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.

Contextual factors in persistent severe back pain: A longitudinal analysis among German employees.

BACKGROUND: Chronic back pain in employees compromises participation in social and daily activities, as well as work. OBJECTIVES: To examine the severity of back pain after 2 years and identify factors predicting stagnation at this level of pain. METHODS: Data were derived from a prospective cohort study with randomized sampling of insurants in the German Pension Insurance using a questionnaire at baseline and follow-up after 2 years. The sample consisted of middle-aged employees (45-59 years) with strong limitations due to back pain (Chronic Pain Grade III or IV), who had not applied for disability pension and did not use medical rehabilitation in the previous 4 years before baseline. Stepwise multivariable logistic regression models with backwards selection were used to identify relevant contextual factors in the stagnation of severe back pain. RESULTS: Of 1208 persons with severe back pain at baseline, 48% had stagnated at that pain level after 2 years. Predictors of persistent severe back pain were older age, poorer general health, more additional disabling conditions, more depressive symptoms, caregiving burden, less pain-related self-efficacy and more fear avoidance beliefs. CONCLUSIONS: In a high-risk subgroup with several co-existing conditions, this analysis highlights (mental) health, social and personal (contextual) factors associated with long-term unfavourable back pain progression. SIGNIFICANCE: Back pain is a condition that often has a chronic or recurrent course, threatening participation in many areas of life. In this study it was found that the unfavourable condition of severe back pain can remain stable for long periods of time in a significant proportion of sufferers. Contextual factors (self-efficacy, fear-avoidance beliefs, caregiving burden) as well as additional health problems should be considered when identifying persons with stagnating pain courses.

[Experts' uncertainties in decisions on the indication for rehabilitation as part of the assessment of long-term care needs: Results of semi-structured interview]. / Entscheidungsunsicherheiten bei der zweistufigen Prüfung einer Rehabilitationsindikation im Rahmen der Pflegebegutachtung ­ Ergebnisse leitfadengestützter Interviews.

OBJECTIVE: As part of assessment of long-term care needs, Medical Services of the compulsory German Health Insurance have to decide whether medical rehabilitation is indicated. The aim of this study was to identify uncertainties and associated factors while deciding whether rehabilitation was indicated in this standardized review process. METHOD: Semi-structured interviews were conducted with a total of twelve nursing experts and six physician experts from six different Medical Services. In the interviews of the two professional groups, thinking aloud and problem-centered methods were used. They were subjected to a cognitive pretest prior to data collection. All interviews were conducted over telephone in May 2021, digitally recorded and transcribed thereafter. They were analyzed based on the method of structuring qualitative content analysis using the MAXQDA software. RESULTS: Uncertainties in decision-making can arise both from case-related characteristics and case-independent contextual factors. Nursing experts associated uncertainties in assessing the criteria of rehabilitation indication primarily with certain diseases (especially dementia or mental illnesses), multimorbidity, an unclear illness and ambulatory care situation, as well as a negative rehabilitation-related attitude of the persons being assessed. The physician experts, who based their decisions on available documentation in the case files, described uncertainties, particularly due to insufficient information relevant to the decision (e. g., on diagnostics, course of disease and treatment, weighting of existing limitations) in the nursing experts' assessments. Across all criteria, the experts' own professional or private rehabilitation experience and their understanding of the role of rehabilitation before and during the need for long-term care, as well as aspects of communication practice and the professional exchange between the nursing and the physician experts also influenced the overall decision-making process. CONCLUSION: The identification of uncertainties in experts' decision-making process and associated factors enables the development of strategies to strengthen specifically the certainty of experts' decision-making and thus may contribute to the promotion of a needs-based rehabilitation access via long-term care assessment.

[Comprehension and Perspectives of the Need for Medical Rehabilitation - Results of a German Online Survey]. / Verständnis und Bedürfnis medizinischer Rehabilitation in der Bevölkerung ­ Ergebnisse einer Online-Befragung.

