EMMSE: Implementation and process evaluation of a cooperative return-to-work management approach

Rehabilitative care commissioned by the German Pension Insurance aims at return-to-work and the prevention of disability-related early retirement. However, high-quality rehabilitation programs are only one determinant of successful reintegration into the workforce. In addition to the individuals with health impairments and rehabilitation facilities, the pension insurance institutions and employers are also key stakeholders. It is therefore essential to consider the interests of all parties involved and to coordinate their efforts in order to achieve successful work participation.
Against this background, our study tested a new case management approach for reintegration. The intervention was carried out by a rehabilitation counselor of the German Pension Insurance based in the Berlin-Brandenburg region. The reintegration plan was developed jointly with the individual and her or his employer.
The implementation of the intervention was accompanied by an uncontrolled observational study. Data on health and work ability were collected by questionnaires prior to the first contact with the rehabilitation counselor. Due to the small sample size, the originally planned follow-up assessments—scheduled for 6 and 12 months after the initial written contact—were not conducted. In addition, the rehabilitation counselor documented the implementation of the individual intervention components.
The study included individuals aged 18 to 60 who were discharged from rehabilitation as unfit for work due to musculoskeletal disorders, but who were assessed as having full work capacity for the general labor market. Eligible individuals still had an employment contract and, following rehabilitation, had neither initiated a gradual return-to-work program nor applied for vocational rehabilitation. These individuals were contacted by the German Pension Insurance based on administratively available data and informed about the study.
Additionally, in a later phase of the project, selected rehabilitation facilities informed directly about the study and recruited individuals who were still employed and considered at increased risk of not returning to work (i.e., discharged as unfit for work or scoring ≥ 27 points on the screening tool for identifying the need for work-related medical rehabilitation). These individuals were likewise only approached if neither a gradual return to work was planned nor vocational rehabilitation had been applied for.
Individuals who had undergone post-acute rehabilitation were excluded.

A total of 195 individuals were contacted by the German Pension Insurance. In addition, social services at selected rehabilitation facilities informed their rehabilitants about the case management opportunity between August and October 2017. Of the 195 individuals contacted by the German Pension Insurance, 62 responded. One additional response came from a person who had been informed about the case management in one of the participating rehabilitation facilities. For 48 individuals, the response was in the form of a completed questionnaire. Further responses were received via telephone or email.
Based on the feedback from potential participants, the most frequently cited reasons for not participating in the offered case management were: having already started or completed a gradual return-to-work program following medical rehabilitation (n = 23), having resumed employment in the meantime (n = 9), or having already submitted an application for vocational rehabilitation (n = 7). In some cases, the intended involvement of the employer was a reason for declining participation in the program. Four individuals stated that they did not want to have a conversation with their employer. One person either could not or did not want to return to their previous employer. Considering the inclusion and exclusion criteria, four individuals were eligible to participate in the case management. These individuals were supported by the rehabilitation counselor.
Of the four participants, two returned to their previous workplaces. However, in neither case could this return be causally attributed to the case management.
The case documentation revealed that none of the participants completed the case management as originally planned. Two individuals returned to work during the course of case management. In one case, the support was discontinued because further long-term medical treatment became necessary, which would have significantly exceeded the intended duration of the intervention. In the fourth case, support was terminated because the possibilities available to the case manager had been exhausted.
The implementation of the case management approach was unsuccessful. Neither the anticipated number of cases was reached, nor were the planned contents adequately implemented.