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Purpose: High levels of physical and psychological stresses experienced by those in the care profession can have a negative impact on their health. The pilot project "Health Check for Carers in the region of Karlsruhe" offered nurses aged 45 and above - based on their self-assessed ability to work using the Work Ability Index (WAI) - the opportunity to participate in a job-related health check, based on their work ability index result. This study looks at the occupational and health situation of older carers, the (subjective) need for a Ü45 health check and draws a comparison between particpants and non-participants., Methods: 1,466 nurses between 45 and 52 years of age were invited to participate in an Ü45 occupational health check and were surveyed in writing afterwards. 202 questionnaires formed the data basis (49 participants and 153 non-participants in the health check). A descriptive analysis was carried out and group differences were analyzed using Chi2- and rank sum tests., Results: The main stress factors of the caregivers were organizational circumstances, high work intensity and insufficient remuneration. Illnesses or health problems of the musculoskeletal system and the psyche were the most widespread of all issues. 18.6% of the respondents were rather or very dissatisfied with their current state of health. 39.1% considered their physical health and 27.6% their mental health to be at high or very high risk from their current job. 25.9% of the care workers considered it very unlikely and 32.4% as rather unlikely that they would be able to work in nursing until they reached retirement age. A need for health check was expressed by 63.0%. Group differences between participants and non-participants were shown by a significantly higher burden due to musculoskeletal disorders (p=0.0002), health satisfaction (p=0.0053), subjective need for a health check (p<0.0001) and occupational stress factors, which included physical working activities (p=0.0035), managing many tasks simultaneously (p=0.0380), dealing with cognitively impaired patients (p=0.0095) and suffering/dying patients (p=0.0164)., Conclusion: Care workers reported a high level of stress at work and frequent health impairments. There is a clear need for an occupational health check for this age group in this field of work., Competing Interests: Die Autor*innen geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Purpose: Besides the quality of life, patients' return to work is one of the most important treatment results of medical rehabilitation paid by the German Pension Insurance. In order to be able to use the return to work as a quality indicator for medical rehabilitation, a risk adjustment strategy for pre-existing characteristics of patients, rehabilitation departments and labour markets had to be developed., Methods: Multiple regression analyses and cross validation were used to develop a risk adjustment strategy, which mathematically compensates the influence of confounders and thus allows for appropriate comparisons between rehabilitation departments regarding patients' return to work after medical rehabilitation. Under the inclusion of experts, the number of employment days in the first and second year after medical rehabilitation were chosen as an appropriate operationalization of return to work. Methodological challenges in the development of the risk adjustment strategy were the identification of a suitable regression method for the distribution of the dependent variable, modelling the multilevel structure of the data appropriately and selecting relevant confounders for return to work. A user-friendly way of communicating the results was developed., Results: The fractional logit regression was chosen as an appropriate regression method to model the U-shaped distribution of the employment days. Low intraclass correlations indicate that the multilevel structure of the data (cross-classified labour market regions and rehabilitation departments) is statistically negligible. Potential confounding factors were theoretically preselected (medical experts were involved for medical parameters) and tested for their prognostic relevance in each indication area using backwards selection. Cross validations proved the risk adjustment strategy to be stable. Adjustment results were displayed in a user-friendly report, including the users' perspective (focus groups and interviews)., Conclusions: The developed risk adjustment strategy allows for adequate comparisons between rehabilitation departments and thus enables a quality assessment of treatment results. Methodological challenges, decisions and limitations are discussed in details throughout this paper., Competing Interests: Die Autor*innen geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The influence of both individual factors and, in particular, the regional labour market on the return to work after medical rehabilitation is to be analyzed based on comprehensive administrative data from the German Pension Insurance and Employment Agencies., Method: For rehabilitation in 2016, pre- and post-rehabilitation employment was determined from German Pension Insurance data for 305,980 patients in 589 orthopaedic rehabilitation departments and 117,386 patients in 202 psychosomatic rehabilitation departments. Labour market data was linked to the district of residence and categorized into 257 labour market regions. RTW was operationalized as the number of employment days in the calendar year after medical rehabilitation. Predictors are individual data (socio-demographics, rehabilitation biography, employment biography) and contextual data (regional unemployment rate, rehabilitation department level: percentage of patients employed before). The estimation method used was fractional logit regression in a cross-classified multilevel model., Results: The effect of the regional unemployment rate on RTW is significant yet small. It is even smaller (orthopaedics) or not significant (psychosomatics) when individual employment biographies (i.e., pre-rehabilitation employment status) are inserted into the model as the most important predictors. The interaction with pre-rehabilitation employment status is not substantial., Conclusions: Database and methods are of high quality, however due to the nonexperimental design, omitted variables could lead to bias and limit causal interpretation. The influence of the labour market on RTW is small and proxied to a large extent by individual employment biographies. However, if no (valid) employment biographies are available, the labour market should be included in RTW analyses., Supplementary Information: The online version contains supplementary material available at 10.1186/s12651-023-00330-1., Competing Interests: Competing interestsThe research leading to these results received funding from the German Pension Insurance., (© The Author(s) 2023.)

