Work ability, effort-reward imbalance and disability pension claims.

Background: Effort-reward imbalance (ERI) and self-rated work ability are known independent correlates and predictors of intended disability pension claims. However, little research has focused on the interrelationship between the three and whether self-rated work ability mediates the relationship between ERI and intended disability pension claims. Aims: To investigate whether self-rated work ability mediates the association between ERI and intended disability pension claims. Methods: Baseline data from participants of the Third German Sociomedical Panel of Employees, a 5-year cohort study that investigates determinants of work ability, rehabilitation utilization and disability pensions in employees who have previously received sickness benefits, were analysed. We tested direct associations between ERI with intended disability pension claims (Model 1) and self-rated work ability (Model 2). Additionally, we tested whether work ability mediates the association between ERI and intended disability pension claims (Model 3). Results: There were 2585 participants. Model 1 indicated a significant association between ERI and intended disability pension claims. Model 2 showed a significant association between ERI and self-rated work ability. The mediation in Model 3 revealed a significant indirect association between ERI and intended disability pension claims via self-rated work ability. There was no significant direct association between ERI and intended disability pension claims. Conclusions: Our results support the adverse health-related impact of ERI on self-rated work ability and intended disability pension claims.

[The impact of catastrophizing on the effect of depression on pain and functional ability : A longitudinal mediator analysis]. / Der Einfluss von Katastrophisieren auf den Effekt von Depressivität auf Schmerz und körperliche Funktion : Eine längsschnittliche Mediatoranalyse.

BACKGROUND: While the association between pain and depression is well proven, little is known about the mechanisms influencing this relationship. The cognitive distortion of catastrophizing plays a significant role in several concepts of both diseases. OBJECTIVE: The aim of the study was to analyze the role of catastrophizing on the effect of depression on pain and functional ability. MATERIAL AND METHODS: Participants were recruited from 11 outpatient rehabilitation centers in Germany at the beginning of orthopedic rehabilitation aftercare. Perceived functional ability (spinal function sort), pain intensity (rating scales) and physical functioning (36-item Short-Form Health Survey, SF-36) were assessed as dependent variables at the beginning of the aftercare (T1) as well as 6 months later (T2). The independent variable depression (Patient Health Questionnaire and Mental Health Index of the SF-36) as well as the mediator catastrophizing (Coping Strategies Questionnaire) were measured at T1. Pathway models were used to analyze the direct and indirect proportions of the total effect of an independent variable on a dependent variable and the role of catastrophizing as a mediator of this association. RESULTS: A total of 241 patients were included in the analyses. Depression had a significant total effect on pain as well as functional capacity. Catastrophizing mediated substantial proportions of these effects (42.9-87.1%). CONCLUSION: Catastrophizing mediates the relationship between depression and pain as well as functional capacity; therefore, the reduction of catastrophizing thoughts and attitudes should be a focus in rehabilitation programs.

[Work-Related Medical Rehabilitation]. / Medizinisch-beruflich orientierte 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.

[Intensified Work-Related Rehabilitation Aftercare: Long-term Results of a Randomized Controlled Multicenter Trial]. / Intensivierte medizinisch-beruflich orientierte Rehabilitationsnachsorge: Langfristige Ergebnisse der randomisiert-kontrollierten Multicenter-Studie.

OBJECTIVE: The objective was to evaluate the effectiveness of an intensified work-related rehabilitation aftercare (IWORAC) in comparison to the conventional intensified rehabilitation aftercare (IRAC). METHODS: Patients with severe limitations of work-related functioning were recruited in 11 outpatient rehabilitation centres at the beginning of their orthopaedic rehabilitation aftercare and randomly assigned to the interventions. The control group (n=150) received the IRAC while the intervention group (n=157) received the IWORAC which amended the IRAC by work-related functional capacity training, work-related psychosocial groups, social counselling and relaxation training. The primary outcome was work ability. Treatment effects were analyzed by generalized linear regression models. RESULTS: There was no statistically relevant between-group difference in follow-up primary or secondary (e. g., duration of sick leave, quality of life) outcomes. Both groups improved their quality of life and work ability considerably. CONCLUSION: RESULTS were not in favour of the IWORAC. The improvement of existing aftercare treatments might require a stronger involvement of the employer.

