[Quality Criteria of Qualitative Studies in Rehabilitation Research]. / Qualitätskriterien qualitativer Studien in der Rehabilitationsforschung.

Considering the variety of research questions, perspectives, and disciplines involved, qualitative studies have become an integral part of rehabilitation sciences. To ensure and estimate their quality and thus the significance of their results, criteria are needed for both researchers and recipients. Due to the specific nature and the heterogeneity of qualitative research approaches, there is still disagreement regarding appropriate universally valid quality criteria. In this article, core criteria that can be used to plan, conduct and receive qualitative studies are presented and discussed with reference to national rehabilitation research. For this purpose, the specific characteristics of rehabilitation research are taken into account and the application of quality criteria is illustrated using concrete examples from the research practice of rehabilitation sciences.

A Mega-Ethnography of Qualitative Meta-Syntheses on Return to Work in People with Chronic Health Conditions.

PURPOSE: The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies. METHODS: We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings. RESULTS: Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model. CONCLUSIONS: RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.

[Workplace and Work-Related Return to Work Interventions for Employees with Common Mental Disorders: Between Health-Promoting Organisational Development and Self-Management]. / Betriebsnahe Versorgungsnetzwerke und -angebote zur Unterstützung des Return to Work nach psychischer Krise: Zwischen gesundheitsförderlicher Organisationsentwicklung und Selbstmanagement der Zurückkehrenden.

PURPOSE: Work-related interventions and alliances between healthcare institutions and companies that aim to support employees with common mental disorders (CMD) returning to work are still quite rare in Germany. The present study examines a small sample of existing alliances and interventions with the aim to describe their cooperation forms and treatment approaches, to identify their strengths and weaknesses, and thus to provide guidance for their further development and dissemination. METHODS: Five alliances/interventions were selected on the basis of a web search. Subsequently 11 group discussions and 17 qualitative interviews with involved health care professionals and occupational stakeholders (n=44) as well as employees with CMD (n=17) were conducted and evaluated by documentary method and qualitative content analysis. RESULTS: The examined interventions follow either a person oriented self-management or a systemic case management approach. The self-management approach focusses on what has to be done by the person him-/herself to get back to work (focus on individual adaption). The systemic approach additionally asks for workplace adaption. Which approach is chosen, depends inter alia on the involved actors' preconscious frames of orientation, i. e. their assumptions regarding the modifiability of work-related risk factors. The main strength of the self-management approach lies in its ability to reinforce self-care, its main shortcoming in the one-sided focus on individual adaption and the risk of individualizing the disease, its causes and coverage. The systemic approach seems to be more sustainable through the combination of individual and workplace adaptions. The challenge here is to find an appropriate balance between individual self-care and occupational health care. CONCLUSION: The findings show how the RTW of employees with CMD can be supported by more collaborative and work-related interventions. However, they also reveal limits and barriers of existing interventions and therefore provide useful hints for their further development and dissemination.

Development and implementation of work-related medical rehabilitation in cancer patients using organizational ethnography and action research methodology.

OBJECTIVES: To develop a work-related medical rehabilitation (WMR) program for cancer patients based on the best available evidence, the expertise of rehabilitation professionals and the perspective of the patients, to ensure the fidelity of its implementation and to prepare its subsequent outcome evaluation. MATERIAL AND METHODS: The implementation study was based on organizational ethnography and action research, and followed a multimethod, participatory and iterative approach to data collection and analysis. The authors carried out observations in 4 rehabilitation centers and conducted focus groups with rehabilitation professionals and patients. The obtained data were subjected to qualitative content analysis. All findings were discussed promptly with the rehabilitation centers at feedback meetings that contributed to the further development of the program. RESULTS: The following WMR modules were defined based on the findings: additional work-related diagnostics, multi-professional team meetings, an introductory session, work-related functional capacity training, work-related psychological groups and intensified social counseling. Process descriptions for the subsequent evaluation of the program via a cluster-randomized trial were also developed, containing, e.g., instructions for patient information and recruitment. CONCLUSIONS: Implementation studies can help to prepare for valid trials as they facilitate ensuring the feasibility, acceptability and fidelity of program implementation and evaluation. Organizational ethnography and action research are suitable methods for carrying out such studies. Int J Occup Med Environ Health. 2019;32(2):217-28.

Meta-Synthesis of Qualitative Research on Facilitators and Barriers of Return to Work After Stroke.

