Comprehensive clarification of the need for intervention in endangered work participation

Background: The effectiveness of preventive and rehabilitative measures in securing work participation depends largely on whether they meet individual needs. This places high demands on diagnostics. Health services that are still strongly oriented towards symptoms of illness without considering the requirements and other special features of the workplace make it difficult to assess the individual’s health needs. If the restriction of occupational capacity due to a health problem is in an advanced stage of chronicity, the success of rehabilitation services is unclear. According to the subjective experience of employees with endangered work participation and according to internal communication in companies, physical, often musculoskeleta complaints are initially in the foreground when it comes to sickness absence. However, the restrictions experienced and their effects are often complex. A comprehensive diagnosis is often late, incomplete or one-sided, and the cooperation between employer and health care provider is inadequate.
The project aims to develop, implement and evaluate an early diagnostic clarification of health problems that endanger work participation. The aim of the model project is to quickly and comprehensively compare individual capacity and job requirements. From this comparison, tailored intervention strategies can be derived to secure individual's work participation.
Methods: The intervention will be developed in four workshops with the stakeholders involved in the first study year. A written manual is created for the standardized implementation of the intervention. In the pilot phase in the second year of the study, the population reached and the delivered and received treatment dose are described. The manual for implementing the intervention will be adapted on the basis of the pilot phase. The effectiveness of the new intervention strategy is tested in a randomized controlled trial with a waiting-list control group that will receive the intervention six months after study inclusion. We will include 210 employees (105 people per group). The primary outcome is self-rated work ability assessed using the Work Ability Score (0 to 10 points) six months after study inclusion.

Results: In the feasibility study, 27 people took part in the GIBI pilot programme. The participants reported a clinically relevant improvement in their general health (difference = 1.52; 95% CI 0.37 to 2.67) from the initial consultation with the occupational health physician company doctor to the last follow-up consultation.
Data from 61 participants (intervention group: n = 32) were included in the randomised controlled trial. After six months, there was a clinically significant but statistically non-significant difference between intervention and control group for subjective work ability (difference = 1.15: 95% CI: -0.05 to 2.35; p = 0.061; SMD = 0.53). For perceived job insecurity, there was an effect with a medium effect size in favour of the intervention group (difference = -16.40; 95% CI: -29.82 to -2.99; p = 0.017; SMD = -0.54). In addition, people in the intervention group reported around four weeks less sick leave in the last six months compared to the control group (difference = -4.00: 95% CI: -7.49 to -0.51; p = 0.025; SMD = -0.52).

Discussion: Successful implementation of GIBI requires close and intensive collaboration between occupational health physicians and rehabilitation centres. The results of the randomised controlled trial indicate that the GIBI intervention leads to a reduction in sick leave and an improvement in job security. For subjective work ability, the benefit could not be statistically verified, which was influenced by the fact that we clearly did not reach the a priori planned sample size of 210 people. The reasons for this are a delayed start to recruitment, the withdrawal of a rehabilitation facility and the overload of occupational physicians due to the pandemic.

In summary, however, GIBI offers employees an opportunity to address their own health and become familiar with rehabilitative services at an early stage. A two-day participation assessment can effectively expand the range of services offered by rehabilitative centres. Regional networks of occupational and rehabilitation medicine could also be used in other forms of care, e.g. for work-related medical rehabilitation, and rehabilitation centres could be developed into regional rehabilitation medicine competence centres.