[Online Rehab-Need Test (OREST): Effectiveness of an Invitation to Proactive Screening (self-test) for the Need for Medical Rehabilitation Among Individuals Covered by the German Statutory Pension Insurance Agencies in Baden-Württemberg and the Rhine Region]. / Online-Rehabedarfstest (OREST): Wirksamkeit einer Einladung zu einem proaktiven Screening (Selbsttest) auf Bedarf an medizinischen Rehabilitationsmaßnahmen bei Versicherten der Deutschen Rentenversicherung Baden-Württemberg und Rheinland.

PURPOSE: Up to now, there has been a lack of proactive approaches on the part of the rehabilitation providers, while simultaneously a suspected unmet rehabilitation need exists in some groups of insured persons. Therefore, the effectiveness of the invitation to a web-based self-test for rehabilitation needs as a new access route to medical rehabilitation was evaluated. The main question was whether the intervention leads to more approved rehabilitation applications in the follow-up period of 22 months and whether this effect is also apparent after controlling other influencing variables. METHODS: A randomized, controlled study with N=8000 insured persons of two regional statutory pension insurance agencies was conducted to check the effectiveness of the intervention. Insured persons of the intervention group (IG; n=4000) were informed by mail about the web-based self-test and received individual access data for it (user ID and PIN). The control group (CG; n=4000) received no information about the self-test. The primary outcome was the rate of approved rehabilitation applications, the secondary outcome was the application rate regardless of approval. RESULTS: Groups do not differ significantly in terms of primary or secondary outcomes. Even after controlling for other influencing factors, the intervention does not contribute to the prediction of outcomes, but some control variables, such as previous rehabilitation experience, prove to be important predictors for the application. CONCLUSION: The mere offer of a self-test for rehabilitation need by the pension insurance institution has no effect on the application process. Hence a letter from the pension insurance institution as the sole means of access does not appear suitable for increasing the rate of meaningful rehabilitation applications.

Intervention policies and social security in case of reduced working capacity in the Netherlands, Finland and Germany: a comparative analysis.

OBJECTIVES: Working age disability is a major challenge for policymakers in European countries. This pertains to both occupational reintegration and social benefits for work incapacity. In many states reforms have been initiated aimed at reducing disability scheme inflow and fostering return to work. Our study was motivated by the question as to which aspects of these reforms seem to have been effective. METHODS: Three different approaches were utilized: case vignettes, interviews and expert workshops in the respective countries (Netherlands and Germany in 2012; Finland in 2015), and a systematic search for relevant studies on occupational reintegration was performed. RESULTS: We found considerable differences as to the assessment of work incapacity and resulting monetary benefits in the three countries. Also, organisation and practices of occupational reintegration vary from one country to another. Major differences concern (1) the timing of interventions, (2) employer responsibility and workplace involvement, (3) incentives and sanctions and (4) organisational and procedural issues. CONCLUSIONS: Our results may partly explain why some reform strategies have been more successful than others, and thus contribute to the further development of social and labour policies in Europe.

Effectiveness and cost-effectiveness of a guided internet- and mobile-based depression intervention for individuals with chronic back pain: protocol of a multi-centre randomised controlled trial.

INTRODUCTION: Depression often co-occurs with chronic back pain (CBP). Internet and mobile-based interventions (IMIs) might be a promising approach for effectively treating depression in this patient group. In the present study, we will evaluate the effectiveness and cost-effectiveness of a guided depression IMI for individuals with CBP (eSano BackCare-D) integrated into orthopaedic healthcare. METHODS AND ANALYSIS: In this multicentre randomised controlled trial of parallel design, the groups eSano BackCare-D versus treatment as usual will be compared. 210 participants with CBP and diagnosed depression will be recruited subsequent to orthopaedic rehabilitation care. Assessments will be conducted prior to randomisation and 9 weeks (post-treatment) and 6 months after randomisation. The primary outcome is depression severity (Hamilton Rating Scale for Depression-17). Secondary outcomes are depression remission and response, health-related quality of life, pain intensity, pain-related disability, self-efficacy and work capacity. Demographic and medical variables as well as internet affinity, intervention adherence, intervention satisfaction and negative effects will also be assessed. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses. Moreover, a cost-effectiveness and cost-utility analysis will be conducted from a societal perspective after 6 months. ETHICS AND DISSEMINATION: All procedures are approved by the ethics committee of the Albert-Ludwigs-University of Freiburg and the data security committee of the German Pension Insurance (Deutsche Rentenversicherung). The results will be published in peer-reviewed journals and presented on international conferences. TRIAL REGISTRATION NUMBER: DRKS00009272; Pre-results.

