Estimating time to reinjury among Washington State injured workers by degree of permanent impairment: Using state wage data to adjust for time at risk.

BACKGROUND: Many injured workers are reinjured, but reinjury risk is challenging to quantify. Because many injured workers face delayed return-to-work, or return to part-time or intermittent jobs, a calendar timescale may overestimate actual work-time at risk, yielding underestimated reinjury rates. Objectives included determining: (1) reinjury risk by degree of permanent impairment and other factors, and (2) how choice of timescale affects reinjury estimates. METHODS: This retrospective cohort study included Washington State workers' compensation (WC) claims for 43,114 injured workers, linked to state wage files (2003-2018). Three timescales were used to define at-risk denominators: (1) calendar quarters; (2) quarters with any wages; and (3) full-time equivalent (FTE) quarters, defined as cumulative work hours ÷ 520. Associations between reinjury outcomes and worker, injury, job, and WC vocational rehabilitation program participation characteristics were assessed using Cox proportional hazards regression. RESULTS: Overall reinjury rates were 5.9 per 100 worker-years using a calendar timescale (95% confidence interval [CI]: 5.8-6.0), 10.0 using any-wage quarters (95% CI: 9.9-10.2), and 12.5 using FTE quarters (95% CI: 12.3-12.7). Reinjury rates were highest in the first two quarters after initial injury, remaining elevated for about 4 years. Using FTE quarters, workers with ≥10% whole body impairment had a 34% higher risk of reinjury relative to workers with no permanent partial disability award (95% CI: 1.25-1.44); no difference was detected using calendar time. CONCLUSIONS: Timescale substantially affects reinjury estimates and comparisons between groups with differential return-to-work patterns. Linking wage data to WC claims facilitates measurement of long-term employment, yielding more accurate reinjury estimates.

[An assessment of the role of the Social Insurance Institution in the occupational activation of people with health problems, conducted by issuing decisions on the appropriateness of vocational retraining]. / Ocena roli Zakladu Ubezpieczen Spolecznych w aktywizacji zawodowej osób z problemami zdrowotnymi, realizowanej poprzez wydawanie orzeczen o celowosci przekwalifikowania zawodowego.

BACKGROUND: The new training allowance policy has been put in the Social Insurance Institution to bring back to employment workers with health problems unfit for their previous occupation. These people, following specific vocational training, may acquire new skills and competencies to stay on the labor market. The aim of this study was to assess the role of the Social Insurance Institution in the activation of persons with health problems, which was carried out by issuing opinions about the appropriateness of vocational retraining. MATERIAL AND METHODS: The analysis included 460 cases in which decisions on the appropriateness of vocational retraining, due to the inability to work in the current profession, were issued in 2009. RESULTS: It was found that 40.9% of the analyzed cases were not in accordance with the principles of adjudicating on the incapacity for work and applicable law. The majority of the study group (72.4%) were people with basic vocational education. No significant changes were found as regards gender, age and the place of residence between the retrained (N = 89) and not retrained subjects (N = 252). In the retrained group including 89 persons, 13 subjects started to collect pension again within 6 months; and 1 person collected pension while working. In addition, 51 (57.3%) retrained subjects were unemployed. After 12 months, the number of unemployed subjects decreased to 31. CONCLUSIONS: The effectiveness of the training allowance as a tool for the activation of people with health problems, expressed as the number of retrained people who returned to the labor market, is low. More than 80% of the people fail to get retrained and some of them again submit pension applications. A large number of incorrect vocational retraining opinions, as well as the lack of cooperation between institutions conducting retraining (the Social Insurance Institution and labor offices) resulted in a limited effectiveness of the training allowance. In order to enhance the effectiveness of the training allowance, it is necessary to carry out organizational and legislative changes, with particular emphasis on expanding the knowledge of medical examiners representing the Social Insurance Institution and occupational health physicians, as well as to improve cooperation between all institutions involved in the occupational activation of people with health problems. Med Pr. 2020;71(3):309-23.

International Comparison of Vocational Rehabilitation for Persons With Spinal Cord Injury: Systems, Practices, and Barriers.

