RESUMO
PURPOSE: The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies. METHODS: We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings. RESULTS: Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model. CONCLUSIONS: RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.
Assuntos
Antropologia Cultural , Retorno ao Trabalho , Humanos , Pesquisa Qualitativa , Alemanha , Doença CrônicaRESUMO
BACKGROUND: So far, there is little data on the quality of work-related medical rehabilitation (WMR)-care in the routine, including from a user perspective. The best data are still available for orthopedic rehabilitation. For psychosomatic rehabilitation, a special need for WMR is known due to the long periods of inability to work and the frequent early retirements. It is unclear how precisely and to what extent WMR services are provided in routine care. METHODS: In 2019, a representative sample (N=34.887) of employed insured persons up to 65 years old, stratified by indication, was surveyed by the German Pension Insurance fund six months after their rehabilitation with the self-assessment tool MBOR-R. In addition, standard data of the rehabilitation provider (RSD) were collected, from which WMR-related therapeutic offer data (KTL) could be taken. Rehabilitants were asked about their return to work as part of the catamnesis. RESULTS: The participation rate in the survey is 29%, complete survey and RSD data are available after exclusion of addiction rehabilitation and post-operative-procedures from a total of 6.128 rehabilitants, of which N=1.460 after psychosomatic rehabilitation. The comparison of indications shows that 37% of the rehabilitation patients need WMR, which is by far the highest rate. WMR care in psychosomatic rehabilitation is still the best developed and most targeted, but still far from the standards required by the pension insurance. More than 50% of the rehabilitants, even after WMR, rate their employment-related treatment offer as too low. These subjective rehabilitation assessments in the MBOR-R questionnaire prove to be a relevant factor for the prognosis of the return to work quotes, in contrast to the documented KTL services, in addition to the need indicators of WMR and the implementation of WMR. DISCUSSION: The results suggest that in the field of psychosomatic rehabilitation, too, increased efforts should be made in the future to offer and expand basic WMR services for all rehabilitants and core and special services for rehabilitants with poor work ability and an increased risk of permanent work disability (BBPL) in routine care. The scope and design of MBOR measures should also be quality-optimized from the user's perspective in order to achieve the greatest possible effects.Limitations of the results result from the restriction to rehabilitants of the German Federal Pension Insurance, to limited participation rates, Limitations of the interpretability of the therapy documentations and due to the study design with a one-point measurement and remembered pre-values.