[Determinants of Intention to Apply for Medical Rehabilitation in Patients with Prior Sickness Benefits]. / Determinanten für intendierte Anträge auf medizinische Rehabilitation bei vorangegangenem Krankengeldbezug.

OBJECTIVES: The aim of the study was to identify determinants of intented applications for rehabilitation. MATERIAL AND METHODS: We included persons paying pension contributions to the Federal German Pension Insurance who had received sickness benefits in the year before the first survey and had not applied or utilized rehabilitation services between 2009 and 2012. RESULTS: 3,165 persons were considered for analysis. Intended applications were associated with low self-rated health, low self-rated work ability, frequent visits to physicians, professional and family support. These associations were relatively stable for different subgroups and were hardly moderated by sociodemographic characteristics. DISCUSSION: The results emphasis the importance of professional and family support for the application for medical rehabilitation.

[Social Support as a Resource for Work Ability]. / Soziale Unterstützung als Ressource für Arbeitsfähigkeit.

PURPOSE: The study examined the association of social support with subjective work ability, subjective prognosis of gainful employment and general health perception. METHODS: The analysis considered cross-sectional data from a sample of 2,983 employees (40-54 years) with sickness benefits in 2012. The postal survey was conducted in May 2013. RESULTS: After adjustment for socio-demographic and work-related characteristics as well as personality factors low social support was significantly associated with lower work ability (b=- 2,7; 95% CI:-3,4 to 1,9), higher odds of poor employment prognosis (OR=2,0; 95% CI: 1,5 to 2,6) and poorer health perception (b=- 8,0; 95% CI:-10,1 to-5,9). CONCLUSIONS: Low social support is potentially an independent predictor of lower work ability, employment prognosis and general health perception. To confirm causal relationships longitudinal data are needed, which will be assessed in 2015 and 2017.

[Implementation of Work-Related Medical Rehabilitation: A Propensity Score Matched Comparison of Two Cohorts from 2012 and 2014]. / Implementierung medizinisch-beruflich orientierter Rehabilitation: Ein Propensity Score gematchter Vergleich zweier Kohorten aus 2012 und 2014.

AIM OF THE STUDY: We examined if the work-related treatment dose has changed in 2014 than compared to 2012, if the work-related treatment dose differed between common medical rehabilitation (MR) and work-related medical rehabilitation (WMR), and if the therapy recommendations for WMR were met in Northern Germany rehabilitation centres in 2014. MATERIAL AND METHODS: Patients who were treated in WMR or conventional medical rehabilitation in 2014 were matched with patients treated in 2012 by using propensity scores. RESULTS: Patients who were treated in WMR in 2014 received more work-related interventions than comparable patients in 2012 (13.5 vs. 2.5 h) and MR patients in 2014 (13.5 vs. 1.2 h). 30 min of social counselling, 180 min of work-related psychological groups and 360 min of work-related functional capacity training were realised for 93.8, 82 and 41% of the patients participating in WMR in 2014 CONCLUSION: WMR programs in Northern Germany meet the recommendations of the WMR guideline.

[Motivational and Volitional Determinants of Applying for Psychosomatic Rehabilitation: Findings of a Cohort Study]. / Motivationale und volitionale Determinanten für die Beantragung einer psychosomatischen Rehabilitation: Ergebnisse einer Kohortenstudie.