Background: Employment rates among people with spinal cord injury or spinal cord disease (SCI/D) show considerable variation across countries. One factor to explain this variation is differences in vocational rehabilitation (VR) systems. International comparative studies on VR however are nonexistent. Objectives: To describe and compare VR systems and practices and barriers for return to work in the rehabilitation of persons with SCI/D in multiple countries. Methods: A survey including clinical case examples was developed and completed by medical and VR experts from SCI/D rehabilitation centers in seven countries between April and August 2017. Results: Location (rehabilitation center vs community), timing (around admission, toward discharge, or after discharge from clinical rehabilitation), and funding (eg, insurance, rehabilitation center, employer, or community) of VR practices differ. Social security services vary greatly. The age and preinjury occupation of the patient influences the content of VR in some countries. Barriers encountered during VR were similar. No participant mentioned lack of interest in VR among team members as a barrier, but all mentioned lack of education of the team on VR as a barrier. Other frequently mentioned barriers were fatigue of the patient (86%), lack of confidence of the patient in his/her ability to work (86%), a gap in the team's knowledge of business/legal aspects (86%), and inadequate transportation/accessibility (86%). Conclusion: VR systems and practices, but not barriers, differ among centers. The variability in VR systems and social security services should be considered when comparing VR study results.

Effects of Vocational Re-training on Employment Outcomes Among Persons with Disabilities in Germany: A Quasi-Experiment.

Purpose To investigate how completing vocational re-training influenced income and employment days of working-age people with disabilities in the first 8 years after program admission. The investigation also included the influence of vocational re-training on the likelihood of receiving an earnings incapacity pension and on social security benefit receipt. Methods This retrospective cohort study with 8 years follow up was based on data from 2399 individuals who had completed either a 1-year vocational re-training program (n = 278), or a 2-year vocational re-training program (n = 1754) or who were admitted into re-training but never completed the program (n = 367). A propensity score-based method was used to account for observed differences and establish comparability between program graduates and program dropouts. Changes in outcomes were examined using the inverse probability-weighted regression adjustment method. Results After controlling for other factors, over the 8 years after program admission, graduates of 1-year re-training, on average, were employed for an additional 405 days, 95% CI [249 days, 561 days], and had earned €24,260 more than without completed re-training, 95% CI [€12,805, €35,715]. Two-year program completers, on average, were employed for 441 additional days, 95% CI [349 days, 534 days], and had earned €35,972 more than without completed re-training, 95% CI [€27,743, €44,202]. The programs also significantly reduced the number of days on social-security and unemployment benefits and lowered the likelihood of an earnings incapacity pension. Conclusion Policies to promote the labor market re-integration of persons with disabilities should consider that vocational re-training may be an effective tool for sustainably improving work participation outcomes.

Work-Related Intervention Programs: Desistance From Criminality and Occupational Integration Among Released Prisoners on Parole.

The present research examines the integration into employment of prisoners on parole who had been under the supervision of the Prisoner Rehabilitation Authority during the period 2007-2010. The supervision program included rehabilitation in the community, with the emphasis on employment. The research compares integration in employment and rates of reincarceration for the supervised group with prisoners who had been released from prison after serving their full sentences. The findings indicate that among prisoners who had participated in the supervision program, there is better integration into employment, a higher wage level, and lower rate of reincarceration. Based on these results, it may be tentatively inferred that the supervision program possesses a high potential for reintegrating released prisoners into the community.

[Vocational Rehabilitation - Comparing Clients of the Federal Employment Agency and the German Pension Insurance]. / Leistungen zur Teilhabe am Arbeitsleben ­ Rehabilitanden der Bundesagentur für Arbeit und der Deutschen Rentenversicherung im Vergleich.

OBJECTIVE: The Federal Employment Agency (Bundesagentur für Arbeit, BA) and the German Pension Insurance (Deutsche Rentenversicherung, DRV) are the major institutions responsible for vocational rehabilitation (VR) in Germany. The following paper compares the characteristics of persons in vocational rehabilitation and the utilization of rehabilitation services between those two institutions and presents short-term developments. METHODS: Administrative data of the BA and the DRV were made comparable. The study analyses persons who have completed VR between 2011 and 2015. RESULTS: We observe an increased use of VR services for both the BA and the DRV. Furthermore, the results show an absolute and proportional increase in persons being employed at the time of approval of VR and in persons receiving technical assistance. The clients of the BA are younger and better educated than the clients of the DRV. The clients of the DRV are more frequently employed at time of approval and receive mainly technical assistance. CONCLUSIONS: Though due to different regulatory responsibilities, BA and DRV clients in VR differ particularly in age, we observe comparable developments in the populations addressed and the interventions provided.

