[Insured Persons with High and Moderate Risk of Reduced Earning Capacity - Identification, Analysis of the Use of a Counselling Service and Illustration of their Health and Occupational Situation]. / Versicherte mit Erwerbsminderungsrisiko: Identifikation, Analyse der Inanspruchnahme eines Beratungsangebots und Darstellung der gesundheitlichen und beruflichen Situation ­ Eine Querschnittstudie.

PURPOSE: The aim of this study was to investigate the life situation, and analyse the need for rehabilitative interventions as well as the use of counselling service offered to persons insured by the German Pension Insurance Braunschweig - Hannover (DRV BS-H), using the moderate and high risk index for temporary disability penson (RI-EMR). METHOD: This is a cross-sectional study. The participants were generated from a random sample of the total insured persons of the DRV BS-H. 1778 persons were contacted offering telephone consultation and a request for participation in a questionnaire survey that recorded, among others, symptoms, burdens and impairments. Employed persons were asked about their stress at work, non-employed persons about their motivation to return to work. 391 (24.5%) participated in the questionnaire survey and 157 (9.8%) of those contacted responded to the offer of counselling service. The contents of the counselling sessions were evaluated descriptively. The questionnaire data were analysed comparatively (ANOVA, χ2-test). RESULTS: The offer of the telephone counselling was not used as expected in advance. Insured persons with a high RI-EMR showed more clearly complaints as well as burdens and impairments due to contextual factors than persons with a moderate RI-EMR. The majority of non-employed persons in both groups showed up in the motivational stage of forming intentions with regard to a possible return to employment. CONCLUSION: The question arises as to how insured persons with prognostically limited participation can be better reached with offers of assistance. The goal of early offer of support services is confronted with the problem that delays occur in the application of the routine data of the DRV and thus of the RI-EMR. Future studies should investigate how to improve insured persons' participation in counselling services and also their motivation to return to work.

[Impairment due to Contextual Factors: External Assessment and Self-Assessment of Rehabilitants in Psychosomatic Rehabilitation]. / Beeinträchtigung durch Kontextfaktoren: Fremd- und Selbstbeurteilung von Rehabilitand:innen in der psychosomatischen Rehabilitation.

OBJECTIVES: In addition to an existing external assessment tool for the ICF-based assessment of the impairment of rehabilitation patients due to environmental and personal contextual factors, a self-assessment tool was developed and used for rehabilitation patients in a psychosomatic rehabilitation clinic. The aim was to compare the assessment of the impairment by contextual factors rated by the external assessment and by the rehabilitation patients on the other hand. Furthermore, the aim of the study was to obtain initial indications of the applicability of the newly designed self-evaluation instrument. METHOD: A sample of N=103 rehabilitation patients was examined via both the external and the self-evaluation tools. A comparative evaluation of the assessment of the external assessor and the rehabilitants' assessments was carried out using measures of assessor agreement (Cohen's Kappa, percentual agreement). The results were set in relation to the data of the routine assessment of the rehabilitation facility (Eta-Coefficient). RESULTS: The external assessor and the rehabilitants get to different results in their assessment of the extent of impairment by individual contextual factors. For eight of the 15 context factors, there was only a moderate degree of agreement between the assessors (Cohen's Kappa). The percentage of non-agreement between rating of the external assessor and self-assessment lies between approx. 20% and up to approx. 40% of the cases for the majority of the context factors. Whether or not there is an impairment across all contextual factors (overall measure) was answered non-concordantly in just under a third of the cases. Mostly moderate correlations were found between the context factors classified as particularly relevant in the self-evaluation tool and scales of psychometric survey (e. g. BDI-II). This result provides a first indication of the convergent validity of the self-report tool. CONCLUSION: More attention should be paid to a supplementary assessment of impairment by contextual factors via the rehabilitation patient's self-assessment in addition to the external assessment. There is a need for further research with regard to the development of the self-assessment tool presented.