Self-Reported Work Ability Predicts Rehabilitation Measures, Disability Pensions, Other Welfare Benefits, and Work Participation: Longitudinal Findings from a Sample of German Employees.

Purpose The study examined the performance of the Work Ability Index in predicting rehabilitation measures and disability pensions, sickness absence and unemployment benefits, and work participation among a sample of workers previously receiving sickness absence benefits. Methods Workers aged 40 to 54 years who received sickness absence benefits in 2012 completed the Work Ability Index in 2013. Outcomes were extracted from administrative data records. Results Data for 2149 participants were included (mean age: 47.8 years; 54.4% women). Mean follow-up was 19 months. Work Ability Index scores were poor (7-27 points) in 21% of the participants, and moderate (28-36 points) in 38.4%. In all, 224 rehabilitation measures and 35 disability pensions were approved. Fully adjusted analyses showed increased risk of rehabilitation measures in workers with poor (HR 4.55; 95% CI 3.14-6.60) and moderate scores (HR 2.08; 95% CI 1.43-3.01) compared to workers with good or excellent scores (37-49 points). The risk of a disability pension increased significantly for workers with poor scores (HR 7.78; 95% CI 2.59-23.35). In addition, poor scores were prospectively associated with a longer duration of sickness absence and employment benefits, and fewer employment days and less income from regular employment. Conclusions The Work Ability Index is a potential tool for following up workers who already have an increased risk of permanent work disability due to previous long-term sickness absence.

[Motivational and Volitional Processes in the Context of Applying for Medical Rehabilitation Services]. / Motivationale und volitionale Prozesse im Kontext der Beantragung einer medizinischen Rehabilitationsleistung.

OBJECTIVES: We analyzed if intention and planning of an application for medical rehabilitation can be described using the health action process approach. MATERIAL AND METHODS: Data were used from the "Third German Sociomedical Panel of Employees". A questionnaire comprising 8 scales was developed. The scales assess outcome expectancies (3 scales), support by family and physicians (2 scales), self-efficacy, intention and action planning (1 scale each). A confirmatory factor analysis was performed to examine the factorial validity of the questionnaire. Structural equation modeling was used to explain intention and planning of an application for medical rehabilitation. RESULTS: 3 294 persons participated in the survey. The average age was 47.9 years (range 40-54 years, SD=4.1). 53% of the participants were women. Further analyses included data of 2 911 (listwise deletion) and 3 288 participants (estimated missing values), respectively. The anticipated 8-factor structure of the questionnaire was confirmed. The model fit of the structural equation model was good. Intention was explained by family-related negative outcome expectancies, self-efficacy, and support by family and physicians. Intention and support by physicians directly affected planning. Additionally, family-related negative outcome expectancies, family and physician support, and self-efficacy were indirectly associated with planning. This indirect effect was mediated by intention. 51% of the variance of intention and 65% of the variance of planning were explained. DISCUSSION: The findings of the structural equation model indicate that the health action process approach is useful to describe the process of applying for medical rehabilitation. A validation of the model needs longitudinal data on actual applications. CONCLUSION: The health action process approach supports our understanding of motivational and volitional determinants of an application for medical rehabilitation. Our results underline the important role that family doctors and occupational physicians have if an application for medical rehabilitation is needed.