Objective: This study examines, inpatient treatment costs, and typical treatment courses of patients with an eating disorder using secondary data., Method: The data were provided by a German health insurance company (data from 4.2 million members from 2004 to 2010; corresponds to a market share of 6% of all statutorily insured persons in Germany). An age and gender matched control group without an eating disorder diagnosis was assessed for comparisons from the same dataset., Results: Two thousand seven hundred and thirty four cases with an eating disorder diagnosis (anorexia nervosa [AN], bulimia nervosa [BN] or combination [ANBN]) were identified. The inpatient costs of treatment were €5471.15 for BN, €9080.26 for AN, €10,809.16 for ANBN and €339.37 for the control group. Interestingly, there are numerous mild episodes of eating disorders that could be successfully treated solely on an outpatient basis with a short treatment duration., Conclusion: Our findings suggest that course and severity of eating disorders can vary from mild to very severe. Data from health insurance companies depict rather different disease and treatment courses than studies on primary data derived from treatment institutions., (© 2022 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Purpose: Occupational rehabilitation is an essential part of supporting return to work by the statutory pension insurance institutes. It is useful if health-related restrictions threaten the ability to work. There are various forms of occupational rehabilitation which differ considerably in terms of content, structure, duration, intensity of care and costs. The aim of the study was to identify personal characteristics that can influence the use of three different occupational rehabilitation measures., Methods: All rehabilitants who underwent an occupational rehabilitation in the cooperating occupational rehabilitation centre (Berufsförderungswerk) from 2009 to 2014 under the funding of the German Federal Pension Fund were included in the analysis. A multinomial logistic regression was calculated in order to obtain information on the predictors of utilization of three occupational rehabilitation measures (integration measure, partial qualification, full training). As potential influencing factors, various sociodemographic characteristics as well as various parameters that reflect the employment status of rehabilitants in the previous year were included in the model., Results: The analyses included a total of 934 rehabilitants who had completed an integration measure (n=443), partial qualification (n=315) or full training (n=176). In the final logistic regression model, gender (p<0.0001), age (p<0.0001), education level (p=0.0033), driving license (p<0.0001), willingness to move (p=0.0012), recognized disability (p=0.0404) and the employment status in the third month before the start of the measure (p=0.0020) proved to be significant predictors of utilization., Conclusion: The utilization of the different occupational rehabilitation measures is determined by various influencing factors. In particular, the more extensive and cost-intensive full training are more likely to be taken up by younger, male and more highly qualified rehabilitants., Competing Interests: Die Autoren geben an, dass einer der sieben Autoren im Zeitraum der Datenerhebung im kooperierenden Berufsförderungswerk tätig war. In dieser Rolle fungierte er als Berater und stellte einen reibungslosen Prozessablauf und die Datenübermittlung sicher., (Thieme. All rights reserved.)

Background: Early retirements make up a large portion of indirect costs of illness caused by chronic back pain., Methods: Claims data from statutory health insurance and German Pension Fund provide the basis for analysis. Cox-Regression was performed for duration to early retirement, whereby beside sociodemographic and treatment characteristics, the effect of rehabilitation was considered., Results: Early retirement started on average 7.1 month later through rehabilitation. Therefore, rehabilitants made € 8,432.60 higher payments to statutory health insurance and German Pension Fund per rehabilitant. Based on the total number of 21,262 early retirees with orthopedic indications, this can save € 180.7 million. The timing of the early retirement was also affected by age and sickness benefits in the previous month. Savings by avoiding entry into early retirement have not yet been taken into account in this model., Conclusion: Rehabilitants receive later pensions due to reduced ability, which allow for more contributions to statutory health insurance and German Pension Fund. This indicates that medical rehabilitation is an economic and effective treatment., Competing Interests: Prof. Dr. med. Gert Krischak ist an der Moor-Heilbad Buchau gGmbH beschäftigt. Dr. biol. hum. Lena Tepohl, Dr. biol. hum. Rainer Kaluscha und Dr. biol. hum. Julia Dannenmaier sind am IFR Ulm tätig. Das IFR Ulm wird von einer gemeinnützigen Stiftung getragen, die Stifter sind die Deutsche Rentenversicherung Baden-Württemberg, die Waldburg-Zeil-Kliniken GmbH & Co., das Universitätsklinikum Ulm, die RehaZentren der Rentenversicherung Baden-Württemberg, das Therapiezentrum Federsee und Nanz Medico: ZAR- Zentren für ambulante Rehabilitation. Ulrich Hartschuh ist für die Deutsche Rentenversicherung Baden-Württemberg tätig, Desiree Immel für die AOK Baden-Württemberg. Die Studie wurde von der Deutsche Rentenversicherung Baden-Württemberg und der AOK Baden-Württemberg finanziert., (© Georg Thieme Verlag KG Stuttgart · New York.)

Quite often critics demand more randomized studies in rehabilitation science to gather methodological evidence of high quality. However, it is also recognized that the design of double-blind, placebo-controlled, randomized studies often cannot simply be transferred into rehabilitation science. Validity concerning the health care is here in the focus. Thus, treatment as-usual is mostly used as placebo treatment and double-blinding is partly not definable. Additionally, it is often difficult to offer 2 similar forms of treatment in one rehabilitation hospital due to lack of capacity. Additionally, contamination effects are to be expected when patients of different study arms communicate. Here cluster-randomized studies may be helpful. However, in comparison to individual randomized studies they need often higher sample sizes, a more complex methodology of sample size calculation as well as extensive methods of statistical analysis.Within this article advantages and disadvantages as well as the characteristics of cluster randomization are described and information is given how they can be implemented into the field of rehabilitation science., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)