Type of Project: Funded project Joint project Study
Patients' need for rehabilitation after hospital discharge - evaluation of a predictor system and development of an assessment tool

Purpose and background of the study: The purpose of the study is to elucidate the different rate of return to work of patients who have participated in an inpatient medical rehabilitation program and who were employed at the time of participation. The reasons for this behavior do not arise suddenly in any of the patients at the end of treatment; rather, they are the more or less conscious product of a long series of experiences. Methodology: The study of the stratification of experience expressed in action suggests a longitudinal study design. Unlike a panel or trend study in which the same variables in the same operationalization are presented to the same people at different times, a biographical interview was recorded with the patients in which the interviewees could recount their actions in detail over time. The uncovering of the horizons of meaning contained in the interviews and the condensation of the texts into a theory close to the subject led to the identification of gender-specific different coping patterns of the changed life situation caused by the health restrictions. These coping patterns were now translated into questions that addressed the aspect of a series of experiences for the respondents in order to compensate for the punctuality of a cross-sectional survey with which long-term action cannot be captured. Results and outlook: The questionnaire was completed by 281 patients at 6 clinics. The testing of the hypotheses showed that people with a well-developed ability to plan their future return to work more quickly than people with a less well-developed ability to plan. The hurdles to be overcome with this planning ability present themselves differently according to gender; while women's attentiveness is focused on stabilizing their relationship with their life partner, men's attentiveness is focused on concerns about maintaining their workplace and job performance. The questionnaire instrument that emerged from the study can help identify patients with action deficits at the time of discharge from the rehabilitation clinic. Counseling that specifically works out the courses of action with those affected that are necessary in the individual case can then significantly accelerate the return of many patients. The project has been completed. In 2003, the results were checked on a new sample of 171 patients. This showed that the evaluation methodology of the IRI (Isny Return Inventory) was able to predict women returning to work with a delay with a sensitivity of 0.71; for men, the sensitivity was 0.52. In view of the considerable shift in the rate of return of the rehabilitants between the 1999/ 2000 and 2003 surveys, the prediction quality determined may be regarded as an acceptable value in terms of sensitivity. Regular calibration is recommended when the IRI is adopted for continuous use. The report of this cross-validation is unpublished. It will be sent as a PDF file upon request. Research association Ulm