Purpose Despite existing rehabilitation services, return to work (RTW) rates among stroke survivors are quite low. An increased number of qualitative studies have been conducted to identify facilitators and barriers to RTW after stroke and to derive recommendations for future interventions. The aim of our study was to carry out a meta-synthesis of those studies and thus strengthen evidence in the field. Methods To identify relevant studies (qualitative studies focusing on RTW after stroke, published in English or German between 2000 and 2015), we conducted a systematic literature search in PubMed, OVID, and Web of Science. After assessing the quality of eligible studies, we synthesized their findings according to meta-ethnographic methodology. Results Fourteen out of 553 studies-three of very high, seven of high, three of medium, and one of low quality-met the inclusion criteria. After the extraction of all first-order concepts and their translation into 64 second-order interpretations, we synthesized the findings by developing a model of RTW factors after stroke. It contains factors related to the person (impairments, coping/adaptation, significance of work/RTW motivation), workplace (job demands/work adaptations, disability management, work climate/social support), and rehabilitation services (availability, accessibility, appropriateness), as well as relevant factors in the interaction of these three stakeholders (work capacity, performance and capability, and initial RTW experiences). Three basic principles-adaptiveness, purposefulness, and cooperativeness-complete the model and led us to its name: the APC model. Conclusions Successful RTW after stroke depends on diverse factors and stakeholders. Rehabilitation strategies have to consider this; otherwise they become RTW barriers themselves.

[Occupational Health Physicians and Rehabilitation - A Cross-sectional Study on Occupational Health Care in Schleswig-Holstein and Baden-Württemberg]. / Betriebsärzte und Rehabilitation ­ Eine Querschnittsstudie zum betriebsärztlichen Handeln in Schleswig-Holstein und Baden-Württemberg.

Objective Description and explanation of involvement of occupational health physicians in rehabilitation Methods Data were collected by a survey of occupational health physicians in Schleswig-Holstein and Baden-Württemberg. Logistic regression models were calculated to identify determinants of the involvement of occupational health physicians before, during and after rehabilitation. Results During the last year 70% of the occupational health physicians have supported at least one worker when applying for medical rehabilitation. About a half has had at least once contact to a rehabilitation facility during the rehabilitation treatment of an employee, and 9 out of 10 physicians have supported at least one employee after her or his rehabilitation when returning to work. Support by occupational health physicians is more likely when they feel responsible for rehabilitation, are well informed and frequently involved in occupational reintegration management. Conclusions Occupational health physicians may be important stakeholders for preparing and supporting rehabilitation.

[Facilitating Processes of Disintegration instead of Occupational Reintegration: A Qualitative Study on Employer-Involvement in Rehabilitation]. / Fortschreibung von Desintegrationskarrieren statt Förderung beruflicher Wiedereingliederung: Eine qualitative Studie zur Arbeitgebereinbindung in den Reha-Prozess.

Purpose To explore the patient's perspective on the involvement of employers into rehabilitation. Methods 8 participants of a work-related medical rehabilitation were interviewed by telephone 4 weeks after discharge. Qualitative content analysis was used to analyze generated data. Results Beside a poor employer-involvement, the interviews revealed that the process of returning to work was characterized and hampered by unused measures of supporting vocational reintegration during rehabilitation, intersection problems in the health care and social security system, and a strategy of waiting by all involved actors. Conclusion Beside an improved employer-involvement, systematic intersection management and full usage of existing measures are demanded to support vocational reintegration.

Work-related medical rehabilitation in patients with musculoskeletal disorders: the protocol of a propensity score matched effectiveness study (EVA-WMR, DRKS00009780).

BACKGROUND: Musculoskeletal disorders are one of the most important causes of work disability. Various rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. As the effects of conventional medical rehabilitation programs on sickness absence duration were shown to be slight, work-related medical rehabilitation programs have been developed and tested. While such studies proved the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation in well-conducted randomized controlled trials, its effectiveness under real-life conditions has yet to be proved. METHODS/DESIGN: The cohort study will be performed under real-life conditions with two parallel groups. Participants will receive either a conventional or a work-related medical rehabilitation program. Propensity score matching will be used to identify controls that are comparable to treated work-related medical rehabilitation patients. Over a period of three months, about 18,000 insured patients with permission to undergo a musculoskeletal rehabilitation program will be contacted. Of these, 15,000 will receive a conventional and 3,000 a work-related medical rehabilitation. We expect a participation rate of 40 % at baseline. Patients will be aged 18 to 65 years and have chronic musculoskeletal disorders, usually back pain. The control group will receive a conventional medical rehabilitation program without any explicit focus on work, work ability and return to work in diagnostics and therapy. The intervention group will receive a work-related medical rehabilitation program that in addition to common rehabilitation treatments contains 11 to 25 h of work-related treatment modules. Follow-up data will be assessed three and ten months after patients' discharge from the rehabilitation center. Additionally, department characteristics will be assessed and administrative data records used. The primary outcomes are sick leave duration, stable return to work and subjective work ability. Secondary outcomes cover several dimensions of health, functioning and coping strategies. DISCUSSION: This study will determine the relative effectiveness of a complex, newly implemented work-related rehabilitation strategy for patients with musculoskeletal disorders. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00009780 , February 10, 2016).