BACKGROUND: In Germany, medical rehabilitation usually requires an application of the persons in need. Therefore, these persons have to understand what rehabilitation is and in what case they need this type of health care service. In addition to people with health problems, their close persons (e. g. family members) should also have rehabilitation-related knowledge. Since there is only limited data on the perspective towards medical rehabilitation services, a survey was conducted. METHOD: In September 2020, we invited 2,401 registered participants (age: 18-79 years) of a population-based online panel study to participate in an online survey. The cross-sectional survey asked about the understanding of need, subjective information as well as attitudes and expectations towards medical rehabilitation services. We analysed the data descriptively, taking into account the participants' rehabilitation experience and health impairment. In a subgroup analysis, the potential factors influencing the subjective need for rehabilitation were tested using logistic regression. RESULTS: Data from 1,464 persons (Ø age: 52.5±14.5 years; 55% non-male) were analysed, 44% of the participants considered themselves to be "rather well" or "very well" informed about medical rehabilitation. The majority associated a need for rehabilitation with the access requirements related to service providers. In case of an emerging need for rehabilitation, family doctors would be the first point of contact. The participants mainly had function-oriented expectations of rehabilitation services and a majority prefer inpatient rehabilitation if necessary. Among 383 persons with long lasting and pronounced health-related impairment, the concrete individual need for rehabilitation was associated by a higher subjective degree of impairment as well as their own previous rehabilitation experience and rehabilitation experience in their personal social environment. CONCLUSION: Despite an overall good understanding of the need for rehabilitation, different rehabilitation views were found in certain population groups. In order to improve the general understanding of rehabilitation in the public and particularly in close persons, adequate dissemination of low-threshold, population-based rehabilitation information is recommended.

Efficacy of Three Numerical Presentation Formats on Lay People's Comprehension and Risk Perception of Fact Boxes-A Randomized Controlled Pilot Study.

(1) Background: Fact boxes present the benefits and harms of medical interventions in the form of tables. Some studies suggest that people with a lower level of education could profit more from graphic presentations. The objective of the study was to compare three different formats in fact boxes with regard to verbatim and gist knowledge in general and according to the educational background. (2) Methods: In May 2020, recruitment started for this randomized controlled trial. Participants were given one out of three presentation formats: natural frequencies, percentages, and graphic. We used Limesurvey® to assess comprehension/risk perception as the primary outcome. The Kruskal-Wallis test and the Mann-Whitney U test were used in addition to descriptive analyses. (3) Results: A total of 227 people took part in the study. Results of the groups were nearly identical in relation to the primary outcome verbatim knowledge, likewise in gist knowledge. However, participants with lower educational qualifications differed from participants with higher educational qualifications in terms of verbatim knowledge in the group percentages. (4) Conclusions: The results indicate that all three forms of presentation are suitable for conveying the content. Further research should take the individual preferences regarding the format into account.

Public information needs and preferences on COVID-19: a cross-sectional study.

BACKGROUND: Right from the beginning of the SARS-CoV-2 pandemic the general public faced the challenge to find reliable and understandable information in the overwhelming flood of information. To enhance informed decision-making, evidence-based information should be provided. Aim was to explore the general public's information needs and preferences on COVID-19 as well as the barriers to accessing evidence-based information. METHODS: We performed a cross-sectional study. Nine hundred twenty-seven panel members were invited to an online survey (12/2020-02/2021). The HeReCa-online-panel is installed at the Martin Luther University Halle-Wittenberg to assess regularly the general public's view on health issues in five regions in Germany. The survey was set up in LimeSurvey, with nine items, multiple-choice and open-ended questions that allowed to gather qualitative data. Quantitative data were analysed descriptively and a content analysis was carried out to categorise the qualitative data. RESULTS: Six hundred thirty-six panel members provided data; mean age 52 years, 56.2% female, and 64.9% with higher education qualifications. Asked about relevant topics related to COVID-19, most participants selected vaccination (63.8%), infection control (52%), and long-term effects (47.8%). The following 11 categories were derived from the qualitative analysis representing the topics of interest: vaccination, infection control, long-term effects, therapies, test methods, mental health, symptoms, structures for pandemic control, infrastructure in health care, research. Participants preferred traditional media (TV 70.6%; radio 58.5%; newspaper 32.7%) to social media, but also used the internet as sources of information, becoming aware of new information on websites (28.5%) or via email/newsletter (20.1%). The knowledge question (Which European country is most affected by the SARS-CoV-2 pandemic?) was correctly answered by 7.5% of participants. The Robert Koch Institute (93.7%) and the World Health Organization (78%) were well known, while other organisations providing health information were rarely known (< 10%). Barriers to accessing trustworthy information were lack of time (30.7%), little experience (23.1%), uncertainty about how to get access (22.2%), complexity and difficulties in understanding (23.9%), and a lack of target group orientation (15,3%). CONCLUSIONS: There are extensive information needs regarding various aspects on COVID-19 among the general population. In addition, target-specific dissemination strategies are still needed to reach different groups.

