Type of Project: Implementation project Scientific Work
Extension of a job-oriented training concept for a more efficient professional reintegration of rehab patients

Background and problem: A frequent problem after occupational accidents is the sometimes long period between the accident and the return to work. Due to increasing cost pressure, accident and pension insurers have a great interest in shortening the time between accident and return to work. It is well known that periods of absence of more than 3 months significantly impair the return to the old job or workplace. For this reason, in addition to gradual reintegration, ways must be found to integrate the occupational aspect even more strongly and earlier into the rehabilitation process. Goal: The concept of Bavaria Work Hardening (BWH) that has been developed aims to help patients who have already survived the acute rehabilitation phase immediately after the accident or surgery to improve their work skills. the aim of the Bavaria Work Hardening (BWH) concept is to rehabilitate patients who have already survived the acute rehabilitation phase immediately after the accident or operation, whose healing process is largely complete but who still have significant limitations, to such an extent in a second inpatient training phase that it should be possible to resume work immediately after completion of this second healing phase. Status: In cooperation with an interdisciplinary team of employees from a large rehabilitation clinic, an overall concept, the BWH training, is initially being developed for orthopedic and neurological patients and will enter the testing and evaluation phase in 2004. This training is a further development of the MBO concept (medically occupationally oriented rehabilitation) with stress bottleneck-related training at the model workplace (MAP). Procedure: The pilot project should run in an area that reaches as many patients as possible. The occupational statistics of the patients with job-oriented rehabilitation treated in the clinic between July 2002 and April 2003 show a focus on the construction sector (66 out of 422 patients corresponding to 15%, including bricklayers, construction machinists, concrete builders, roofers, carpenters, road builders). These occupational groups will be considered first. Work areas will be simulated on which training should be as close to the occupation as possible. This is a training with different sub-areas, whereby the occupation-specific training at the MAP or in the BWH area will be in the foreground during the clinic stay. BWH training ideally leads to an increase in work-related resilience, i.e., functional improvement, rather than pain relief. Only patients with remaining residual abilities that appear improvable to the point where return to work is likely or at least possible can benefit from BWH training. Training is based on so-called work hardening, a highly structured goal-oriented individualized treatment program that targets productivity, assurance, physical resilience, and normal work behavior. Workload improvement training must be planned and continuously monitored in collaboration between the patient, occupational physician, psychologist, physiotherapist, sports therapist and occupational educator. Individually adapted training lasting several hours takes place daily, consisting of work simulation training, endurance training, fitness and, to a lesser extent, physical therapy. The work is carried out in compliance with ergonomic working postures and working techniques at the various training stations with specified breaks. Status: Currently, the training stations are being set up and the training units and overall concept are being drawn up, as are training protocols. During the pilot phase, further concepts for other occupational groups will be developed, as well as a program to electronically record the training and the patient's progress.