Objective: Analyses of motivational and volitional determinants of applying for psychosomatic rehabilitation Methods: Determinants of a rehabilitation request were assessed by a questionnaire in 2013. Applications for psychosomatic rehabilitation measures until the end of 2014 were extracted from administrative data records. Included were employees with mental disorders. Results: Only 55 of 974 persons requested a rehabilitation measure. The intention to apply for a rehabilitation measure was strongest determined by self-efficacy and family and professional support. Planning was explained by intention and to a lesser extent by family and physician support. Persons with higher planning scores were more likely to apply for a rehabilitation measure. Physician support also increased the likelihood of a rehabilitation request. Conclusion: The analyses identified determinants of rehabilitation claims that are modifiable. This gives opportunities to support rehabilitation claims. However, the contribution of these factors to explain rehabilitation requests is only limited.

[Are Two-Year Vocational Retraining Programs Really Better than One-Year Programs? Findings of a Propensity Score Matched Analysis]. / Sind Vollqualifizierungen wirklich besser als Teilqualifizierungen? Ergebnisse einer Propensity Score gematchten Analyse.

AIM OF THE STUDY: To analyze if one- and 2-year vocational retraining programs achieve similar effects on employment. METHODS: Analyses were performed with longitudinal administrative data. We included persons aged 18-59 years, who started their retraining between January and June 2005. One- and 2-year program participants were matched by propensity scores. RESULTS: The matched groups were balanced regarding all baseline scores (one-year program: n=514; 2-year program: n=514). 4 and 5 years after start of the vocational retraining program, annual income, the duration of welfare benefits and the risk of a disability pension were comparable in both groups. However, the accumulative income between 2005 and 2009 was 9 294 Euro higher (95% CI: 3 656-14 932 Euro) in one-year retraining participants. Moreover, participants of one-year programs received less welfare benefits. CONCLUSION: The development of a vocational rehabilitation strategy needs to consider the accumulative advantage of one-year programs.

[Sports Activity Following Joint Arthroplasty: Experiences and Expectations of Elderly Patients--Findings from a Qualitative Content Analysis of Guided Interviews]. / Sportliche Aktivität nach Gelenkersatz: Erfahrungen und Erwartungen älterer Rehabilitanden- Ergebnisse einer qualitativen Inhaltsanalyse leitfadengestützter Interviews.

OBJECTIVE: The study investigated specific motives and barriers of sports activities in elderly patients with hip or knee arthroplasty. METHODS: We conducted guided interviews and analysed them by content analysis. RESULTS: 7 women and 8 men were interviewed. In total, we coded 520 passages; on average 34.7 (SD=11.1) per interview. Our findings document severe preoperative handicaps and identified a variety of sports activities which were practiced before treatment. The most emphasized motive was the social function of sports. The main barriers were the self-definition as a sick and elderly person and insecurity and concerns over the course of illness and healing. Very constraining advises on sports activities without consideration of the individual experience in sports were not perceived as helpful. CONCLUSION: Counselling on sports activities following joint replacement needs to consider individual motives, barriers and previous sports experience in order to be perceived as supportive.

[Are Administrative Data Prognostically Relevant for Intended Disability Pension Claims and Indicators of Subjective Need for Rehabilitation?]. / Sind administrative Daten für Rentenantragsintentionen und Indikatoren subjektiven Rehabilitationsbedarfs prognostisch bedeutsam?

OBJECTIVES: The aim of the study was to examine the associations of the Risk Index Disability Pension (RI-DP), which was calculated from administrative data, with intended disability pension claims and other health- and work-related characteristics. MATERIAL AND METHODS: Insured persons of the Federal German Pension Insurance were surveyed by questionnaire in 2013. Questionnaire data were additionally linked to administrative data. The gross sample was restricted to persons, who received sick leave benefits in the previous year while not claiming or utilizing any rehabilitation services for the previous 4 years. RESULTS: 1,261 men and 1,495 women were included in the analyses. The odds of an intended disability pension claim were 4.8-times higher in men and 3.4-times higher in women if RI-DP scores were high. Furthermore, high RI-DP scores were also associated with frequent disability days, poor self-rated work ability and frequent visits to physicians. DISCUSSION: The associations of the RI-DP with the examined characteristics imply that administrative data could support early identification of rehabilitation needs.

