[Results of a Survey Regarding the Implementation of Work-Related Medical Rehabilitation for Patients with Musculoskeletal Disorders: Evaluation and Training of Work-Related Functional Capacity]. / Ergebnisse einer Befragung orthopädischer Rehabilitationseinrichtungen zur Umsetzung der Medizinisch-beruflich orientierten Rehabilitation: Leistungsdiagnostik und Arbeitsplatztraining.

PURPOSE: Although work-related medical rehabilitation (WMR) has been established as a component of the rehabilitative care system for some time, particularly in patients with musculoskeletal disorders, studies indicated strong heterogeneity regarding the implementation of the guideline for WMR in Germany. This study is the first to examine the implementation of work-related functional capacity training and the preceding work-related diagnostics based on a nationwide survey of WMR health care professionals. METHODS: Rehabilitation facilities (n=317) authorized to carry out WMR in patients with musculoskeletal disorders were invited to participate in a nationwide survey. 86 of 317 facilities responded to the self-developed questionnaire and met the inclusion criteria. RESULTS: 67% of the WMR facilities described a systematic use of functional capacity evaluation (FCE) at the beginning of rehabilitation in at least 50% of the rehabilitants. 70% stated that they systematically matched abilities and work demands. Furthermore, 57% reported that profile comparisons were used to tailor training of work-related functional capacity. The training itself was provided to at least every second rehabilitant with a total duration of 360 minutes or more in about every second facility. The FCE procedures and the work-related functional capacity training were primarily carried out by occupational therapists. CONCLUSION: Work-related diagnostics and the work-related functional capacity training are often but not yet always implemented in line with the guideline for WMR. Promoting interdisciplinarity seems to be a promising approach regarding the further development of WMR.

[Results of a Survey Regarding the Implementation of Work-Related Medical Rehabilitation for Patients with Musculoskeletal Disorders: Identification of a Need and the Assessment of Work Demands]. / Ergebnisse einer Befragung orthopädischer Rehabilitationseinrichtungen zur Umsetzung der Medizinisch-beruflich orientierten Rehabilitation: Bedarfsidentifizierung und Analyse der Arbeitsanforderungen.

PURPOSE: Research indicates that the implementation of work-related medical rehabilitation (WMR) is characterized by pronounced heterogeneity and that the requirements defined by the German Pension Insurance are not consistently met. The study aimed to investigate the implementation of the WMR guideline in patients with musculoskeletal disorders with regard to the identification of a need for WMR as well as the assessment of the individual demands of work. METHODS: 317 rehabilitation facilities authorized for WMR in patients with musculoskeletal disorders were invited to participate in a nationwide survey. 86 of 317 facilities responded to the self-developed questionnaire and met the inclusion criteria. RESULTS: Although most facilities reported that nearly all patients receive WMR if they have a need for it, the proportion of WMR measures provided was below ten percent in the majority of cases. With regard to work demands, respondents demanded greater involvement of employers in order to strengthen validity. CONCLUSION: The findings indicate that WMR is largely implemented in accordance with the WMR guideline. The main challenges include meeting the need for WMR and strengthening the involvement of employers in the assessment of work requirements.

Do patient characteristics affect the predictive validity of Functional Capacity Evaluations?

PURPOSE: The aim of this study was to identify patient-related characteristics that affect the predictive validity of the FCE assessment ELA. METHODS: A prospective multicenter study was conducted on 303 patients with musculoskeletal disorders (MSD) recruited from eleven rehabilitation centers. The ELA-based estimation of the participants' ability to cope with physical work demands was considered valid if RTW was paired with a positive ELA outcome (≥ moderate) as well as if non-RTW was accompanied by a negative ELA outcome (rather or very poor). In the remaining cases, the ELA result was judged as non-valid. To reduce the risk of false conclusions, the rating was performed inversely in participants that (1) reported severe limitations regarding their productivity at work, (2) attributed RTW to a change in job resp. a reduction of their physical work demands and in those that (3) attributed non-RTW to non-physical reintegration barriers only. Using questionnaires, 28 patient-related characteristics were collected. Logistic regression models were calculated to identify characteristics that affected the predictive validity of ELA. RESULTS: ELA was considered valid in 208 of 303 (69%) participants. A moderate and strong pain-related disability at work were associated with a 0.15-fold (95% confidence interval (95% CI) 0.05-0.46), respectively, 0.19-fold (95% CI 0.05-0.72) chance for a valid outcome. In addition, a negative influence was found in participants that reported psychosocial distress (odds ratio (OR) 0.35; 95% CI 0.15-0.82), a native language different from the national language (OR 0.16; 95% CI 0.05-0.56) as well as in those that expected to return to work, but not within one month (OR 0.17; 95% CI 0.06-0.46). Further variables-including age, employment status, fear-avoidance beliefs and the level of physical work demands-did not affect the predictive validity of ELA. CONCLUSIONS: The results suggest that the predictive validity of ELA is primarily limited by patients that report a moderate or strong pain-related disability at work, psychosocial distress as well as the expectation to return to work, but not within one month. Furthermore, a negative influence can be assumed for language barriers.