[The Return to Work Status One Year After Vocational Retraining: Is it an Indicator for Long Term Occupational Participation?] / Was sagt das Return to Work ein Jahr nach Ende einer beruflichen Bildungsleistung über die längerfristige berufliche Teilhabe aus?

BACKGROUND AND OBJECTIVE: Vocational retrainings (VR) in the context of vocational rehabilitation are lengthy and expansive interventions. The question is whether the return to work (RTW) 12 months after VR can be a proxy variable for long term income trajectories. METHODS: Based on register data of the German Pension Insurance (Scientific Use File SUFRSDLV09B) fixed-effects-regressions were calculated to measure the effect of VR on the annual mean daily income in each of the 3 years after VR compared to initial level prior to VR and depending on the RTW. RESULTS: The mean difference for the daily income was about -20 € per day. For persons being employed prior to the VR a loss of income up to 50 € per day was measured. Persons being unemployed prior to the VR increased their daily income up to 30 €. Moderate to large effects of the RTW could be measured (d=0.52 to 1.33). CONCLUSION: The RTW 12 months after VR seems to be a good representation for long term income trajectories. Therefore, it can be recommended as an indicator for outcome quality of VR.

Stakeholders' views on vocational rehabilitation programs: a call for collaboration with Occupational Health Physicians.

BACKGROUND: The triple-dip recession taking place in Italy in 2008-2014 impacted negatively on health, mainly by increasing the rate of unemployment. This increased the prevalence of mental health disorders, while reducing the number of available places on vocational rehabilitation programs (VRPs) delivered by the psychiatric services. OBJECTIVES: To explore the different points of views of stakeholders (namely, users and professionals) involved in VRPs developed inside an Italian Community Mental Health Center (CMHC). METHODS: A sample of users, psychiatrists, educators and nurses of an Italian CMHC involved in VRPs took part in a focus group. Content analysis was performed with MAXQDA 12, by developing a hierarchical code system a posteriori (i.e., derived from the data). The respondent validation phase was carried out by means of a multiple-choice questionnaire, administered to all participants. RESULTS: A total of 86 emerging issues were coded, divided into two macro-areas: Positive and Negative Reinforcements (48 contributions, 56%, and 38 contributions, 44%, respectively), further subdivided into three areas: professional (service) factors, personal (i.e, user-related) factors, and work environment features (including relationships in the workplace). Some contributions raised issues concerning occupational health protection (e.g. need of information about the rights and duties of the users-workers, as well as the risks they are exposed to in the workplace). CONCLUSIONS: The analysis suggested to address specific issues concerning work and VRPs by means of psycho-education group interventions currently carried out at CMHCs, and pointed to the need to foster collaboration between mental health professionals and the occupational health physician of the company where the VRP is started and where the user might be employed.

Comparing predictors of employment in Individual Placement and Support: A longitudinal analysis.

Individual Placement and Support (IPS) is an evidence-based model of supported employment for people with serious mental illness. We assessed the effects and relative contributions of predictors of employment among IPS recipients using measures of baseline client characteristics, local economic context, and IPS fidelity. A recent work history, less time on the Social Security rolls, greater cognitive functioning, and a lower local unemployment rate were associated with greater probability of employment. The ability of the model to discriminate between outcomes was limited, and substantial improvements in our understanding of IPS employment outcomes will require the study of novel client, environmental, and IPS implementation factors.

Economic, Labor, and Regulatory Moderators of the Effect of Individual Placement and Support Among People With Severe Mental Illness: A Systematic Review and Meta-analysis.

As Individual Placement and Support (IPS) has become the international standard for vocational rehabilitation of adults with serious mental illness, researchers must consider the relationship between IPS and local environments. This meta-analysis used mixed-effects meta-regressions to assess the impact of site-level moderators on the likelihood that IPS recipients, compared with recipients of alternative vocational services, achieved competitive employment. Potential moderators included change in gross domestic product (GDP), local unemployment and unionization rates, and indices describing employment protection regulations, level of disability benefits compensation, and efforts to integrate people with disabilities into the workforce. Regulatory moderators represent facilitators and barriers to employment that may reinforce or detract from the effectiveness of IPS. Across 30 sites drawn from 21 randomized controlled trials in 12 countries (33% in the United States), IPS recipients were 2.31 (95% CI 1.99-2.69) times more likely to find competitive employment than recipients of alternative vocational rehabilitation services. The significant competitive-employment rate advantage of IPS over control services increased in the presence of weaker employment protection legislation and integration efforts, and less generous disability benefits. Policy makers should recognize and account for the fact that labor and disability regulations can create an arrangement of incentives that reduces the relative efficacy of supported employment.