Direct and indirect effects of organizational justice on work ability.

BACKGROUND: Organizational justice (OJ), involving transparent workplace procedures and treating staff members with respect, has been of growing concern in recent epidemiological research as a determinant of health-related outcomes. AIMS: To examine the factorial validity of the German version of Moorman's Organizational Justice Questionnaire (OJQ), to investigate the direct cross-sectional effect of OJ on self-rated work ability and to analyse if there is an additional indirect effect of OJ on work ability mediated by effort-reward imbalance. METHODS: An analysis of cross-sectional data from the Second German Sociomedical Panel of Employees, involving white-collar workers employed at least half time. We performed confirmatory factor analyses to test the factorial validity of the OJQ and analysed the direct and indirect associations of OJ and self-rated work ability by path model analysis. RESULTS: Of the 1217 participants (47% female; mean age: 51) 36% had poor work ability. Factor analyses confirmed the two-factor structure of the German OJQ. Work ability was explained directly by OJ (ß = 0.30) and effort-reward imbalance (ß = -0.27). Additionally, we identified an indirect effect of OJ that was mediated by effort-reward imbalance (ß = 0.14). The total effect of OJ on work ability was remarkably strong (ß = 0.44). Associations remained unchanged after adjustment for socio-demographic parameters. CONCLUSIONS: This study showed the importance of considering additional indirect pathways when examining the impact of OJ on the work ability of employees.

[Specific work-related problems: do they matter in access to work-related medical rehabilitation?]. / Besondere berufliche Problemlagen: Spielen sie eine Rolle beim Zugang in die medizinisch-beruflich orientierte Rehabilitation?

BACKGROUND: The study determined if need for rehabilitation in work-related medical rehabilitation (WMR) is more frequently characterised by specific work-related problems than in conventional medical rehabilitation (MR). METHODS: In 6 rehabilitation centres, persons with back pain (M50, M51, M53, M54) were surveyed about work-related restrictions of work ability at begin of their rehabilitation. RESULTS: Differences in work ability of WMR and MR patients confirmed need-related access. However, these differences were exclusively explained by screening-based access decisions. If access was not supported by a screening, WMR and MR patients did not differ. Decisions by rehabilitation centres compared with decisions by insurance agencies resulted in similar differences between WMR and MR patients. CONCLUSION: Screening-based decisions about access enable a more need-related access to WMR. As there were no differences between access decisions by rehabilitation centres and insurance agencies, access decisions can be realised already by the insurance agency.

[Success factors of work-related orthopaedic rehabilitation]. / Erfolgsfaktoren medizinisch-beruflich orientierter orthopädischer Rehabilitation.

Work-related rehabilitation has for several years been gaining greater importance in orthopaedic rehabilitation. High-quality studies have confirmed that work-related medical rehabilitation has favourable effects on earning capacity and work-life participation. This does however not hold true for all work-related rehabilitation programmes. In this context, 5 theses concerning success factors of work-related medical rehabilitation are developed. It is set out that the effects of work-related medical rehabilitation on work ability and work-life participation can be improved if programmes realize a needs-oriented assignment, include cognitive-behavioural components, follow a multimodal approach, step up treatment intensity, and if treatments are manualized.

[Improved outcome quality following total knee and hip arthroplasty in an integrated care setting: results of a controlled study]. / Verbesserte Behandlungsqualität durch integrierte Versorgung bei Knie- und Hüftgelenkersatz: Ergebnisse einer kontrollierten Studie.

