Berufliche Wiedereingliederung nach einer medizinisch-beruflich orientierten orthopädischen Rehabilitation: Eine clusterrandomisierte Studie

Background: Since the 1990s work-related programmes became more important in orthopaedic rehabilitation. However, in Germany orthopaedic rehabilitation initially focussed on improvements in evaluating functional capacity and on the development of appropriate modules of exercise therapy while psychosocial work demands have been less considered in the rehabilitation process so far. Objective: Aims of the study were implementation and efficacy evaluation of an intensified multimodal work-related programme following a cognitive behavioural approach. Methods: Participants were patients with substantial work-related problems. Included patients were randomized in groups either to the work-related programme or to the common orthopaedic rehabilitation (cluster randomization). Primary outcome was return to work. Analyses were based on post-treatment data and data after six months. Results: 236 (86.8%) patients consented to participate. Questionnaires at post-treatment were completed by 155 (65.7%) persons and after six months by 169 (71.6%) persons. The medical performance evaluation given in the discharge letters documented a better performance of the intervention group (positive capacity: p=0.037; negative capacity: p=0.016). This evaluation was also reflected by the patients evaluation at post-treatment. Participants of the intervention group reported higher work-related self-efficacy (p<0.001) and felt that they are better prepared for the time after their rehabilitation (p=0.006). After six months participants of the intervention group had a 2.4-fold higher chance (p=0.007) of returning to work, reported a better mental condition (HADS depression: p=0.014; SF-36 Mental Health Index: p=0.026) and a more salutary work-related behaviour (AVEM striving for perfection: p=0.012). Regarding physical outcomes both groups achieved moderate to high effects. Conclusions: Results of the trial confirm that an intensified work-related programme with a well-defined multimodal composition like the one presented here is able to enhance the chances of participation in working life for patients with substantial work-related problems.