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.

A recovery-oriented day hospital in psychiatry: A springboard for reintegration.

Psychiatric disorders are common and can cause psychological disabilities. While the creation of day hospitals (DHs) was intended to direct psychiatric care towards community settings, they may have paradoxically contributed to a form of chronicity. Furthermore, the heterogeneity and lack of evaluation of care within DHs prevent the availability needed to collect objective data on users outcomes. In this article, we aim to describe and measure the effects of a transformation of practice within a sector-based DH initially focused on traditional institutional psychiatry towards a rehabilitation model of care which offers different therapeutic tools, structured in three stages, and whose main objective is professional integration. This retrospective mirror study compares, before and after the transformation of this DH, several indicators including the rate of professional integration and its maintenance after two years. We found that this psychosocial rehabilitation model for care allowed a very clear increase in the professional integration rate and its maintenance at two years while reducing the length of stay to around 18 months. These promising results therefore highlight the pivotal role of DHs as "stepping stones" in addressing psychological disabilities towards recovery.

The role of cardiac rehabilitation in vocational reintegration Belgian working group of cardiovascular prevention and rehabilitation position paper.

Cardiovascular disease is one of the main causes of morbidity and sick leave in Belgium, imposing a great socio-economic burden on the contemporary healthcare system and society. Cardiac rehabilitation is an evidence-based treatment strategy that not only improves the cardiac patients' health state but also holds promise so as to facilitate vocational reintegration in the society. This position paper was developed and endorsed by the Belgian Working Group of Cardiovascular Prevention and Rehabilitation. It provides an overview of the currently available Belgian data with regard to the role of cardiac rehabilitation in return to work after an initial cardiac event. It identifies the relevant barriers and facilitators of vocational integration of cardiac patients and summarises the contemporary Belgian legal and medical framework in this regard. Cardiac rehabilitation remains a primordial component of the post-acute event management of the cardiac patient, facilitating vocational reintegrating and thereby decreasing the pressure on social security. Despite the availability of a relevant legislative framework, there is a need for well-defined algorithms to assess readiness for return to work that can be used in daily clinical practice.

[Working After Lung Transplantation]. / Arbeiten nach Lungentransplantation.

Working After Lung Transplantation Abstract. Whether patients return to work after a successful lung transplant depends on various factors. The best predictive factor for employment after transplantation is the employment status before transplantation. Currently, there is no internationally standardized procedure regarding the questions of when and according to what criteria patients should be reintegrated into the working environment after lung transplantation. The risk of infection at the workplace/during the work activity should definitely be assessed before resuming work: a detailed work history is mandatory, an additional workplace inspection a further option. Advice should be based on the medical literature and general recommendations, and psychosocial factors must also be taken into account. In case of ambiguities, an interdisciplinary discussion is recommended.