OBJECTIVE: In Germany, the introduction of the Law on integrated care (IC) (§ 140 a-d SGB V) opened up the possibility of cross-sectional health care settings and new forms of remuneration, and improved the conditions for a closer cooperation between health care providers. Patients awaiting a hip or knee arthroplasty expect a higher benefit from such an intensified cooperation of operating hospital and rehabilitation centre. However, to date there is no study that investigated the anticipated effects on functional outcomes. Therefore, the aim of our study was the efficacy evaluation of an arthroplastic IC model in comparison with usual care. METHODS: The controlled multicentre trial included pensioners who received an arthroplasty following gonarthrosis or coxarthrosis. Implantation of the arthroplasty was accomplished in 11 hospitals. Participants of the intervention group (IG; 3 hospitals) were treated within an IC model, participants of the control group (CG; 8 hospitals) were treated within conventional care. Primary outcome were the functional complaints measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: 481 patients attended the study (IG: n = 249; KG: n = 232). Response at end of treatment was 85.9% (n = 413), response after 4 months was 89.4% (n = 430) and after 1 year 85.9% (n = 413). Multivariate analyses confirmed a reduction of treatment time by 4 days (b = -3.964; 95% CI: -5.833 to -2.094; p < 0.001) and improved functional outcomes on the WOMAC (4 months: b = -7.219; 95% CI: -11.184 to -3.254; p < 0.001; 12 months: b = -8.070; 95% CI: -12.101 to -4.039; p < 0.001). Patients of the IG rated the process better (e. g. cooperation between hospital and rehabilitation centre: b = 0.672; 95% CI: 0.401 to 0.943; p < 0.001); reported a better self-rated health after 1 year (b = 4.418; 95% CI: 0.050 to 8.786; p = 0.047), and were physically more active (b = 1.603; 95% CI: 0.655 to 2.551; p = 0.001). CONCLUSION: The IC setting improved coordination and communication at the interface between hospital and rehabilitation centre (internal patient orientation). Higher patient satisfaction and better outcome quality (external patient orientation) are not only achievable by improved medical devices but also by innovative communicative and organisational structures bringing along an improved process quality.

[Risk Index Disability Pension (RI-DP). A register-based case-control study with 8,500 men and 8,405 women]. / Risikoindex Erwerbsminderungsrente (RI-EMR). Eine prozessdatenbasierte Fall-Kontroll-Studie mit 8500 Männern und 8405 Frauen.

The aim of our study was to identify variables of prognostic relevance for disability pensions (DP) in the register data of the German Pension Fund (GPF) and to use the identified variables to construct a risk index. The study was designed as a case-control study of insurants of the GPF Bund using disability pensioners from 2004-2008 as cases and active insurants as controls. Independent variables were selected from the accumulated register data from 2001-2003. Data of 8,500 men and 8,405 women were analyzed. The strongest predictor of future DP were days of sickness benefits. Men with short-term benefits had 6.1 times higher odds of receiving a DP, while men receiving long-term benefits had even 66.3 times higher odds of receiving a DP. For women, the odds were increased 3.8 and 38.4 times, respectively. The risk index score was calculated by transforming the linear combination of parameter estimators and personal characteristics to values ranging from 0-100. ROC analyses and survival analyses confirmed the prognostic relevance of the index score. Independent samples were used to validate our models. Our results show that the GPF has information which could enable an active strategy to enhance the provision of medical rehabilitation.

[Patients with low back pain. Psychosocial work-related factors and return to work - a literature review]. / Rückenschmerzpatienten. Psychosoziale arbeitsplatzbezogene Faktoren und berufliche Wiedereingliederung - eine Literaturübersicht.

BACKGROUND: Since the 1990s work-related rehabilitation programs have gained more importance in orthopaedic rehabilitation. Although inception cohort studies of patients with low back pain have indicated the prognostic relevance of psychosocial work-related factors for return to work, these factors and the interaction of these factors with restrictions in functional capacity have been less extensively considered during the rehabilitation process so far. METHODS: Systematic reviews on the course of low back pain were reviewed concerning the prognostic relevance of psychosocial work-related factors for return to work. RESULTS: Seven reviews were comparable concerning the outcome analysed (return to work) and the populations considered (acute/subacute). These reviews confirmed that patients with low back pain and low social support from supervisors and colleagues, low decision latitude, high psychosocial work demands and a poor subjective prognosis have a lower chance of returning to work. The prognostic relevance of job satisfaction was contradictory. CONCLUSION: Rehabilitation should be aimed at supporting and developing strategies for coping with psychosocial work stress.