Impacting Entry into Evidence-Based Supported Employment: A Population-Based Empirical Analysis of a Statewide Public Mental Health Program in Maryland.

We use discrete-time survival regression to study two empirical issues relating to take-up of individual placement and support (IPS) supported employment (SE) services for persons with serious mental illness: (1) the influence of client characteristics on take-up probability, and (2) the possible impacts of a major recent initiative in one state (Maryland) to overcome barriers to IPS-SE expansion. Our longitudinal analysis of population-based Medicaid cohorts, during 2002-2010, provides tentative evidence of positive state initiative impacts on SE take-up rates, and evidence of effects on take-up for clients' diagnoses, prior work-history, health and demographic characteristics, and geographic accessibility to SE providers.

[The Impact of Psychological Comorbidities Concerning a Pension for Reduced Earning Capacity after Medical Rehabilitation]. / Der Einfluss psychischer Komorbiditäten auf den Bezug einer EM-Berentung nach medizinischer Rehabilitation.

Background: The role of psychological comorbidities as a risk factor associated with a further chronification in low back pain is evident. In this paper we explore, whether psychological comorbidities recorded in the discharge letters have a time-stable and from other risk factors independent impact on a pension for reduced earning capacity. Methods: A sample of 10% is drawn from a routine data set provided by the German Pension Fund. Several risk factors are defined and presented descriptively. The survival analysis will be accomplished by cox regressions. Results: Younger patients (≤ 55 years) with at least one comorbid mental disorder have a 1.93 times higher chance of getting a pension for reduced earning capacity in the follow-up period. The influence is time stable and independent from other risk factors. Conclusion: A screening of psychological symptoms with a risk stratified therapy could increase the effectiveness.

[Recommendations for the Stepwise Occupational Reintegration: Can the Characteristic of the Patients Explain the Differences Between the Rehabilitation Centers?]. / Nachsorgeempfehlungen zur stufenweisen Wiedereingliederung: Inwieweit erklären Rehabilitandenmerkmale die bestehenden Unterschiede zwischen den Einrichtungen?

BACKGROUND: The first step to initiate a stepwise occupational reintegration (SOR) is the recommendation of the rehabilitation centers. Therefore rehabilitation centers have a significant impact on the use of SOR. There is evidence that the recommendation rate between the rehabilitation centers differs clearly. The present survey therefore analyses in detail the differences of the recommendation rate and examines which patient-related factors could explain the differences. METHODS: This study is based on analysis of routine data provided by the German pension insurance in Baden-Württemberg (Rehabilitationsstatistikdatenbasis 2013; RSD). In the analyses rehabilitation measures were included if they were conducted by employed patients (18-64 years) with a muscular-skeletal system disease or a disorder of the connective tissue. Logistic regression models were performed to explain the differences in the recommendation rate of the rehabilitation centers. RESULTS: The data of 134 853 rehabilitation measures out of 32 rehabilitation centers were available. The recommendation rate differed between the rehabilitation centers from 1.36-18.53%. The logistic regression analysis showed that the period of working incapacity 12 month before the rehabilitation and the working capacity on the current job were the most important predictors for the recommendation of a SOR by the rehabilitation centers. Also the rehabilitation centers themselves have an important influence. DISCUSSION: The results of this survey indicate that the characteristic of the patients is an important factor for the recommendation of SOR. Additionally the rehabilitation centers themselves have an influence on the recommendation of SOR. The results point to the fact that the rehabilitation centers use different criteria by making a recommendation.

Collaboration between mental health and employment services to support employment of individuals with mental disorders.