["That One Can See How it is Supposed to be." Conception, Piloting and Evaluation of an Interprofessional Rehabilitation-Related Module for the Training Courses in Medicine, Nursing, and Physiotherapy]. / "Dass man mal sieht, wie es eigentlich sein sollte." Konzeption, Pilotierung und Evaluation eines interprofessionellen rehabilitationsbezogenen Moduls für die Medizin, Pflege und Physiotherapie.

BACKGROUND: Considering the growing rehabilitative care requirements, good interprofessional cooperation is of central relevance for health care professions and is increasingly demanded. Interprofessional cooperation does not yet play a significant role in health professions' education, despite the fact that it is considered an important element of success in outcome- and patient-centered health care. The field of rehabilitation lacks interprofessional teaching concepts and material. METHODS: An interprofessional team of instructors developed the didactic and thematic concept for the module. The module focuses on rehabilitation and discharge management. The learning objectives were developed based on the National Competency-Based Catalogue of Learning Objectives for Medicine. The formative evaluation was based on a questionnaire filled out by the students and the learning guides. RESULTS: 47 participants took part in three runs. The results of the formative evaluation demonstrate that the module was overall well received. The trainees rated the module more favorably than the medical students. While participants emphasized the good practical eye-to-eye interaction between the professions and the honest feedback conversation, they also pointed to the contrast they perceived to their everyday practice. They also wished for more time having verbal interprofessional exchange. The medical students criticized that interprofessional modules were only offered in their final year. CONCLUSION: To the author's knowledge, this is the first publication of an interprofessional module on rehabilitation and discharge management including piloting and positive evaluation for the three professional groups of medicine, nursing and physical therapy. Improvement suggestions of the participants led to modifications that will be realized in the next version of the module. The course sets important impulses for the further development of interprofessional cooperation and the teaching of rehabilitation-related skills. The modular package is available to other lecturers in a free online platform for rehabilitation-related teaching materials.

Work ability score as predictor of rehabilitation, disability pensions and death? A German cohort study among employees with back pain.

BACKGROUND: Sickness absence, disability pensions, and use of healthcare due to disabling back pain are a high economic burden in Germany. Assessment are needed to identify employees who are likely to need intensive support. OBJECTIVE: The cohort study examined whether rehabilitation, disability pensions and death can be predicted by a simple self-reported rating of work ability in employees with back pain in Germany. METHODS: Employees aged 45 to 59 years who reported back pain in the last 3 months completed the Work Ability Score in 2017 (0-10 points). Individual scores were categorized into poor (0-5 points), moderate (6-7) and at least good (8-10) work ability. Outcomes were extracted from administrative records covering the period until the end of 2018. Proportional hazard models were fitted to determine the prognostic benefit of the Work Ability Score. RESULTS: Data for 6,917 participants were included (57.8% women). The median follow-up time was 20 months. Of the participants, 52.1% had a good or excellent, 27.7% a moderate, and 20.2% a poor Work Ability Score. During follow-up, 548 persons were granted rehabilitation measures, 57 persons disability pensions, and 23 died. Fully adjusted analyses showed an increased risk of a rehabilitation measure (hazard ratio = 2.65; 95% CI 2.11; 3.34) and a disability pension (HR = 4.12; 95% CI 2.02; 8.39) in employees with poor work ability. A premature death was not associated with poor work ability. CONCLUSIONS: The Work Ability Score is a potential tool to identify individuals, reporting back pain, with an increased risk of health-related early retirement and work disability.

