[Stay at Work - Feasibility and Acceptance of a Part-Time Medical Rehabilitation]. / Stay at Work ­ Machbarkeit und Akzeptanz einer berufsbegleitenden Form der medizinischen Rehabilitation.

PURPOSE: Back pain is associated with significant impairments of participation, which should be prevented by medical rehabilitation programs. The existing evidence shows that the German rehabilitation model is not effective for all target groups. In addition to intensified measures for patients with a high risk of failed return to work, a less intense rehabilitation form could be useful for patients with moderate disabilities. Therefore, in this study the feasibility of a part-time medical rehabilitation (German abbreviation: BbR) was examined. The BbR was designed as a closed group program with a therapy duration of 48 hours (2 appointments per week over 12 weeks). Furthermore, different access paths to BbR as well as the effects were focused. METHODS: Twelve groups with 6 to 12 participants each were planned in 3 outpatient rehabilitation centers. In addition to the regular application process, insured persons were recruited via the network of rehabilitation centers as well as the company service of the German Pension Insurance. The BbR focused on employed patients who were not on sick-leave and had the need for rehabilitation due to back pain. The evaluation was multi-perspective and multi-methodical. All participants completed questionnaires at admission, while and at discharge of the BbR. In addition, discussions in groups were conducted with representatives of the rehabilitation centers, the pension insurance and employers. RESULTS: In total, 7 groups with 56 participants could be realized in 2 rehabilitation centers. The typical BbR-participant was female, married, without children, 48 years old and working full for medium-sizes enterprise without shift work. The majority had no or minor no time of sick-leave in the year prior to rehabilitation. 59% of them were recruited by the rehabilitation centers; only few persons were assigned by the pension insurance. Two thirds would not have applied for a medical rehabilitation without the offer of BbR. Overall, the participants were very satisfied with the BbR. However, the compatibility of the BbR with the job and everyday life was perceived as a challenge. A pre-post comparison showed moderate to strong differences in self-rated health, pain, functional status and work ability. CONCLUSION: The BbR seems to be a useful additional concept in the German rehabilitation system for patients with moderate disabilities. Before dissemination, the identified challenges should be solved. This applies in particular to the recruitment and compatibility of rehabilitation with work and everyday life.

[Insurants' Views on Different Forms of Medical Rehabilitation - A Qualitative Study]. / Wie bewerten Versicherte unterschiedliche Ausgestaltungen der medizinischen Rehabilitation?

OBJECTIVE: The aim of the study was to assess insurants' views on various forms of medical rehabilitation of the German Federal Pension Insurance (DRV). METHODS: In ten focus groups, participants (n=78, 65% female, M=52.2 years) discussed the advantages and disadvantages of inpatient rehabilitation, outpatient rehabilitation, rehabilitation parallel to work, and case management. Central to discussion were treatment modalities such as setting, duration and cooperation with other actors in the health care system. The focus groups were transcribed and analyzed qualitatively (Mayring, 2008). RESULTS: Many participants expressed the need to be removed from their daily routine in order to concentrate on rehabilitative treatment. The perceived lower treatment intensity and double pressure of outpatient rehabilitation are feared to have a negative effect on treatment outcome. According to participants, the fit between the rehabilitation form and the needs of the rehabilitant is crucial. CONCLUSION: The qualitative data can be used to adjust rehabilitation treatment to insurants' needs.