PURPOSE: The aim of this study was to investigate the extent of the interdisciplinary collaboration between mental health (MHS) professionals and social security professionals (SSI), their perceptions of this interdisciplinary collaboration and whether these perceptions differed between professionals of the two organizations. METHOD: We obtained data from mental health professionals and social security professionals in the context of a national agreement between MHS and SSI to improve the collaboration between MHS professionals and SSI professionals in the support of individuals with mental disorders to improve work outcome of these individuals. RESULTS: Mental health professionals as well as SSI professionals reported a moderate level of interdisciplinary collaboration, which does not seem to be affected by demographic variables, such as age, gender, profession and region. When professionals collaborated in a structural way they were more positive regarding their interdisciplinary collaboration with professionals of the other organization than professionals that collaborated in an ad hoc manner. CONCLUSIONS: Interdisciplinary collaboration was perceived as moderate by collaborating mental health professionals and social security professionals. In order to improve the collaboration between MHS and SSI on a local microlevel, organizations need to facilitate more structural collaboration between the professionals. IMPLICATIONS FOR REHABILITATION: Collaborating mental health professionals and social security professionals perceived their interdisciplinary collaboration as moderate. In order to improve the collaboration between mental health services (MHS) and vocational rehabilitation services on a local microlevel, organizations need to facilitate more structural collaboration between the professionals. Integrated services with the participation of MHS as well as vocational rehabilitation services, e.g. to share client information and to refer clients to each other, need to be developed. A national agreement between MHS and vocational rehabilitation services is a good starting point to improve collaboration between both the sectors.

[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.

Municipal return to work management in cancer survivors undergoing cancer treatment: a protocol on a controlled intervention study.

BACKGROUND: Cancer survivors are often left on their own to deal with the challenges of resuming work during or after cancer treatment, mainly due to unclear agreements between stakeholders responsible for occupational rehabilitation. Social inequality exists in cancer risk, survival probability and continues with regard to the chance of being able to return to work. The aim is to apply an early, individually tailored occupational rehabilitation intervention to cancer survivors in two municipalities parallel with cancer treatment focusing on enhancing readiness for return to work. METHODS/DESIGN: In a controlled trial municipal job consultants use acceptance and commitment therapy dialogue and individual-placement-and-support-inspired tools with cancer survivors to engage them in behaviour changes toward readiness for return to work. The workplace is involved in the return to work process. Patients referred to surgery, radiotherapy or chemotherapy at the Oncology Department, Aarhus University Hospital, Denmark for the diagnoses; breast, colon-rectal, head and neck, thyroid gland, testicular, ovarian or cervix cancer are eligible for the study. Patients must be residents in the municipalities of Silkeborg or Randers, 18-60 years of age and have a permanent or temporary employment (with at least 6 months left of their contract) at inclusion. Patients, for whom the treating physician considers occupational rehabilitation to be unethical, or who are not reading or talking Danish are excluded. The control group has identical inclusion and exclusion criteria except for municipality of residence. Return to work is the primary outcome and is indentified in a social transfer payment register. Effect is assessed as relative cumulative incidences within 52 weeks and will be analysed in generalised linear regression models using the pseudo values method. As a secondary outcome; co-morbidity and socio-economic status is analysed as effect modifiers of the intervention effect on return to work. DISCUSSION: The innovative element of this intervention is the timing of the occupational rehabilitation which is much earlier initiated than usual and the active involvement of the workplace. We anticipate that vulnerable cancer survivors will benefit from this approach and reduce the effects of social inequality on workability. TRIAL REGISTRATION: Current Controlled Trials ISRCTN50753764 . Registered August 21(st), 2014.

Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials.

BACKGROUND: Computer-assisted cognitive remediation (CACR) has been demonstrated to enhance cognition of patients with severe mental illness (SMI). Patients with improved cognitive skills may find it easier to be employed, and the ability to maintain employment is an important sign of recovery. AIM: To assess whether CACR is an effective method to enhance work-related outcomes in patients with SMI. METHOD: Prospective controlled trials evaluating CACR on productivity outcomes were systematically identified from the OVID databases. Employment rates, total days of work in a year, and total annual earnings were defined as the productivity outcomes. RESULTS: Nine trials were published between 2005 and 2014 and were conducted in the United States, Germany, Italy, Singapore and Japan. A total of 740 patients with mean age of 36.4 years were included. The duration of CACR ranged from 2 months to 2 years, and the patients were followed-up from 1 year to 3 years. Patients receiving CACR showed 20% higher employment rate (95% CI = 5%-35%), worked 19.5 days longer in a year (95% CI = 2.5-36.6 days), and earned US$959 more in total annual earnings (95% CI = US$285 to US$1634) than those not receiving CACR. CONCLUSION: CACR can enhance productivity outcomes for patients with SMI, including higher employment rate, longer duration of work and higher income. The economic benefit of CACR can enhance the quality of life for patients with SMI, and may reduce financial burden on the health and welfare system. Therefore, CACR can be recommended and incorporated into regular vocational rehabilitation programs.

