[Sensitivity and specificity of the PHQ-9 for identifying suicidality in medical rehabilitation]. / Sensitivität und Spezifität des PHQ-9 zur Identifikation von Suizidalität in der medizinischen Rehabilitation.

PURPOSE: Suicidality is rarely assessed in patients treated in German rehabilitation centers, although individuals with physical and mental impairments have an increased risk for suicidality. The item 9 of the 9-item depression module of the Patient Health Questionnaire (PHQ-9) asks about the desire to be dead or to harm oneself and could be used as a possible screening for suicidality. The Columbia Suicide Severity Rating Scale (C-SSRS) is a standardized interview to assess suicidality. We assessed the prevalence of suicidality in orthopedic and cardiac rehabilitation using the C-SSRS and the PHQ-9, examined the diagnostic accuracy of the item 9 of the PHQ-9 and of the PHQ-9 total score for identifying suicidality and surveyed the acceptance of the suicidality assessment by the rehabilitants. METHODS: Study participants were screened with the PHQ-9 and subsequently interviewed using C-SSRS. Sensitivity and specificity of the item 9 of the PHQ-9 and the PHQ-9 total score were tested for the presence of suicidality assessed with the C-SSRS and in a sensitivity analysis for the presence of nonspecific active suicidal ideation (item 2 of the C-SSRS). We calculated the area under the curve (AUC) to predict the ability of the PHQ-9 to discriminate between individuals with and without acute suicidality. Screening and interview were evaluated by the rehabilitants. RESULTS: Among 405 study participants, the prevalence of acute suicidality measured by the C-SSRS was 0.5%. 4% reported nonspecific active suicidal ideation on the C-SSRS. 10.4% reported suicidal ideation on item 9 of the PHQ-9. The sensitivity of item 9 and the PHQ-9 total score for identifying acute suicidality was only 50.0% (95% CI: 1.3% to 98.7%). However, item 9 was sensitive (81.3%, 95% CI: 54.4% to 96.0%) and specific (92.5%, 95% CI: 89.5% to 95.0%) for identifying nonspecific active suicidal ideation. Estimators for sensitivity were highly uncertain because of the low prevalence of acute suicidality. Addressing suicidality was rated as useful and helpful by study participants. CONCLUSION: If the response to item 9 is positive, the immediate risk of suicide is low. However, PHQ-9 is suitable for identifying patients with non-specific suicidal thoughts. A conspicuous score on the item 9 of the PHQ-9 should be further clarified by a psychotherapist.

Use of a job exposure matrix to predict the risk of work disability in individuals with back pain: An inception cohort study.

BACKGROUND: Low back pain has a high economic burden in Germany due to back pain-related sick leave, disability pensions, and health care utilization. Work-related factors can predict disabling back pain. Job exposure matrices can be used to consider job demands and occupational characteristics in routine data analysis. OBJECTIVE: This longitudinal analysis tested whether rehabilitation utilization due to musculoskeletal disorders is associated with occupation-linked job exposures in employees with back pain. METHODS: Data from a German cohort study were used, including employees aged 45 to 59 years with self-reported back pain in the last three months. Individuals' job titles were assessed in the baseline survey in 2017 and matched with parameters of aggregated job exposure indices. Administrative data from the German Pension Insurance were used to extract information on rehabilitation utilization. Proportional hazard models tested the associations. RESULTS: We considered data of 6,569 participants (mean age: 52.3 years; 57.7% women). During follow-up, with a maximum of 21 months, 296 individuals (4.5%) utilized medical rehabilitation due to musculoskeletal disorders. Adjusted analyses showed that high physical (HR = 2.87; 95% CI 1.74; 4.75) and overall (HR = 2.34; 95% CI 1.44; 3.80) job exposures were associated with a higher risk of rehabilitation utilization. CONCLUSION: Individuals with back pain working in occupations with high physical job exposures have a higher risk for rehabilitation utilization. To prevent work disability in individuals with back pain, occupational groups with high physical job exposures should be actively informed about tailored intervention options.

Sequences of vocational rehabilitation services in Germany: a cohort study.