Rehabilitation utilization of non-migrant and migrant persons with back pain: A cohort study using different definitions of migrant background.

Background: Medical rehabilitation (MR) by the German Pension Insurance is approved to maintain and to restore work ability and to avoid disability pensions. Studies on the rehabilitation utilization by people with a migration background (PMB) compared to people without a migration background (non-PMB) showed heterogeneous results, which may be partly due to different definitions of migration status. The aim of this paper was to test whether there are differences in utilization of MR between employed PMB and non-PMB with self-reported back pain. Methods: We used data from a large German cohort study that analyzed the effectiveness of MR for individuals with back pain and was conducted between 1st January 2017 and 31st December 2019. Employees aged 45 to 59 years who reported back pain in the last three months completed the baseline questionnaire in 2017. We used four definitions of migration background (MB) to differentiate by first- and second-generation migration, by one- and two-sided migration background, by language, or by nationality. Data on rehabilitation utilization was extracted from administrative records covering the period until the end of 2018. Findings: Data of 6,713 participants were included, and 514 individuals utilized MR during follow-up. Adjusted analyses showed a decreased risk of rehabilitation utilization in people with a first-generation MB (HR = 0·46; 95% CI 0·29; 0·72), people with a two-sided MB (HR = 0·47; 95% CI 0·31; 0·72), people whose native language was not German (HR = 0·52; 95% CI 0·30; 0·91), and people without German nationality (HR = 0·29; 95% CI 0·12; 0·72) when compared to non-PMB. Interpretation: This study showed that employees with a MB reporting back pain had a significantly reduced risk for utilization of rehabilitation services. This underutilization could be observed considering different definitions of MB. Future research on rehabilitation utilization by PMB should consider the impact of different definitions on the results. Funding: The study was funded by the German Research Foundation (grant numbers: BE 5885/2-1; MA 6981/2-1). The German Research Foundation functions as a self-governing institution for the promotion of science and research in Germany.

[Reasons and Influencing Factors for the Willingness to Document Preferences Regarding Organ Donation: Results of an Online Survey]. / Gründe und Einflussfaktoren für die Bereitschaft zur Dokumentation von Präferenzen bezüglich Organspende. Ergebnisse einer Online-Umfrage.

OBJECTIVE: Different options to regulate decisions about organ transplantation were subjected to discussions prior to parliamentary decision on 16.01.2020. The goal of this study was the description of citizens' attitudes towards organ donation and investigation of predictors of (documentation of) willingness to donate. METHODS: Cross sectional online survey in Berlin and Saxony-Anhalt between 25.11.2019 till 16.01.2020. Descriptive, statistical analysis. We report absolute and relative frequencies. We conducted logistic regression analysis for the influence of age, income and gender on knowledge, willingness to donate and possession of an organ donor card. RESULTS: Of 20 020 invited citizens, 676 (3.4%) participated in the online survey; 54.9% were in favour of an opt-out regulation, 49.4% supported an opt-in regulation, 63.3% of respondents were willing or rather willing to donate an organ and 43.2% possessed an organ donor card. Willingness to donate and possession of an organ donor card decreased with increasing age. A Higher educational level was associated with having an organ donor card. Gender, income, education and knowledge about organ donation were not associated with the willingness to donate an organ. Of those who were willing to donate but who had not a donor card, 45.7% had communicated their will to relatives. Reasons indicated for lack of documentation included practical reasons as also fears related to medical care in case of critical health state. DISCUSSION: None of the discussed legislative regulations on organ donation has been supported by a clear majority of respondents. Distinct population-based surveys can serve as starting point for developing targeted initiatives to increase the documentation of citizens' will regarding organ donation following brain death.

Barriers to applying for medical rehabilitation: a time-to-event analysis of employees with severe back pain in Germany.

