[Holistic clarification of the need for intervention at the interface of rehabilitation and occupational medicine when work participation is at risk]. / Ganzheitliche Klärung des Interventionsbedarfs bei gefährdeter beruflicher Teilhabe an der Schnittstelle von Rehabilitation und Betriebsmedizin: Eine Machbarkeitsstudie.

Introduction: For employees whose work participation is at risk, a comprehensive and workplace-oriented diagnosis is required in order to understand the health problems and to support affected persons with individual solutions. We developed a novel diagnostic service to ensure work participation that combines rehabilitative and occupational health medicine. The aim of this feasibility study was to evaluate the implementation and to analyze changes in health and working ability. Methods: The observational study (German Clinical Trials Register: DRKS00024522) included employees with health restrictions and limited working ability. Participants received an initial consultation from an occupational health physician, a 2-day holistic diagnostics work-up at a rehabilitation center and up to four follow-up consultations. Questionnaire data collected at the initial consultation and at the first and last follow-up consultations included subjective working ability (0-10 points) and general health (0-10). Results: Data from 27 participants were analyzed. The participants were 63% female and on average 46 years old (standard deviation, SD = 11.5). From the initial consultation to the final follow-up consultation, participants reported improvement in their general health (difference = 1.52; 95% confidence interval. CI: 0.37-2.67; d = 0.97). Discussion and conclusion: The model project GIBI offers low-threshold access to a confidential, comprehensive and workplace-oriented diagnostic service to support work participation. Successful implementation of GIBI requires intensive cooperation between occupational health physicians and rehabilitation centers. To evaluate the effectiveness, a randomized controlled trial (n = 210) with a waiting list control group is currently underway.

Study protocol of a randomized controlled trial evaluating home treatment with peer support for acute mental health crises (HoPe).

BACKGROUND: Home treatment (HT) is a treatment modality for patients with severe mental illness (SMI) in acute mental crises. It is frequently considered equivalent to psychiatric inpatient treatment in terms of treatment outcome. Peer Support (PS) means that people with lived experience of a mental illness are trained to support others on their way towards recovery. While PS is growing in international importance and despite a growing number of studies supporting its benefits, it is still not comprehensively implemented into routine care. The HoPe (Home Treatment with Peer Support) study investigates a combination of both - HT and PS - to provide further evidence for a recovery-oriented treatment of psychiatric patients. METHODS: In our randomized controlled trial (RCT), HT with PS is compared with HT without PS within a network of eight psychiatric clinical centers from the North, South and East of Germany. We investigate the effects of a combination of both approaches with respect to the prevention of relapse/recurrence defined as first hospitalization after randomization (primary outcome), disease severity, general functioning, self-efficacy, psychosocial health, stigma resistance, recovery support, and service satisfaction (secondary outcomes). A sample of 286 patients will be assessed at baseline after admission to HT care (data point t0) and randomized into the intervention (HT + PS) and control arm (HT). Follow-Up assessments will be conducted 2, 6 and 12 months after admission (resulting in three further data points, t1 to t3) and will be analyzed via intention-to-treat approach. DISCUSSION: This study may determine the positive effects of PS added to HT, prove additional evidence for the efficacy of PS and thereby facilitate its further implementation into psychiatric settings. The aim is to improve quality of mental health care and patients' recovery as well as to reduce the risk of relapses and hospitalizations for patients with SMI. TRIAL REGISTRATION: The trial is registered with ClinicalTrials.gov: NCT04336527 , April 7, 2020.

A comprehensive diagnostic service to clarify intervention needs when work participation is at risk: study protocol of a randomized controlled trial (GIBI, DRKS00027577).

BACKGROUND: Effective care services for people whose work participation is at risk require low-threshold access, a comprehensive diagnostic clarification of intervention needs, a connection to the workplace and job demands, and interdisciplinary collaboration between key stakeholders at the interface of rehabilitation and occupational medicine. We have developed a comprehensive diagnostic service to clarify intervention needs for employees with health restrictions and limited work ability: this service is initiated by occupational health physicians. METHODS/DESIGN: Our randomized controlled trial tests the effectiveness of a comprehensive diagnostic service for clarifying intervention needs (GIBI: Comprehensive clarification of the need for intervention for people whose work participation is at risk). The comprehensive intervention comprises three elements: initial consultation, two-day diagnostics at a rehabilitation center and follow-up consultations. We will include 210 employees with health restrictions and limited work ability, who are identified by occupational health physicians. All individuals will receive an initial consultation with their occupational health physician to discuss their health, work ability and job demands. After this, half the individuals are randomly assigned to the intervention group and the other half to the waiting-list control group. Individuals in the intervention group start two-day diagnostics, carried out by a multi-professional rehabilitation team in a rehabilitation center, shortly after the initial consultation. The diagnostics will allow first recommendations for improving work participation. The implementation of these recommendations is supported by an occupational health physician in four follow-up consultations. The control group will receive the comprehensive two-day diagnostic service and subsequent follow-up consultations six months after the initial consultation. The primary outcome of the randomized controlled trial is self-rated work ability assessed using the Work Ability Score (0 to 10 points) six months after study inclusion. Secondary outcomes include a range of patient-reported outcomes regarding physical and mental health, impairment, and the physical and mental demands of jobs. DISCUSSION: This randomized controlled trial is designed to test the effects of a new complex intervention involving a comprehensive clarification of intervention needs in order to promote work participation and prevent the worsening of health and work disability. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00027577, February 01, 2022).