RESUMO
Background: Following discharge, it is crucial for patients to transfer intentions and action plans from inpatient rehabilitation into everyday life. This ensures their reintegration into social and working life and prevents economic costs due to sick leave or reduced earning capacity pension. However, most established aftercare programs do not specifically address occupational problems or challenges during occupational measures such as graded return to work. The aim of this study is to evaluate the efficacy of the low-threshold online self-help intervention marena (Meine Arbeitsbezogene Reha-Nachsorge - My Work-related Rehabilitation Aftercare) to support return to work. Methods: A two-arm randomized-controlled-trial (RCT) will be conducted. A total of N = 400 rehabilitation inpatients across different indication areas (psychosomatic, orthopedic, or cardiologic) aged 18 to 65 years with a planned return to work after medical rehabilitation, have a heightened social-medical risk and private internet access and are insured with the German Pension insurance or statutory health insurance, will be recruited in four medical and psychosomatic clinics in Germany. Participants will be allocated to either the intervention (IG) or the control group (CG). In a stepped-care model, participants of the IG will receive access to the non-guided internet- and mobile-based intervention marena (IG subgroup 1) or marena in combination with GSA-Online plus (IG subgroup 2), a guided psychodynamic internet-based intervention that has proven effective in two trials regarding occupational and health objectives. Based on a priori defined indication criteria, clinic staff will recommend either IG subgroup 1 or IG subgroup 2. The CG will receive optimized treatment as usual with access to a survey feature within marena. The primary outcome will be work status after 6 months (T2) and 12 months (T4). The endpoint at 12 months (T4) after discharge from inpatient rehabilitation will be considered as secondary endpoint. Work status is defined as positive if the participant is working and has ≤ 6 weeks of sick leave at T2 and ≤ 12 weeks of sick leave at T4. Secondary outcomes include successful completion of graded return to work, successful application for benefits for participation in working life, current work ability, social-medical risk, subjective prognosis of future employment, quality of life, somatic symptoms, coping, social support, depression, anxiety, and psychosocial stress. Discussion: This study will contribute to the evidence concerning efficacy of online aftercare interventions. If proven efficacious, marena could provide an individualized and adaptable self-help approach to promote return to work following inpatient rehabilitation.
RESUMO
Background: Internet-based mental health interventions are considered effective in providing low-threshold support for people with mental health disorders. However, there is a lack of research investigating the transferability of such online programs into routine care settings. Low treatment adherence and problems with technical implementation often limit a successful transfer into clinical routines. This naturalistic study aims to identify influencing factors on program adherence in patients who participated in an online intervention during inpatient or day-clinic psychotherapeutic treatment. Methods and findings: In a naturalistic study, we investigated the transferability of the transdiagnostic psychodynamic online self-help program KEN-Online, which includes eight consecutive units. Between May 2017 and October 2018, patients who received inpatient or day-clinic psychotherapeutic treatment at the Department of Psychosomatic Medicine and Psychotherapy in the University Medical Center Mainz have been offered to use KEN-Online. Of the n = 749 patients who were admitted to the clinic, n = 239 patients (32%) registered for participation in KEN-Online. While 46.9% of the participants did not complete any unit (inactive participants), 53.1% completed at least the first unit (active participants). Age, number of diagnoses, and symptom severity were associated with (in)active participation. Adherence decreased over time resulting in only 17 participants (7.6%) who completed all units. None of the sociodemographic and medical characteristics proved to be significant predictors of adherence. Analyses of effectiveness showed a significant reduction of anxiety and depression in active participants in the course of participation, with higher improvements in participants that completed more than half of the units. Conclusion: Adherence to the online self-help program KEN-Online was lower in the naturalistic setting than in a previous clinical trial, but was still associated with greater program effectiveness. Adherence-promoting measures are crucial to increase the effectiveness of such interventions in clinical settings.
RESUMO
PURPOSE: In order to sustain the treatment results of medical rehabilitation in the long term and to support the transfer of learned strategies into everyday life, outpatient aftercare is often indicated. This is especially true for psychosomatic rehabilitation patients with occupational stress, for whom reintegration into working life is a particular challenge. Since access to care services close to home is limited, internet-based aftercare interventions offer the possibility of timely and flexible aftercare tailored to the patient's needs. In a randomized controlled trial, the internet-based job-related aftercare GSA-Online proved to be effective across indications with regard to job-related and health-related outcome criteria. The aim of the present study is to examine these outcome criteria in a subsample of patients undergoing inpatient psychosomatic rehabilitation. METHODS: Occupationally stressed rehabilitation inpatients were assigned to the intervention (IG) or control group (CG) by means of cluster randomization after meeting the inclusion criteria and participating an inpatient vocational stress management training. After discharge from rehabilitation, patients in the IG were given access to GSA-Online for twelve weeks. In the intervention, maladaptive social interactions in the workplace were identified with the help of self-written blog posts and addressed with the help of therapeutic comments. The active CG received access to selected online information on health-promoting behaviors. Target measures included subjective prognosis of gainful employment (SPE), depressiveness (PHQ-9), and anxiety (GAD-7). Self-report measures were assessed at the end of aftercare and at follow-up (twelve months after the end of rehabilitation). Missing values were replaced using multiple imputation. RESULTS: Ninety-one percent of the IG (N=89) and 70% of the CG (N=106) logged on to the website at least once. There were no group differences in the subjective prognosis of gainful employment at the end of aftercare but a trend toward more optimistic scores in the IG at follow-up. Significantly lower psychological distress was observed in the IG, especially with regard to anxiety (at both measuring points) but also with regard to depressive symptoms (follow-up) and experience of stress (end of intervention). CONCLUSION: In the subsample of psychosomatic rehabilitation, the internet-based, job-related aftercare GSA-Online led to a significant reduction in psychological symptoms. Regarding the subjective prognosis of gainful employment, there was at least a trend in favor of IG. A larger sample is needed to more closely examine the results of this exploratory evaluation. Additionally measures to increase adherence in the IG should be explored.
