Rehabilitation最新文献

Purpose: The aim of this job coaching study was to explore and describe goals of coachees (employees with a severe disability) and the companies they were employed in by examining goals, whether these changed from beginning to end, and if these were reached or skipped.

Methods: Sixty-two case files of job coaching were analysed qualitatively. Job coaching is an intervention on the job for employees with severe disabilities. The intervention had a duration of several months, and included training of the person as well as adjustment of the workplace. Goals were formulated by the coach in the beginning, during the intervention and at the end of job coaching. A deductive-inductive analysis based on Mayring was conducted to classify and quantify the expressed goals.

Results: A total of 370 goals were classified into 13 categories, within two overarching dimensions: context-oriented and person (i.e. coachee)-oriented goals. These goals covered a wide range of topics, with most goals focusing on mastering work (task) (24.55%), followed by workplace & task adaption (12,42%).

Conclusions: Despite the fact that job coaching is person-focused, especially on work tasks, context aspects such as work environment and team communication need to be addressed, in order to ensure work integration.

Purpose: The approaching retirement of numerous physicians threatens to create a shortage of medical professionals in many areas and has already been confirmed to be the case in the field of medical rehabilitation. The aim of the present study was to broaden the scope of research to encompass inpatient mother/father-child preventive and rehabilitation clinics.

Methods: Directors of inpatient mother/father-child preventive and rehabilitation clinics were asked to evaluate the medical staffing situation and to explain their strategies for recruiting medical staff in their facilities. To calculate a medical staff shortage score, the indicators proportion of vacant positions, vacancy period, and fluctuation rate were used.

Results: The majority of clinic directors were rather or very satisfied with the current medical staffing situation, but the future situation constituted a major concern for them. Job advertisements and professional or private networks were primarily used to recruit medical staff. Of the 67 clinics surveyed, around 60 per cent did not have a shortage of medical professionals, while nine clinics were experiencing high levels of shortage.

Conclusion: Slightly less than half of inpatient mother/father-child preventive and rehabilitation clinics are already affected by a shortage of medical professionals. It seems appropriate to react and to respond with targeted measures to ensure medical care in preventive and rehabilitation clinics for mothers, fathers and their children.

Purpose: The INFORM project aimed to assess the training and support needs of rehabilitation-related knowledge and skills among those working in social and health professions in medical rehabilitation, as well as facilitators and barriers to the use of offers.

Methods: Following a mixed-methods approach, training and support demands of the clinical staff were explored within as well as across professions in group discussions (n=9 and 6, respectively) and interviews (n=10), supplemented by interviews with clinical heads (n=5). A nationwide online survey was conducted to verify and quantify the qualitative results (n=431 employees).

Results: The initial phase of work in the professional field of medical rehabilitation proved challenging to new entrants, particularly without adequate onboarding, and was predominantly characterized as 'learning by doing'. This resulted in a crucial need for subsequent or further imparting of rehabilitation-specific skills. This included both overarching topics (e.g., communication with patients, dealing with workloads, interprofessional collaboration) and occupation-specific topics (e.g., innovations in social medicine, provision of assistive devices, support in coping with illness). There was a strong interest in online training for knowledge transfer as well as cross-clinic and interprofessional exchange. High levels of self-motivation and (also financial) support from clinics and superiors, respectively, were identified as promoting factors in using offers, while a lack of time or financial resources and limited availability of offers were identified as barriers.

Conclusion: Medical rehabilitation, particularly interprofessional collaboration, requires specific expertise and skills development in those working in social and health professions; this necessitates continuous training and professional exchange beyond the onboarding phase. Therefore, more flexible (digital), rehabilitation-specific, practical, and especially interprofessional offers are needed that can be better integrated into the daily work of rehabilitation staff. Options for action arise both at the individual and organizational levels, as well as for rehabilitation providers and professional associations.

Purpose: In 2022, lawmakers established the Single Points of Contact for Employers (§185a SGB IX) across Germany with the aim of improving opportunities for people with disabilities to particpate in the labor market. The EAA are intended to inform, advise, and support employers on issues related to disability and work. The EAA's funding and employment structures differ considerably between the federal states. The aim of this article was to compare the EAA's counseling figures across the various federal states and to identify opportunities for further developing the EAA's case data documentation.