OBJECTIVE: Longitudinal studies on barriers to applying for rehabilitation in Germany are lacking in light of the suspected underutilization of rehabilitation services. The aim of this study was to examine application behaviour in persons with disabling back pain and to identify relevant predictors for making an application. DESIGN: A prospective cohort study with randomized sampling of insurants in the German Pension Insurance, using a questionnaire at baseline and follow-up with linked administrative data for 1.5 years. SUBJECTS/PATIENTS: Employed persons (age range 45-59 years) with a high degree of limitations due to back pain and a self-reported risk of permanent work disability (not applied for disability pension, no medical rehabilitation within the last 4 years). METHODS: Multivariable Cox regression was used to examine the influence of pre-selected variables on making an application in the follow-up period. RESULTS: Of 690 persons, only 12% applied for rehabilitation. Predictors for making an application were: support from physicians (hazard ratio (HR)=2.24; 95% confidence interval (95% CI) 1.32-3.80), family, and friends (HR=1.67; 95% CI 1.02-2.73), more pain-related disability days (HR=1.02; 95% CI 1.01-1.03), and worse work ability (HR=0.86; 95% CI 0.75-0.97). An intention to apply at baseline mediated the effect of family and physician support on the application. CONCLUSION: The low number of applications for rehabilitation despite disabling back pain indicates access barriers to, and underuse of, medical rehabilitation.

[Factors Influencing the Access to and Utilization of Medical Rehabilitation Services Recommended after Care Assessment - Results of Qualitative Interviews with Professionals Involved in the Decision Process]. / Einflussfaktoren auf Beantragung und Inanspruchnahme empfohlener Rehabilitationsleistungen nach einer Pflegebegutachtung ­ Ergebnisse qualitativer Interviews mit professionellen Akteur/innen.

PURPOSE: In Germany, persons in need of care can receive a rehabilitation recommendation from the medical service of the health insurance companies. Approximately half of these recommendations lead to applications and every fourth recommendation to actual utilisation of medical rehabilitation. Little is known about the supporting factors for and barriers to this special access to medical rehabilitation for persons in need of care. To explore the influencing factors - both personal and procedural - from the perspectives of involved professionals. METHODS: Interviews regarding on the access to medical rehabilitation were conducted with expert raters from the medical service of the German statutory health insurance system and with employees in long-term care and in health insurance. For data analysis systematic text condensation was used. RESULTS: Based on 53 interviews with 56 involved professionals, individual- and process-related influencing factors were identified. In addition to sociodemographic, health-related, personal and financial characteristics, rehabilitation-related attitudes and a strong attachment to the home environment seem to be particularly relevant. Furthermore, service-related (e. g. expectations and wishes) and process-related (e. g. care structures) characteristics also seem to have an impact. The importance of social support from relatives was emphasized. CONCLUSIONS: The results point to potential supporting factors and barriers in the access to rehabilitation by means of care assessment. They should be considered for possible improvements of the assessment and approval procedures as well as the necessary early and sufficient councelling of the concerned persons and their relatives.

Effectiveness of medical rehabilitation in persons with back pain - lessons learned from a German cohort study.

PURPOSE: Evidence for health-related effects of German medical rehabilitation programs for back pain is inconclusive. This cohort study aimed to examine the effectiveness of medical rehabilitation in residents with back pain (German Clinical Trial Register: DRKS00011554). MATERIAL AND METHODS: A sample of 45 000 people aged 45-59 years was randomly drawn from two pension agencies. We used propensity score matching to compare persons with back pain who completed a medical rehabilitation program with similar untreated subjects. Questionnaire data were assessed in 2017 and 2019, and linked with administrative data. The primary outcome was pain disability. RESULTS: In total, 6610 persons with back pain were considered for matching and we finally compared 200 persons treated in a medical rehabilitation program with 200 untreated subjects. Pain disability was reported more favorable in the control group without medical rehabilitation compared to the intervention group (difference = 4.2; 95% CI -0.8-9.2), as well as other secondary outcomes. CONCLUSIONS: At first glance, the findings suggest that medical rehabilitation was ineffective in improving health, pain and work ability among employed persons with back pain, but we found plausible explanations indicating that the estimated effects in favor of the untreated subjects are methodologically induced.IMPLICATIONS FOR REHABILITATIONPropensity score matching can be used to assess the effects of multimodal interventions in persons with back pain in routine care.Inappropriate recruitment of controls may underestimate treatment effects.When using observational data and propensity score matching to analyze the effectiveness of medical rehabilitation, baseline survey should be conducted directly before the start of rehabilitation to identify comparable controls.

