Institute for Social Medicine and Epidemiology, Universität zu Lübeck, Lübeck, Germany
Institute for Social Medicine and Epidemiology, Universität zu Lübeck, Lübeck, Germany.
Occup Environ Med. 2019 Dec;76(12):913-919. doi: 10.1136/oemed-2019-106065. Epub 2019 Oct 8.
Since 2014, the Federal German Pension Insurance has approved several departments to implement work-related medical rehabilitation programmes across Germany. Our cohort study was launched to assess the effects of work-related medical rehabilitation under real-life conditions.
Participants received either a common or a work-related medical rehabilitation programme. Propensity score matching was used to identify controls that were comparable to work-related medical rehabilitation patients. The effects were assessed by patient-reported outcome measures 10 months after completing the rehabilitation programme.
We compared 641 patients who were treated in work-related medical rehabilitation with 641 matched controls. Only half of the treated patients had high initial work disability risk scores and were intended to be reached by the new programmes. The dose of work-related components was on average in accordance with the guideline; however, the heterogeneity was high. Work-related medical rehabilitation increased the proportion of patients returning to work by 5.8 percentage points (95% CI 0.005 to 0.110), decreased the median time to return to work by 9.46 days (95% CI -18.14 to -0.79), and improved self-rated work ability by 0.38 points (95% CI 0.05 to 0.72) compared with common medical rehabilitation. A per-protocol analysis revealed that work-related medical rehabilitation was more effective if patients were assigned according to the guideline and the minimal mandatory treatment dose was actually delivered.
The implementation of work-related medical rehabilitation in German rehabilitation centres affected work participation outcomes. Improving guideline fidelity (reach and dose delivered) will probably improve the outcomes in real-world care.
DRKS00009780.
自 2014 年以来，联邦德国养老保险已批准多个部门在德国各地实施与工作相关的医疗康复计划。我们的队列研究旨在评估实际情况下与工作相关的医疗康复的效果。
参与者接受常规或与工作相关的医疗康复计划。使用倾向评分匹配来确定与与工作相关的医疗康复患者可比的对照组。在完成康复计划 10 个月后，通过患者报告的结果测量来评估效果。
我们比较了 641 名在与工作相关的医疗康复中接受治疗的患者和 641 名匹配的对照组。只有一半的治疗患者有较高的初始工作残疾风险评分，并且预期这些患者会从新计划中受益。与工作相关的康复治疗剂量平均符合指南，但异质性很高。与常规医疗康复相比，与工作相关的医疗康复使返回工作岗位的患者比例增加了 5.8 个百分点（95%置信区间 0.005 至 0.110），返回工作的中位时间缩短了 9.46 天（95%置信区间 -18.14 至 -0.79），自我评估的工作能力提高了 0.38 分（95%置信区间 0.05 至 0.72）。一项符合方案分析表明，如果根据指南分配患者并且实际提供了最低强制性治疗剂量，那么与工作相关的医疗康复效果会更好。
德国康复中心实施与工作相关的医疗康复计划影响了工作参与结果。提高指南的一致性（可达性和提供的剂量）可能会改善实际护理中的结果。
DRKS00009780。
