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Effects of nationwide implementation of work-related medical rehabilitation in Germany: propensity score matched analysis
  1. Matthias Bethge1,
  2. Miriam Markus1,
  3. Marco Streibelt2,
  4. Christian Gerlich3,
  5. Michael Schuler4
  1. 1 Institute for Social Medicine and Epidemiology, Universität zu Lübeck, Lübeck, Germany
  2. 2 Department of Rehabilitation, Federal German Pension Insurance, Berlin, Germany
  3. 3 Center of Mental Health, University of Würzburg, Würzburg, Germany
  4. 4 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
  1. Correspondence to Professor Matthias Bethge, Institute for Social Medicine and Epidemiology, Universität zu Lübeck, Lubeck 23562, Germany; Matthias.Bethge{at}


Objectives Since 2014, the Federal German Pension Insurance has approved several departments to implement work-related medical rehabilitation programmes across Germany. Our cohort study was launched to assess the effects of work-related medical rehabilitation under real-life conditions.

Methods Participants received either a common or a work-related medical rehabilitation programme. Propensity score matching was used to identify controls that were comparable to work-related medical rehabilitation patients. The effects were assessed by patient-reported outcome measures 10 months after completing the rehabilitation programme.

Results We compared 641 patients who were treated in work-related medical rehabilitation with 641 matched controls. Only half of the treated patients had high initial work disability risk scores and were intended to be reached by the new programmes. The dose of work-related components was on average in accordance with the guideline; however, the heterogeneity was high. Work-related medical rehabilitation increased the proportion of patients returning to work by 5.8 percentage points (95% CI 0.005 to 0.110), decreased the median time to return to work by 9.46 days (95% CI -18.14 to -0.79), and improved self-rated work ability by 0.38 points (95% CI 0.05 to 0.72) compared with common medical rehabilitation. A per-protocol analysis revealed that work-related medical rehabilitation was more effective if patients were assigned according to the guideline and the minimal mandatory treatment dose was actually delivered.

Conclusions The implementation of work-related medical rehabilitation in German rehabilitation centres affected work participation outcomes. Improving guideline fidelity (reach and dose delivered) will probably improve the outcomes in real-world care.

Trial Registration Number DRKS00009780

  • rehabilitation
  • programme evaluation
  • return to work
  • employment
  • health service research

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  • Correction notice This article has been corrected since it published Online First.

  • Contributors MB, MS and MS planned and designed the study. MM did the data management. MB and MM analysed the data. All authors interpreted the data. MB drafted the first version of the manuscript. All authors read and approved the final manuscript.

  • Funding This research was funded by the Federal German Pension Insurance, and this institution paid money to the University of Lübeck and the University of Würzburg.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Ethics Committee of the University of Lübeck (15-356).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.