Self-Reported Prognosis of Employability as an Indicator of Need for Rehabilitation: A Cohort Study in People with Back Pain.

PURPOSE: Rehabilitation is a key strategy to enable people with disabilities or chronic diseases to participate in society and employment. In Germany, the approval of rehabilitation services is linked to personal requirements, including significantly compromised work ability due to illness. The subjective prognosis of employability (SPE) is a brief 3-item scale. The total score assesses the self-rated risk of permanent work disability and was therefore proposed to be an indicator to operationalize the requirements to determine the need for a medical rehabilitation measure. This cohort study examined whether rehabilitation and disability pensions can be predicted by the SPE in employees with back pain. Moreover, the study tested the applicability of the SPE regarding interrupted employment. METHODS: Employees aged 45 to 59 years who reported back pain in the last three months completed the SPE in 2017. The total score ranges from 0 to 3 points, with higher values indicating a higher risk of permanent work disability. Data on rehabilitation, disability pensions, and interrupted employment were extracted from administrative records covering the period until the end of 2018. Proportional hazard and logistic regression models were fitted. RESULTS: Data of 6,742 participants were included (mean age: 52.3 years; 57.8% women). Maximum follow-up was 21 months. Of the participants, 38.8, 33.6, 21.4, and 6.2% had an SPE score of 0, 1, 2, and 3 points, respectively. During follow-up, 535 individuals were approved for a rehabilitation measure and 49 individuals for a disability pension. Fully adjusted analyses showed an increased risk of a rehabilitation in employees with an SPE score of 3 points (HR=2.20; 95% CI 1.55; 3.11) and 2 points (HR=1.76; 95% CI 1.33; 2.31) compared to employees with an SPE score of 0 points. The risk of a disability pension (HR=13.60; 95% CI 4.56; 40.57) and the odds of interrupted employment (OR=2.58; 95% CI 1.72; 3.86) were also significantly increased for those with an SPE score of 3 points. CONCLUSIONS: The brief SPE is an appropriate tool to identify individuals reporting back pain at risk of rehabilitation, poor work participation outcomes, and permanent work disability. HINTERGRUND: Rehabilitation ist eine Schlüsselstrategie, um Menschen mit Behinderungen oder chronischen Erkrankungen die Teilhabe an der Gesellschaft und am Arbeitsleben zu ermöglichen. In Deutschland ist die Bewilligung von Rehabilitationsleistungen an persönliche Voraussetzungen geknüpft, u. a. an eine erhebliche Gefährdung der Erwerbsfähigkeit aufgrund von Krankheit. Die subjektive Erwerbsprognose (SPE) ist eine kurze 3-Item-Skala. Der Gesamtscore bewertet das selbst eingeschätzte Risiko einer dauerhaften Arbeitsunfähigkeit und wurde daher als Indikator zur Operationalisierung der Voraussetzungen und zur Bestimmung des Bedarfs an einer medizinischen Rehabilitationsmaßnahme vorgeschlagen. Die Kohortenstudie untersucht, inwiefern Rehabilitationen und Erwerbsminderungsrenten durch die SPE bei Beschäftigten mit Rückenschmerzen vorhergesagt werden können. Zudem wurde die Assoziation zwischen der SPE und unterbrochener Beschäftigung getestet. METHODEN: Die SPE wurde im Jahr 2017 bei Versicherten im Alter von 45 bis 59 Jahren, die Rückenschmerzen in den letzten drei Monaten berichteten, erhoben. Der Gesamtscore reicht von 0 bis 3 Punkten, wobei höhere Werte ein höheres Risiko für eine dauerhafte Erwerbsunfähigkeit anzeigen. Daten zu Rehabilitationen, Erwerbsminderungsrenten und unterbrochener Beschäftigung umfassen den Zeitraum bis Ende 2018 und wurden aus den Versichertenkonten extrahiert. Die Zusammenhänge wurden mittels proportionaler Hazard- und logistischer Regressionsmodelle getestet. ERGEBNISSE: Es wurden die Daten von 6.742 Teilnehmenden eingeschlossen (mittleres Alter: 52,3 Jahre; 57,8% weiblich). Der maximale Nachbeobachtungszeitraum betrug 21 Monate. 38,8, 33,6, 21,4 und 6,2% hatten einen SPE-Score von 0, 1, 2 bzw. 3 Punkten. Im Beobachtungszeitraum wurde 535 Personen eine Rehabilitationsmaßnahme und 49 Personen eine Erwerbsminderungsrente bewilligt. Vollständig adjustierte Analysen zeigten ein erhöhtes Risiko für eine Rehabilitation bei Beschäftigten mit einer SPE von 3 Punkten (HR=2,20; 95% KI 1,55; 3,11) und 2 Punkten (HR=1,76; 95% KI 1,33; 2,31) im Vergleich zu Personen mit einer SPE von 0 Punkten. Das Risiko einer Erwerbsminderungsrente (HR=13,60; 95% KI 4,56; 40,57) und die Wahrscheinlichkeit für eine unterbrochene Beschäftigung (OR=2,58; 95% KI 1,72; 3,86) waren ebenfalls signifikant erhöht für diejenigen mit einer SPE von 3 Punkten. SCHLUSSFOLGERUNGEN: Die SPE ist bei Menschen mit selbstberichteten Rückenschmerzen ein geeignetes Assessmentinstrument zur Identifizierung von Personen, bei denen ein erhöhtes Risiko für eine Rehabilitation, gefährdete berufliche Teilhabe und dauerhafte Arbeitsunfähigkeit besteht.