Development and Validation of a Clinical Prediction Rule of the Return-to-Work Status of Injured Employees in Minnesota.

PURPOSE: Vocational rehabilitation services can be a valuable resource to injured employees at risk for sustaining permanent disability. The aim of this study was to develop and validate a predictive model of return-to-work (RTW) status at workers' compensation claim closure that may assist rehabilitation counselors tasked with determining how to allocate such services. METHODS: A cross-sectional, retrospective study was conducted using data obtained from 15,372 workers' compensation claims in Minnesota's administrative claims database. The association between a set of 15 predictor variables representing medical and contextual factors and the RTW status as of claim closure of the accessible population was assessed using backward stepwise logistic regression. The most parsimonious set of variables that reliably predicted the outcome was selected as the optimal RTW model. This model was then internally validated via a split-dataset approach. RESULTS: Risk factors for failure to RTW by claim closure include the following: (1) attorney involvement; (2) higher level of permanent impairment (PI); (3) shorter job tenure; (4) lower pre-injury average weekly wage (AWW); (5) injury affecting the head and neck or the back; and (6) lower level of educational attainment. The optimal RTW model included four main effects (attorney involvement; severity of PI; age; job tenure) and three first-order interaction effects (pre-injury AWW × pre-injury industry; attorney involvement × severity of PI; attorney involvement × job tenure). When applied to the full dataset, the overall classification rate was 74.7%. CONCLUSIONS: This study's optimal RTW model offers further support for evaluating disability from a biopsychosocial perspective. Given the model's performance, it may be of value to those assessing rehabilitation potential within Minnesota's, and possibly other, workers' compensation system(s).

[A supported employment experience in western Switzerland for persons with mental health disorders]. / Une expérience de soutien à l'emploi pour les personnes souffrant de troubles psychiques en Suisse romande.

Access and maintenance of competitive employment represent a challenge for people with mental health problems. Effective methods to support employment attain only a fraction of people who wish to re-enter the labour market. The objective of the article is to describe the development of a service to support competitive employment for mental disorders in collaboration between public psychiatry, disability insurance and social welfare. Three pathways were differentiated according to target populations and to ensure fidelity to effective intervention models: 1) individual placement and support (IPS) for severe psychiatric disorders; 2) progressive rehabilitation for instable situations and 3) critical time clinical case management for untreated mental disorders in employment integration programs.

The effectiveness of community-based rehabilitation programmes: an impact evaluation of a quasi-randomised trial.

BACKGROUND: Community-based rehabilitation (CBR) programmes have been described as highly effective means of promoting the rights and opportunities of persons with disabilities (PwD). Although CBR is often the main way in which PwD in low-income and middle-income countries access rehabilitation services, there is little literature providing rigorous evaluation of their impact on people's well-being. METHODS: Data were collected in the Mandya and Ramanagar districts (Karnataka state, India), between December 2009 and May 2010. In total 2540 PwD were interviewed using stratified random sampling: 1919 CBR beneficiaries (who joined the programme between 1997 and 2009) and 621 persons who were living in villages not covered by the programme. We controlled for the systematic differences between people joining and not joining the programme using the propensity score matching method controlling for covariates at individual and village level. We evaluated the impact of the programme on the subgroups of PwD who are disadvantaged on the dimensions of interest: access to pensions, use of aid appliances, access to paid jobs and improvement in personal-practical autonomy after 4 and 7 years of joining the CBR. RESULTS: We observed a positive and significant impact of the programme on access to services, rights and opportunities of PwD. The results indicate that compared with the control group access to pensions and allowances, aid appliances, access to paid jobs and personal-practical autonomy increased by 29.7%, 9.4%, 12.3% and 36.2%, respectively, after 7 years. CONCLUSIONS: The CBR programme analysed has a positive impact on access to services and the well-being of PwD who are particularly deprived on outcomes of interest.