Self-Reported Prognosis of Employability as an Indicator of Need for Rehabilitation: A Cohort Study in People with Back Pain

Abstract

Purpose Rehabilitation is a key strategy to enable people with disabilities or chronic diseases to participate in society and employment. In Germany, the approval of rehabilitation services is linked to personal requirements, including significantly compromised work ability due to illness. The subjective prognosis of employability (SPE) is a brief 3-item scale. The total score assesses the self-rated risk of permanent work disability and was therefore proposed to be an indicator to operationalize the requirements to determine the need for a medical rehabilitation measure. This cohort study examined whether rehabilitation and disability pensions can be predicted by the SPE in employees with back pain. Moreover, the study tested the applicability of the SPE regarding interrupted employment. Methods Employees aged 45 to 59 years who reported back pain in the last three months completed the SPE in 2017. The total score ranges from 0 to 3 points, with higher values indicating a higher risk of permanent work disability. Data on rehabilitation, disability pensions, and interrupted employment were extracted from administrative records covering the period until the end of 2018. Proportional hazard and logistic regression models were fitted. Results Data of 6,742 participants were included (mean age: 52.3 years; 57.8% women). Maximum follow-up was 21 months. Of the participants, 38.8, 33.6, 21.4, and 6.2% had an SPE score of 0, 1, 2, and 3 points, respectively. During follow-up, 535 individuals were approved for a rehabilitation measure and 49 individuals for a disability pension. Fully adjusted analyses showed an increased risk of a rehabilitation in employees with an SPE score of 3 points (HR=2.20; 95% CI 1.55; 3.11) and 2 points (HR=1.76; 95% CI 1.33; 2.31) compared to employees with an SPE score of 0 points. The risk of a disability pension (HR=13.60; 95% CI 4.56; 40.57) and the odds of interrupted employment (OR=2.58; 95% CI 1.72; 3.86) were also significantly increased for those with an SPE score of 3 points. Conclusions The brief SPE is an appropriate tool to identify individuals reporting back pain at risk of rehabilitation, poor work participation outcomes, and permanent work disability.

Contextual factors in persistent severe back pain: A longitudinal analysis among German employees

“…Even when considering all other predictors, age remained as a relevant risk factor for stagnation (despite the already narrow age range in the sample). In addition, a large part of the stagnation group assessed their own employment prognosis negatively, which is a predictor for interrupted employment and disability pensions (Fauser, Zimmer, et al., 2022). Those in our sample with persistent back pain were more likely to be out of employment or to have applied for a disability pension than the reference group of people with decreasing back pain.…”

Holistic clarification of the need for intervention at the interface of rehabilitation and occupational medicine when work participation is at risk

“…In Deutschland wurden Probleme beim Zugang zu Rehabilitationsleistungen festgestellt. Etwa die Hälfte der Personen, denen eine Erwerbsminderungsrente bewilligt wird, hat im Vorfeld keine medizinische Rehabilitation in Anspruch genommen [ 3 , 4 ]. Die Teilnahme an einer medizinischen Rehabilitation erfordert einen Antrag der bedürftigen Person und die Unterstützung durch Haus‑, Fach- oder Betriebsärzt*innen.…”

Effectiveness of a screening tool to assess prevention and rehabilitation needs of 45 to 59 years old in primary care – study protocol of a pragmatic randomized controlled trial (PReHa45)

“…In order to prevent a reduction in work ability at an early stage and to simplify access to prevention and rehabilitation services, the principle of "prevention before rehabilitation before pension" must be strengthened. In fact, half of those who receive a disability pension for the first time have not received any medical rehabilitation or other services offered by the German Pension Insurance to enhance work ability (3)(4)(5)(6). If a disability pension is granted, employees are very unlikely to return to work (7).…”