Methods: Methodologically, the study followed a multi-method design combining descriptive analyses of state-level EAA case data for the 2024 reporting period with guided expert interviews. In addition, the findings were discussed with EAA experts in a participatory dialogues.

Results: The results showed substantial differences between the federal states in terms of documented contact occasions. These differences can be attributed to variyng interpretation of key terms and documentation practices, different employment situations and prior structures as well as heterogeneous provider structures.

Conlusion: The EAA case documentation offers opportunities for a targeted management of this new labor market policy instrument. Documentation should be further standardized across federal states in order to enhance comparability. Nevertheless, each federal state should formulate individual (sub)goals, taking into account its own conditions and specificities.

Purpose: Returning to the workplace after inpatient medical rehabilitation poses significant challenges for many rehabilitants. When conventional rehabilitation aftercare is not available, internet-based aftercare offers an effective alternative to support rehabilitants in incorporating action and coping strategies developed during rehabilitation into daily personal and professional life. This paper presents the development and pilot testing of the internet-based self-help intervention "marena" (My Work-Related Rehabilitation Aftercare), which was designed to support rehabilitants during this complex transition.

Methods: The intervention was developed in an agile, iterative process based on comprehensive literature research and expert interviews. Its features and content were continuously refined through expert feedback loops. Rehabilitants were actively involved in order to identify potential usability problems and evaluate usability and user experience.

Results: Marena includes, among other elements, task planning with pre-designed aftercare plans, a knowledge base with frequently asked questions, and established rehabilitation strategies and exercises. Marena promotes key behaviour change techniques by providing information and supporting self-monitoring and setting aftercare goals. The pilot study included n=7 participants. Usability was rated as good, achieving a System Usability Score of 75.33 (SD=6.97). User experience was assessed in the User Experience Questionnaire with an overall score of 1.02 (SD=1.07), indicating an average rating. A total of 38 usability issues were identified, with the most frequent and severe problems occurring in the areas of design and functionality.

Conclusion: Despite some limitations, the pilot study provides valuable insights into user interactions with the intervention. The investigation identified key usability issues, which led to specific optimizations of the application. The results highlight the importance of pilot-testing internet-based interventions with future users for identifying usability-problems early on. The intervention is currently undergoing evaluation for effectiveness in a randomized controlled trial.

Purpose: The aim of the study was to investigate the acceptance and satisfaction of the hybrid rehabilitation concept among psychosomatic rehabilitation patients and rehabilitation clinic staff. The aim was to identify facilitators, barriers, potential for improvement and strategies for successful implementation.

Methods: The hybrid concept was developed and tested in a psychosomatic rehabilitation clinic from June 2021 to December 2022. It consists of a 4-week inpatient phase followed by a fifth rehabilitation week at home ("bridge week") with digital therapy units and self-exercises. The qualitative evaluation is based on 34 longitudinal interviews (before and after the outpatient week and after 6 months) with 12 rehab patients using the hybrid rehab and two focus groups with 8 rehab staff. The data were analysed according to Mayring.

Results: The hybrid rehab patients were mostly satisfied with the concept, especially with the outpatient week, which eased the transition from rehab to everyday life. The flexibility of the therapy process and the therapeutic support during the return to everyday life were particularly positive. The direct transition to the outpatient week and technical difficulties posed challenges. A home environment with few disruptive factors, sufficient opportunities for retreat and a supportive social environment were identified as important success factors. There was also a high level of acceptance from the rehabilitation staff. The initial additional administrative workload was reduced once the processes were optimised and established. A motivated team was crucial for successful implementation. The staff felt that the hybrid rehab was up to date and met their needs, so they were in favour of continuing with the concept.

Conclusion: Hybrid rehabilitation with a digital bridge week is a promising, needs-based alternative to traditional inpatient psychosomatic rehabilitation that has met with a high level of acceptance among both rehabilitants and rehabilitation staff. By selecting suitable rehabilitation patients and ensuring optimal technical and organisational conditions, the concept shows potential to improve the transfer of rehabilitation content into everyday life. However, further studies are needed to evaluate its long-term effectiveness.

Purpose: The rehapro model project 'Employment Entry Incentive' (ESP), a bonus scheme designed to encourage individuals with long-term health impairments to take up regular employment. This qualitative study examined the effects of the ESP from the perspective of its recipients. Additionally, it explored the specific challenges for return to work faced by this target group.