The role of different nephrology experts in informed shared decision-making for renal replacement therapy.

BACKGROUND: Interprofessional teams and peer support are being increasingly considered in informed shared decision-making. In Germany, there appear to be deficits in the implementation of informed shared decision-making in the choice of renal replacement therapy, such as the lack of collaboration in interprofessional teams and the absence of structured peer support programmes for patients with chronic kidney disease. OBJECTIVE: To explore nephrologists' and nurses' perspectives regarding their involvement in shared decision-making when choosing renal replacement therapy. DESIGN: Guideline-based, problem-centred interviews were used. PARTICIPANTS: A total of 20 nephrologists and 15 nurses were recruited from 21 dialysis units all over Germany. APPROACH: Interviews were audio-recorded and transcribed. They were analysed thematically using structuring and summary content analysis, supported by the qualitative data analysis software MAXQDA 12. RESULTS: The most important findings were the late or missing participation of nurses in the informed shared decision-making process and the unstructured peer support. Along with time and financial factors, these aspects were seen as barriers to shared decision-making with patients who are often overwhelmed by the diagnosis. Furthermore, informed shared decision-making has been insufficiently considered in professional education and training. CONCLUSION: Shared decision-making in the choice of renal replacement therapy is particularly challenging due to the patients' high disease burden. The greater incorporation of informed shared decision-making in education and training as well as the consistent involvement of nursing staff and structured peer counselling already in the predialysis phase with adequate reimbursement can address the identified hurdles.

RENaBack: low back pain patients in rehabilitation-study protocol for a multicenter, randomized controlled trial.

BACKGROUND: Millions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country. METHODS: The aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program. The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG). DISCUSSION: An improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers. TRIAL REGISTRATION: DRKS, DRKS00020373 . Registered on 15 April 2020.

SmartCards as Analogous Tools to Operate Tablet Computers for Elderly-A Feasibility Study.