BACKGROUND: This study aimed to describe sequences of vocational rehabilitation services among individuals with approved vocational rehabilitation in Germany and to identify typical service sequences. METHODS: We used administrative data on vocational rehabilitation services and questionnaire data on health and work ability to describe frequencies and sequences of vocational rehabilitation services financed by the Federal German Pension Insurance. Through sequence analysis, we were able to map the service sequences. We did cluster analyses to identify typical different service sequences. RESULTS: Our sample included 1,652 individuals with 2,584 services. Integration services and two-year vocational retraining were the most common services. We could identify three different service clusters around integration services: shorter ones, followed by employer benefits and without employer benefits. We found two different clusters around two-year vocational retraining: shorter and longer clusters. Two-year vocational retraining was more often initiated by preparatory services and followed by employer benefits than integration services. Longer services in both clusters were associated with better baseline data for physical health, work ability, risk of future work disability, and younger age than shorter services. People in two-year-vocational retraining reported at baseline better general health, better work ability, low risk of future work disability, and less mental illness compared to people in integration services. CONCLUSIONS: Multiple services, that is, sequences of services, were more likely to occur among individuals with more complex services like two-year vocational retraining. Utilization of complex services and longer services was influenced by health, age, risk of future work disability, and education. TRIAL REGISTRATION: German Clinical Trials Register DRKS00009910, registration 25/01/2016.

[How do Persons Perceive Rehabilitation Counseling? A Qualitative Study on Experienced Rehabilitation Counseling Implemented by the Federal German Pension Insurance among Persons with Approved Vocational Rehabilitation]. / Wie wird die Begleitung durch einen Reha-Berater erlebt? Eine qualitative Studie zur Wahrnehmung des Reha-Beraters der Deutschen Rentenversicherung Bund bei Personen mit bewilligten Leistungen zur Teilhabe am Arbeitsleben.

BACKGROUND AND OBJECTIVE: Persons with approved vocational rehabilitation participate in a conversation with a rehabilitation consultant shortly after approval. The aim of the consultation is to select individually suitable services from the available range of services, based on the illness and employment biography of persons with approved vocational rehabilitation. The initial consultation is thus of essential importance for the further rehabilitation process. To date, there has been little research about what characterizes successful counseling from the point of view of persons with approved vocational rehabilitation. The aim of the qualitative study was to examine the perspective on counseling for persons with approved vocational rehabilitation financed by the German Federal Pension Insurance. METHOD: Telephone interviews based on guidelines were conducted with 16 persons. The interviews were recorded and transcribed. The data was analyzed with MAXQDA using qualitative content analysis and the technique of inductive category development. RESULTS: Three perceived forms of counseling could be distinguished: a supportive counseling, a passive counseling and an inhibitory counseling. Persons with experienced passive and inhibitory counseling reported uncertainty and withdrawal in the further rehabilitation process. CONCLUSION: There is an individual perception of the counseling and support provided by the rehabilitation consultant, which can have an impact on the attitude and behaviour of persons in the further course of vocational rehabilitation. The challenge is to enable supportive experiences within the time-limited framework of the initial consultation.

Measuring work functioning in individuals with musculoskeletal disorders with reference to the International Classification of Functioning, Disability, and Health: a systematic literature review.

The assessment of work functioning is important to define needs in the context of vocational rehabilitation. The International Classification of Functioning, Disability, and Health (ICF) serves as a framework to describe functioning and health. In reference to the ICF, work functioning can be described as consisting of work activities and work participation. A range of instruments are used in rehabilitation practice to assess work functioning. The purpose of this systematic review was to identify questionnaires measuring work functioning with reference to the ICF and to describe these instruments, their linkage to the ICF, and their psychometric properties. Instruments should be suitable for individuals with musculoskeletal disorders. Web of Science and PubMed were searched for English and German studies published between 2001 and 2015. We focused on self-reported questionnaires measuring work functioning with reference to the ICF. Sixteen questionnaires fulfilled the inclusion criteria. The instruments varied in their linkage to the ICF and in their focus on work functioning. Questionnaires measuring concrete work activities differ from instruments measuring aspects of work participation in terms of absenteeism. The Work Rehabilitation Questionnaire is the instrument covering most ICF categories. The results show a range of different instruments that could be useful in certain settings. The description and comparison of the questionnaires can help to choose appropriate instruments in practice.