Work-related medical rehabilitation in patients with mental disorders

Background: Rehabilitation care in accordance with the German Social Code VI aims to support return to work and to prevent the need to receive a disability pension. In order to achieve this goal for people at a high risk of not being able to return to work, work-related medical rehabilitation (WMR) was developed. To date, the evidence on the effectiveness of WMR for people with mental disorders is based on two randomized controlled trials that tested a very specific approach (external work capacity evaluation with accompanying therapeutic groups). In our randomized controlled and multicenter trial, we examined whether patients benefit more from WMR implemented in real-life care than from conventional medical rehabilitation (MR).

Methods: We recruited participants in five rehabilitation centers in Germany. We included patients aged 18 to 60 years with mental disorders for whom the need for WMR was determined by at least 27 points on the SIMBO-C in the participating rehabilitation centers. The participants were randomly assigned to WMR or MR in a one-to-one ratio. Outcomes were assessed using questionnaires at the beginning and end of rehabilitation and three and twelve months after completion of rehabilitation.

1,637 people were included in the analyses (mean age: 49.6 years; SD = 9.4; 59.3% female). Work ability of most of the participants was very clearly restricted: 20.5% were on sick leave for 14-26 weeks in the year prior to rehabilitation, 16.7% for 27-39 weeks and 45.7% for at least 40 weeks. At the end of rehabilitation, WMR participants reported more work-related content during rehabilitation, a higher work-related consistency of their rehabilitation and a higher achievement of work-related goals. At the end of rehabilitation, they reported significantly better physical role functioning and social functioning compared to MR participants. Individuals who participated in WMR and were unable to work for more than 26 weeks in the year prior to rehabilitation had almost consistently more favorable outcomes at the end of rehabilitation than comparable individuals in the control group. In the rehabilitation centers where participants reported a significantly better achievement of work-related rehabilitation goals in WMR, an advantage of WMR was also seen for many other outcomes. In the other two rehabilitation centers, these advantages in favor of WMR were not apparent. Three and twelve months after rehabilitation, differences between WMR and MR were more heterogeneous. Advantages in favor of WMR were particularly evident in two of the facilities in which WMR participants reported better achievement of work-related rehabilitation goals.