Type of Project: Funded project Study
Optimizing the availability and use of job descriptions and job knowledge in medical rehabilitation (OpAA)

Background: Comprehensive knowledge of the rehabilitant's workplace is a fundamental prerequisite for successful reintegration into working life after medical rehabilitation, as it enables a vocational orientation of therapeutic services in the rehabilitation process and a rehabilitation discharge report that comments precisely on the workplace and can be used directly by the user side (company doctors, rehabilitation consultants / doctors providing further treatment) for reintegration. These two aspects are indispensable for medical-professional orientation in rehabilitation (MBOR). As a rule, however, workplace knowledge in rehabilitation clinics is rather low. Accordingly, the chances of reintegration are not optimal, to the detriment of the rehabilitation patient and the cost bearer. In order to remedy these deficits, instruments were developed in the course of the KoRB studies to provide the missing workplace knowledge for physicians, therapists and social workers in the rehabilitation clinics as standard. Specifically, these are a workplace rehabilitation questionnaire to be sent from the rehab clinic, a form to routinely record the responsible occupational physician, and informational materials on the role of the occupational physician in order to achieve better compliance of the rehabilitant for the involvement of occupational physicians in the rehabilitation process. Against this background and with the aforementioned instruments, the OpAA study aims to routinely provide rehabilitation clinics with satisfactory knowledge of patients' workplaces in order to enable individualized workplace-related therapy and an e-report that can make concrete statements about the workplace, thus creating a solid basis for MBOR and increasing the chances of reintegration after medical rehabilitation. Methodological approach: OpAA is a two-phase qualitative study, which in phase 1 empirically tests the practicability and suitability of the instruments to be used and provides an objectivity check of the patient statements in the questionnaire on the workplace in the form of filling out in pairs (rehabilitant and company doctor as raters on the same workplace in each case) and calculation of the pair differences (interrater reliability). The focus of phase 2 is the implementation of the tested instruments into the clinical routine in order to provide comprehensive workplace knowledge for all potential users and the verification of the actual use of this workplace knowledge. The methodological framework is set by a formative evaluation aimed at revising identified weaknesses and implementing a modified approach as the project work progresses. The result of both phases is the manualization of the procedure. Results: One goal of the project was a rehabilitant questionnaire on the workplace that can routinely provide clinics with all important information on the rehabilitant's workplace before the start of the measure. It was to ensure that a reliable job description could be drawn up by the patient alone, thus bypassing the company doctor, who is usually difficult to reach. First of all, it was checked in 15 companies whether the information provided by the patient in the questionnaire was at approximately the same level and with the same reliability as would be achieved by the company doctor filling in the questionnaire. The objectivity of the patient's statements and thus the quality of the questionnaire were tested on the basis of the agreement between the patient's (employee's) and the company physician's assessment of the same workplace. The agreement between the employee's and the company physician's assessment was generally high to very high. It has thus been possible to develop an instrument that can routinely provide rehabilitation facilities with medically usable knowledge about the workplace without the involvement of company physicians, which is often difficult, particularly in the case of SME employees. Once the validity and quality of the patient/employee information in the questionnaire has been confirmed, the instrument will be adjusted and individualized for use in rehabilitation clinics. For this purpose, expert panels in the participating facilities with the indications orthopedics, psychosomatics and cardiology discuss - which diagnosis-specific modifications are required, - how all relevant professions receive the required information on the workplace at the right time, - how workplace knowledge can be translated into therapy, - how it finds its way into the discharge report? The goal is a best-practice documentation of the workplace/occupational history. Summary and outlook: With the OpAA questionnaire on the workplace, an instrument has been created that provides valid patient information on the workplace and is already available in the facilities before the start of rehabilitation. After the verification of the applicability in the clinical everyday life, the diagnosis-specific specification and the clinic-related individualization, the clinics should be able to treat closer to the workplace and to create an e-report, which - where necessary - provides clear and operationalizable socio-medical recommendations for the plant and company physicians as well as the rehab consultants. This can be expected to improve the chances of reintegration and retention of the workplace after a medical rehabilitation measure. In addition, a method has been developed to enable rehab facilities to routinely record the contact details of the responsible company doctor, a hitherto unsolved problem for employees from SMEs.