[Comparison of medical rehabilitation in various European countries and the impact of European law on rehabilitation practice in Germany]. / Medizinische Rehabilitation im europäischen Vergleich und Auswirkungen des europäischen Rechts auf die deutsche Rehabilitation.

Medical rehabilitation practice differs substantially among European countries. In most countries, rehabilitation is predominantly carried out on an outpatient basis. It is funded by health care, and rehabilitation facilities are not very specialized in terms of specific indications. In contrast, medical rehabilitation in Germany is mostly carried out on an in-patient basis as a contained 3­week treatment. European law and European policies merely have an indirect impact on rehabilitation practice in Germany. In this article, the advantages and disadvantages of the various forms of rehabilitation services are discussed.

Missing data due to a 'checklist misconception-effect'.

OBJECTIVES: To analyze the extent and relevance of a postulated "checklist misconception-effect" (a specific response pattern characterized by symptom-free persons not checking the "not at all"-category). METHODS: Our data is derived from a survey of blue collar workers (n = 228) who previously had filed in applications for medical rehabilitation benefits. We defined the "checklist misconception-effect" by the following response pattern: (1) at least one missing value and (2) at least one valid item response and (3) no 'not at all' responses. RESULTS: 75% of the responders had complete data, 16.2% a postulated 'checklist misconception-effect'. Substantial co-variations with socio-demographic characteristics or health status indicators could not be found. Additional imputation of missing values under the assumption of a "checklist misconception-effect" led to a reduction of missing data in the somatisation-subscale score from 12.3% to 0.4% compared to a simple manual-based calculation. Correlation with various external criteria (general health perception, level of functioning, depression) remained unchanged. CONCLUSIONS: Ignoring the "checklist misconception-effect" would overestimate symptom load. However, the validity of this effect has still to be proven in methodological studies.

[Predictive validity of a brief scale to assess subjective prognosis of work capacity (SPE Scale) in a cohort of LVA insured patients with severe back pain or functional complaints relating to internal medicine]. / Prädiktive Validität einer kurzen Skala zur subjektiven Prognose der Erwerbstätigkeit (SPE-Skala) in einer Kohorte von LVA-Versicherten mit schweren Rückenschmerzen oder funktionellen Beschwerden der inneren Medizin.

OBJECTIVES: Vocational (dis-)ability is a central concept in social medicine. Beside from medical factors psychological and system factors play a crucial role in determining vocational disability. The development of instruments assessing the prognosis of gainful employment is an important task in rehabilitation research. METHODS: A short scale measuring the subjective prognosis of gainful employment (SPE-scale) was administered to 481 blue collar workers suffering from severe back pain or else functional syndromes. Employment status two or three years following the assessment is known. RESULTS: 11% of the subjects have applied for early retirement; 5% actually have retired. There are statistically significant relations of SPE-scores and subjects employment status. Effect sizes of the SPE-scores equal or even outrank those of other instruments assessing vocational (dis-)ability. The positive predictive power of the scale is low, though. CONCLUSIONS: The SPE scale can be recommended for further use in (rehabilitation) research. The employment of the instrument for medical appraisal has to be viewed with more caution. The percentage of subjects at risk for early retirement is largely overestimated in case of a positive test. Instruments like the SPE-scale can assist but never replace the medical appraisal.