatest in April 2020 (63.2%). Utilization of cancer rehabilitation was reduced by 11.5% for benefits according to section 15 social security code VI (IRR=0.885; 95% CI: 0.864 to 0.906) and by 26.5% for benefits according to section 31 (IRR=0.735; 95% CI: 0.717 to 0.754) due to the pandemic. For pensioners the decline in utilization was more pronounced in Western Germany than in Eastern Germany and greater for non-post-acute rehabilitations than for post-acute rehabilitations. CONCLUSION: The analyses show a pandemic-related decline in cancer rehabilitations, especially in cancer rehabilitation services for pensioners. Failure to seek medical rehabilitation, through which physical and psychological recovery and relief from disease and treatment side effects can be achieved, will have a lasting impact on the participation for many cancer survivors. Repeated monitoring of work ability and health of chronically ill people could generate necessary data to clarify why people in need of rehabilitation have avoided seeking medical rehabilitation and how they can be supported.

Use of a job exposure matrix to predict the risk of work disability in individuals with back pain: An inception cohort study.

BACKGROUND: Low back pain has a high economic burden in Germany due to back pain-related sick leave, disability pensions, and health care utilization. Work-related factors can predict disabling back pain. Job exposure matrices can be used to consider job demands and occupational characteristics in routine data analysis. OBJECTIVE: This longitudinal analysis tested whether rehabilitation utilization due to musculoskeletal disorders is associated with occupation-linked job exposures in employees with back pain. METHODS: Data from a German cohort study were used, including employees aged 45 to 59 years with self-reported back pain in the last three months. Individuals' job titles were assessed in the baseline survey in 2017 and matched with parameters of aggregated job exposure indices. Administrative data from the German Pension Insurance were used to extract information on rehabilitation utilization. Proportional hazard models tested the associations. RESULTS: We considered data of 6,569 participants (mean age: 52.3 years; 57.7% women). During follow-up, with a maximum of 21 months, 296 individuals (4.5%) utilized medical rehabilitation due to musculoskeletal disorders. Adjusted analyses showed that high physical (HR = 2.87; 95% CI 1.74; 4.75) and overall (HR = 2.34; 95% CI 1.44; 3.80) job exposures were associated with a higher risk of rehabilitation utilization. CONCLUSION: Individuals with back pain working in occupations with high physical job exposures have a higher risk for rehabilitation utilization. To prevent work disability in individuals with back pain, occupational groups with high physical job exposures should be actively informed about tailored intervention options.

Increasing the use of medical rehabilitation by children and adolescents with migrant background through a multimodal information campaign: protocol of a trend study and accompanying process evaluation (MiMi-Reha-Kids, DRKS00019090).

Background: Chronic illnesses can have an unfavorable impact on the participation opportunities of children and adolescents. The German health care system offers medical rehabilitation in order to prevent negative effects, however, migrant children and adolescents make use of this option less frequently than their peers without a migrant background. A multimodal information campaign was developed to increase the use of medical rehabilitation by children and adolescents with a migrant background, and to reduce disparities in health care. Methods: The process evaluation will examine the implementation of a multimodal information campaign intended to increase the use of medical rehabilitation by migrant children and adolescents. The information campaign follows a low-threshold participatory approach. In a first step, persons from different migrant communities in Berlin and Hamburg are trained to become transcultural health mediators. These mediators then share their knowledge about chronic illnesses and medical rehabilitation with other families at information events held in their native language. The transcultural mediators also support migrant families in applying for medical rehabilitation. The effectiveness of the intervention will be tested by a trend study with repeated cross-sectional surveys. For this purpose, all families in the project regions of Berlin and Hamburg whose child has received medical rehabilitation are surveyed annually in order to be able to map changes in the proportions of children and adolescents with a migrant background over the course of the project. Discussion: The study protocol describes a complex intervention to increase the use of medical rehabilitation by migrant children and adolescents, and the accompanying process evaluation and trend study. The intervention is intended to contribute to reducing health inequalities in Germany. Conclusion: The study described in this protocol will provide extensive data on the multimodal information campaign and can thus help organizations and institutions adapt or further develop similar measures for other regions. Clinical trial registration: German Clinical Trials Register (DRKS00019090).

Rehabilitation utilization of non-migrant and migrant persons with back pain: A cohort study using different definitions of migrant background.

Background: Medical rehabilitation (MR) by the German Pension Insurance is approved to maintain and to restore work ability and to avoid disability pensions. Studies on the rehabilitation utilization by people with a migration background (PMB) compared to people without a migration background (non-PMB) showed heterogeneous results, which may be partly due to different definitions of migration status. The aim of this paper was to test whether there are differences in utilization of MR between employed PMB and non-PMB with self-reported back pain. Methods: We used data from a large German cohort study that analyzed the effectiveness of MR for individuals with back pain and was conducted between 1st January 2017 and 31st December 2019. Employees aged 45 to 59 years who reported back pain in the last three months completed the baseline questionnaire in 2017. We used four definitions of migration background (MB) to differentiate by first- and second-generation migration, by one- and two-sided migration background, by language, or by nationality. Data on rehabilitation utilization was extracted from administrative records covering the period until the end of 2018. Findings: Data of 6,713 participants were included, and 514 individuals utilized MR during follow-up. Adjusted analyses showed a decreased risk of rehabilitation utilization in people with a first-generation MB (HR = 0·46; 95% CI 0·29; 0·72), people with a two-sided MB (HR = 0·47; 95% CI 0·31; 0·72), people whose native language was not German (HR = 0·52; 95% CI 0·30; 0·91), and people without German nationality (HR = 0·29; 95% CI 0·12; 0·72) when compared to non-PMB. Interpretation: This study showed that employees with a MB reporting back pain had a significantly reduced risk for utilization of rehabilitation services. This underutilization could be observed considering different definitions of MB. Future research on rehabilitation utilization by PMB should consider the impact of different definitions on the results. Funding: The study was funded by the German Research Foundation (grant numbers: BE 5885/2-1; MA 6981/2-1). The German Research Foundation functions as a self-governing institution for the promotion of science and research in Germany.