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.

Predictive validity of a customized functional capacity evaluation in patients with musculoskeletal disorders.

PURPOSE: To examine whether the performance-based work-related functional capacity evaluation (German title: Einschätzung körperlicher Leistungsfähigkeiten bei arbeitsbezogenen Aktivitäten-ELA) can predict return to work (RTW) in patients with musculoskeletal disorders (MSD). METHODS: A multicenter cohort study was conducted on 162 employed or self-employed patients with various injury-related and chronic MSD, recruited from four outpatient rehabilitation clinics. Patient-reported data on health and work ability were collected at discharge. The FCE test was performed subsequently. The overall FCE-based estimation of the ability to cope with the physical demands of work (positive vs. negative) was used to predict RTW. Successful RTW was defined as a combination of (self-)employment at the 3-month follow-up and a low level of sick leave (< 1.5 weeks) due to MSD. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using logistic regression models to evaluate the predictive validity of the adjusted FCE results. RESULTS: Based on the FCE test, 82% of the patients were estimated as being able to cope with the physical demands of work. 77% of the patients with a positive FCE outcome returned to work (positive predictive value) and 83% with a negative FCE outcome did not (negative predictive value). Patients whose functional capacity was estimated to match the job demands were associated with sixfold higher odds of returning to work after adjusting for patient-reported data on health and work ability. The agreement between the FCE result and RTW differed only on a low to moderate level between the therapists who administered the FCE (72-89%). CONCLUSION: The FCE test at discharge predicts RTW among patients with musculoskeletal disorders.

[The Prognostic Validity of the Functional Capacity Evaluation ELA in Work-Related Medical Rehabilitation]. / Die prognostische Validität des FCE-Verfahrens ELA in beruflich orientierten medizinischen Rehabilitationsmaßnahmen.

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.

Promoting Return to Work After Vocational Rehabilitation Using a Work-Related Fitness App: Protocol for a Cluster-Randomized Controlled Trial.

BACKGROUND: Retraining programs in vocational rehabilitation are often characterized by a low level of physical activity, even when targeting jobs with primarily physical demands. They might therefore be accompanied by a decline in functional capacity if the lack of physical activity is not compensated by increased activity during leisure time. The implementation of a work-related exercise app might be a promising approach to promoting a return to work in vocational rehabilitation. We developed the "WORKout-app" which provides exercise plans based on a comparison of the physical demands of the retraining profession and the current functional capacity. OBJECTIVE: The aim of this study is to examine the effects of app-based exercise during vocational rehabilitation on perceived work ability (primary outcome), occupational self-efficacy, days of sick leave, and return to work (secondary outcomes). METHODS: We conducted a cluster-randomized controlled trial with 2 arms (intervention: WORKout-app vs control: treatment as usual) in 4 cohorts of 5 vocational rehabilitation centers in Germany. Participants are nested within retraining classes per vocational rehabilitation center and per cohort assigned to either the intervention condition or the control condition. The target sample size at the participant level is 598. Measurement time points include baseline, the end of rehabilitation, 3 months after the end of rehabilitation, and 6 months after the end of rehabilitation. Linear and generalized linear mixed-effects models are performed to test for treatment differences in outcomes. RESULTS: This study is funded by the German Federal Pension Insurance. The trial is registered with the German Clinical Trials Register (DRKS00030775) and approved by the Ethics Committee of the German Sport University Cologne (145/2022). CONCLUSIONS: The findings of the study will inform researchers and practitioners about the effectiveness of an exercise app developed to counteract the effects of physical inactivity during vocational rehabilitation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50200.