[Return to work following work-related orthopaedic rehabilitation: a cluster randomized trial]. / Berufliche Wiedereingliederung nach einer medizinisch-beruflich orientierten orthopädischen Rehabilitation: Eine clusterrandomisierte Studie.

BACKGROUND: Since the 1990s work-related programmes became more important in orthopaedic rehabilitation. However, in Germany orthopaedic rehabilitation initially focussed on improvements in evaluating functional capacity and on the development of appropriate modules of exercise therapy while psychosocial work demands have been less considered in the rehabilitation process so far. OBJECTIVE: Aims of the study were implementation and efficacy evaluation of an intensified multimodal work-related programme following a cognitive behavioural approach. METHODS: Participants were patients with substantial work-related problems. Included patients were randomized in groups either to the work-related programme or to the common orthopaedic rehabilitation (cluster randomization). Primary outcome was return to work. Analyses were based on post-treatment data and data after six months. RESULTS: 236 (86.8%) patients consented to participate. Questionnaires at post-treatment were completed by 155 (65.7%) persons and after six months by 169 (71.6%) persons. The medical performance evaluation given in the discharge letters documented a better performance of the intervention group (positive capacity: p=0.037; negative capacity: p=0.016). This evaluation was also reflected by the patients' evaluation at post-treatment. Participants of the intervention group reported higher work-related self-efficacy (p<0.001) and felt that they are better prepared for the time after their rehabilitation (p=0.006). After six months participants of the intervention group had a 2.4-fold higher chance (p=0.007) of returning to work, reported a better mental condition (HADS depression: p=0.014; SF-36 Mental Health Index: p=0.026) and a more salutary work-related behaviour (AVEM striving for perfection: p=0.012). Regarding physical outcomes both groups achieved moderate to high effects. CONCLUSIONS: Results of the trial confirm that an intensified work-related programme with a well-defined multimodal composition like the one presented here is able to enhance the chances of participation in working life for patients with substantial work-related problems.

[Factors of successful integrated care settings for total knee and hip arthroplasty: findings of a qualitative process analysis]. / Erfolgsfaktoren integrierter Versorgungsprozesse in der Endoprothetik: Ergebnisse einer qualitativen Prozessanalyse.

AIMS: In Germany, introduction of the law on Integrated Health Care (IC) (section sign 140a-d SGB V) opened up the possibility of cross-sectoral health care settings and new forms of remuneration, and improved the conditions for a closer cooperation between health care providers. However, cross-institutional and interdisciplinary work contexts demand new organizational structures in order to assure the coordination of different competences, resources and interests. This study aims at identifying factors of successful integrated care settings for total hip and knee arthroplasty. Using the example of an integrated care setting between an orthopaedic hospital and a rehabilitation clinic it will be examined which factors lead to successful implementation of the services and measures designed. METHOD: A qualitative research design was developed comprising different methods of data assessment (participant observation, guided expert interviews, document analyses) enabling a comprehensive exploration. Overall, data were derived from six consultations with patients, two integrated care information sessions and various documents (17 patient files, information material, patient lists, etc.). RESULTS: First of all, the different phases of development and implementation of integrated care settings were described. In this context, clearly defined aims, structures and appropriate measures seem to be crucial for an ideal long-term cooperation. Furthermore, the staff perspective on the effects of the IC programme on their daily routines proved an essential basis for process reconstruction. The staff members pointed out four main aspects regarding IC settings, i. e., improved image, increased knowledge, intensity of relationship, and less and more work effort. Against this background, factors of successful IC settings could be generated such as the need for central coordination, a regular staff information systems as well as accompanying process monitoring. CONCLUSION: Several key factors of successful integrated care settings in arthroplasty could be generated which provide important clues for shaping future interdisciplinary and cross-sectoral cooperation settings in health care services in general.