PROREHAB: Promoting access to rehabilitation

In Germany, persons can request medical rehabilitation to improve work ability and participation in working life. A particular target group of these services are persons with a high risk of health-related early retirement, e.g. persons who received sick leave benefits. However, if need for rehabilitation does not lead to a formal rehabilitation request, this legal opportunity to keep handicapped people in working life remains unused. In 2011, 59.6 % of all male pensioners and 52.7 % of all female pensioners did not use medical rehabilitation before their health-related early retirement.
In our study, the effects of a web-based information guide on medical rehabilitation, which addressed persons with prior sick leave benefits, was examined. The theoretical framework of this web-based guide was based on Schwarzer’s Health Action Process Approach. This model distinguishes two phases when realizing health-related behavior: a motivational (forming an intention) and a volitional phase (acting). The website offered the opportunity to assess the need for rehabilitation by completing the Work Ability Index. In cases of low Work Ability Index scores persons were advised to apply for a medical rehabilitation. Handling and submission of the required application documents was supported by a step-by-step instruction.
The efficacy of the web-based information portal was investigated in a randomized controlled trial. Participants of the intervention group were informed on the aims of medical rehabilitation and the opportunity to use medical rehabilitation. Additionally, a link to the web-based information guide was provided. Participants of the control group received a short hint on the opportunity to request this service.
The primary outcome was the proportion of requested and utilized medical rehabilitation services after one year. These data were extracted from the insurance accounts. Secondary outcomes included the number of days receiving sickness absence benefits and the number of days in insured employment after one year, also obtained from the insurance accounts. Additional secondary outcomes were assessed after one year by using questionnaires. These outcome measures included attitudes toward rehabilitation and applying for rehabilitation (positive and negative outcome expectations, self-efficacy), indicators of health-related quality of life (subscales of the 36-Item Short-Form Health Survey: physical functioning, mental well-being, general health), as well as subjective work ability and days with perceived impairments.

Participants in the intervention group did not differ from those in the control group after the intervention period with regard to either the rate of applied for or the rate of utilized medical rehabilitation services. There were also no differences between the intervention and control groups in terms of the secondary outcome measures. Access analysis suggests that the informational website was only used to a limited extent.