Effectiveness of work-related medical rehabilitation in cancer patients: study protocol of a cluster-randomized multicenter trial.

BACKGROUND: Work is a central resource for cancer survivors as it not only provides income but also impacts health and quality of life. Additionally, work helps survivors to cope with the perceived critical life event. The German Pension Insurance provides medical rehabilitation for working-age patients with chronic diseases to improve and restore their work ability, and support returning to or staying at work, and thus tries to sustainably avoid health-related early retirement. Past research showed that conventional medical rehabilitation programs do not support returning to work sufficiently and that work-related medical rehabilitation programs report higher return-to-work rates across several health conditions, when compared to medical rehabilitation. Therefore, the current study protocol outlines an effectiveness study of such a program for cancer survivors. METHODS: To evaluate the effectiveness of work-related medical rehabilitation in cancer patients we conduct a cluster-randomized multicenter trial. In total, 504 rehabilitation patients between 18 and 60 years with a Karnofsky Performance Status of ≥70 %, a preliminary positive social-medical prognosis of employability for at least 3 h/day within the next 6 months and an elevated risk of not returning to work will be recruited in four inpatient rehabilitation centers. Patients are randomized to the work-related medical rehabilitation program or the conventional medical rehabilitation program based on their week of arrival at each rehabilitation center. The work-related medical rehabilitation program comprises additional work-related diagnostics, multi-professional team meetings, an introductory session as well as work-related functional capacity training, work-related psychological groups, and social counseling. All additional components are aimed at the adjustment of the patients' capacity in relation to their individual job demands. Role functioning defines the main study outcome and will be assessed with the EORTC-QLQ30. Secondary outcome measures are the remaining scales of the EORTC-QLQ30, fatigue, self-rated work ability, disease coping, participation in working life, realization of work-related goals and therapies during rehabilitation, and treatment satisfaction. DISCUSSION: A positive evaluation of work-related medical rehabilitation in cancer patients is expected due to the promising findings on the effectiveness of such programs for patients with other health conditions. Results may support the dissemination of work-related medical rehabilitation programs in German cancer rehabilitation. TRIAL REGISTRATION: German Clinical Trials Register DRKS00007770 . Registered 13 May 2015.

Multiprofessional teamwork in work-related medical rehabilitation for patients with chronic musculoskeletal disorders.

OBJECTIVE: Systematic reviews indicate the effectiveness of multimodal rehabilitation. In Germany this has been shown, in particular, for work-related medical rehabilitation. A recently published guideline on work-related medical rehabilitation supports the dissemination of these programmes. The feasibility of this guideline was examined in a multicentre study. This paper presents findings on the relevance of multiprofessional teamwork for the implementation of successful work-related medical rehabilitation. METHODS: Focus groups were conducted with 7 inpatient orthopaedic rehabilitation teams and examined using qualitative content analysis. RESULTS: Multiprofessional teamwork emerged inductively as a meaningful theme. All teams described multiprofessional teamwork as a work-related medical rehabilitation success factor, referring to its relevance for holistic treatment of multifactorially impaired patients. Although similar indicators of successful multiprofessional teamwork were named, the teams realized multiprofessional teamwork differently. We found 3 team types, corresponding to multidisciplinary, interdisciplinary and transdisciplinary team models. These types and models constitute a continuum of collaborative practice, which seems to be affected by context-related factors. CONCLUSION: The significance of multiprofessional teamwork for successful multimodal rehabilitation was underlined. Indicators of ideal multiprofessional teamwork and contextual facilitators were specified. The contingency approach to teamwork, as well as the assumption of multiprofessional teamwork as a continuum of collaborative practice, is supported. Stronger consideration of multiprofessional teamwork in the work-related medical rehabilitation guideline is indicated.