Implementing the German model of work-related medical rehabilitation: Did the delivered dose of work-related treatment components increase?

Publication date: Available online 7 July 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Matthias Bethge, Miriam Markus, Marco Streibelt, Christian Gerlich, Michael Schuler

Abstract

Objective

Work-related components are an essential part of rehabilitation programs to support return to work of patients with musculoskeletal disorders. In Germany, a guideline for work-related medical rehabilitation was developed to increase work-related treatment components. In addition, new departments were approved to implement work-related medical rehabilitation programs. The aim of our study was to explore the state of implementation of the guideline's recommendations by describing the change in the delivered dose of work-related treatments.

Design

Nonrandomized controlled trial (cohort study).

Setting

59 German rehabilitation centers.

Participants

9,046 patients with musculoskeletal disorders were treated in work-related medical rehabilitation or common medical rehabilitation. Patients were matched one-to-one by propensity scores.

Interventions

Work-related medical rehabilitation in 2014 and medical rehabilitation in 2011

Main outcome measures

Treatment dose of work-related therapies.

Results

The mean dose of work-related therapies increased from 2.2 hours (95% CI: 1.6-2.8) to 8.9 hours (95% CI: 7.7-10.1). The mean dose of social counseling increased from 51 to 84 minutes, the mean dose of psychosocial work-related groups from 39 to 216 minutes, and the mean dose of functional capacity training from 39 to 234 minutes. The intraclass correlation of 0.67 (95% CI: 0.58-0.75) for the total dose of work-related therapies indicated that the variance explained by centers was high.

Conclusions

The delivered dose of work-related components was increased. However, there were discrepancies between the guideline's recommendations and the actual dose delivered in at least half of the centers. It is very likely that this will affect the effectiveness of work-related medical rehabilitation in practice.

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