BACKGROUND: Older adults sometimes shy away from using modern digital communication devices due to lacking experience and fear of failure. Within the present project, SmartCards were developed as analogous means to operate tablet computers for older adults with little previous computer experience. We investigated whether the SmartCards-Tablet-System would (a) increase use of digital communication and (b) affect loneliness, autonomy, cognitive ability and wellbeing of the users. METHODS: The suitability and acceptance of the system was evaluated during a three month trial period with seniors in retirement homes, seniors with home assistance care and a waiting control group. RESULTS: Acceptance, duration of use and frequency of use were high in both experimental groups. Cognitive ability significantly improved after three months' use in both experimental groups. Effects on loneliness, autonomy and wellbeing could not be observed. DISCUSSION: Our results indicate that seniors are very much able and curious to use modern digital devices if the interface and hardware are adjusted to their needs and capabilities without being stigmatizing. The use of modern communication services and the World Wide Web can promote contact of seniors with their (younger) relatives.

Is strain due to household and family work associated with a subjective need for rehabilitation among employees? A cross-sectional study.

BACKGROUND: The gender-specific unequal distribution of paid employment and unpaid household and family work may entail specific implications for women's and men's health and work ability. Medical rehabilitation is provided to maintain or restore work ability and to prevent disability pensioning. However, more than half of the employees who receive disability pension have not utilized any pre-retirement rehabilitation services. The study was conducted to examine associations between strain due to unpaid work and the subjective need for rehabilitation among employees with an increased risk of early retirement due to adverse health conditions. METHODS: Cross-sectional data from the "Third German Sociomedical Panel of Employees" (GSPE-III) were analysed. The sample comprises 1,908 German employees aged between 42 and 56 years. Logistic regression analyses were conducted separately for women and men to explore the association between the strain level and the subjective need for rehabilitation. RESULTS: Overall, women reported a higher strain level compared to men. Strain due to housework was not associated with the subjective need for rehabilitation in men and women. However, after adjustment for socio-demographic, work- and health-related characteristics the odds for a subjective need for rehabilitation were three times higher for women (OR=2.9, p <0.001) and two times higher for men (OR=2.0, p=0.027) with a high level of strain due to family work compared to persons with a low strain level. DISCUSSION: This study analysed the strain of unpaid work in the context of the utilization of medical rehabilitation services. Although women report a gender-specific higher strain due to unpaid work, a high strain level due to family work seems to be an additional and independent factor influencing the subjective need for rehabilitation for both genders equally. CONCLUSION: To prevent disability pensioning, more consideration should be given to the strain factors associated with unpaid family work when designing and organising interventions to promote access to medical rehabilitation services.

[Determinants of the Wish for Rehabilitation and the Intention to Apply in Persons with Back Pain]. / Determinanten des subjektiven Rehabilitationsbedürfnisses und der Antragsintention bei Personen mit Rückenschmerzen.

PURPOSE: Up to now, the main focus of analysis has been on determinants of the application for and utilization of medical rehabilitation due to back pain. The prevalence and determinants of motivational and volitional preceding stages of the application have not yet been well examined. Therefore, this study analyses the prevalence and determinants of the wish for rehabilitation and the intention to apply. METHODS: Data were derived from the baseline survey of a cohort study including a sample of 45,000 persons randomly drawn from the statutory pension agencies (GPI North and GPI Central Germany). The baseline data of persons aged 45-59 years with back pain within the past 3 months, neither receiving disability pension nor medical rehabilitation during the past 4 years were analysed. Determinants of the wish for rehabilitation and the intention to apply were identified using multivariate logistic regression analyses. RESULTS: 2,348 of the 6,549 persons with back pain (36%) wished to participate in a rehabilitation program. Of these 774 (33%) declared their intention to apply. Both dependent variables were strongly associated with the social support by family and friends. The wish for rehabilitation was also strongly determined by the previous experience with rehabilitation services. Another important determinant of the intention to apply was the support by physicians and therapists. Other factors were found to influence both dependent variables differently. CONCLUSION: In order to improve the need-based access to rehabilitation, the preceding stages (wish for rehabilitation and intention to apply) and their partly different determinants should be considered. The support by family and friends as well as physicians and therapists are important. This is a further indication that information and the involvement of these actors are key elements to ensure an acquired access to rehabilitation.