Methods: Between February 2021 and July 2022, qualitative interviews were conducted with 22 ESP recipients and analyzed using a Grounded Theory approach. A total of 11 women and 11 men from the jurisdictions of the German Pension Insurance (DRV) Braunschweig-Hannover (DRV BS-H) and DRV Mitteldeutschland (DRV MD) were interviewed by telephone. The study was conducted using a mixed methods design.

Results: The ESP primarily had a stabilizing function and facilitated transition into new employment by mitigating short-term financial constraints. It was frequently used for mobility and unforeseen expenses, contributing to planning reliability in everyday life. All participants were motivated to take up employment regardless of the ESP. No adverse incentives were identified. A crucial factor in job search was the alignment of the employment conditions with the individual's health situation and the prospect of long-term professional integration.

Conclusion: The ESP provides low-threshold financial support that facilitates return to work and contributes to stabilizing individuals' life situations in the initial months of employment. Its flexibility allows for needs-based application. The alignment of employment conditions with existing health limitations is critical for successful reintegration. The potential of the ESP as a labor market reintegration measure lies in its positive effects on participation and stability across various aspects of life.

Objective: The entry bonus (ESP) is an innovative benefit designed to promote participation in working life, which has been trialled as part of the rehapro support programme. Its main objective is to facilitate the rapid and self-directed reintegration of people with long-term health impairments into the labour market. The ESP is offered as an alternative to the integration subsidy (EGZ) and provides employees with monthly support of up to €400 over a period of six months, as well as a one-time success bonus after twelve months of employment. The measure is intended to motivate people to take up employment, facilitate their transition into working life and improve their chances of participating in social life.

Methodology: In the cohort study, rehabilitation statistics data (RSD) from insured persons of the pension insurance institutions Mitteldeutschland and Braunschweig-Hannover who received the ESP or EGZ were evaluated. The main target parameter was the reintegration rate six, 13 and 15 months after the start of the measure and a cost comparison. Secondary parameters such as the sectors of employment were analysed for both groups using descriptive analyses. In addition, a binary logistic regression analysis was performed to investigate predictors of 15 months of employment.

Results: During the intervention period, 485 persons received ESP. The RSD analysis showed a higher employment rate for the group receiving ESP for the periods of 6 months, 13 months and 15 months after the start of the measure (91.3% for 6 months, 83.7% for 13 months and 81.2% for 15 months after the start of the measure). The employment rate for the EGZ group was 89.3% after 6 months, 68.7% after 13 months and 63.4% after 15 months after the start of the programme. ESP recipients had 2.4 times higher odds to be in employment after 15 months than EGZ recipients. The measure costs per case were 2.8 times higher in the EGZ group than in the ESP group.

Conclusion: Reintegration rate and economic analysis of the ESP show a positive outcome of the pilot project. The benefit reaches a target group that has long-term health restrictions and, in some cases, has been unemployed for a long-term period. KEY MESSAGE: : The entry bonus is a non-purpose-tied benefit for employees. Compared to payments to employers, ESP is an alternative option and achieves a better integration rate at lower costs than the EGZ.

Purpose: The risk index for permanent work disability (RI-EMR) can be used to identify insured persons with a high likelihood of receiving a disability pension in the next five years. To tailor more precisely proactive outreach as well as support services to these people, the study aimed to explore their specific problems and needs, and cluster them to typical case constellations.

Methods: Interviews were conducted with 50 insured persons with a high RI-EMR score (≥60). Recruitment and sampling were carried out using a letter and a short questionnaire. The analysis followed a mix of sequential-narrative and category-based approach, supplemented by a systematic-contrastive case comparison. Subsequently, it was examined whether the identified case types could be found in the administrative data of the German Pension Insurance (GPI).

Results: We identified 6 case constellations that differed in terms of their illness and employment biographies and remaining earning capacity, leading to different support needs. These ranged from information, counselling, and application support regarding specific rehabilitation services, to case management, as well as the initiation of a participation plan procedure and transition support into a (permanent) work disability or (premature) old age pension. The case types could be found in the administrative data of the GPI, so that statements about their approximate proportions in the overall population could be made.

Conclusion: Within the group of insured individuals with a high RI-EMR, types of different problems and needs can be described, and identified by using routine data. This provides concrete hints for tailored outreach and support for the target group.