Short-term goal attainment of in-patient rehabilitation in Germany and long-term risk of early retirement in patients with musculoskeletal diseases: results from a prospective 5-year follow-up study

Abstract

Purpose: Occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. The aim of this study was to evaluate the prognostic value of various short-term rehabilitation outcome parameters on early retirement in Germany. Method: In a prospective multi-centre cohort study of self-rated patient status, physician chosen therapy goals and attainment were measured by means of standardized questionnaires at the beginning and end of medical rehabilitation. Information with regard to disability was collected by self-report over a 5-year follow-up period. Results: We included 1268 MSD patients aged 45–57 who underwent a 3-week, multidisciplinary, in-patient rehabilitation programme in 10 rehabilitation centres in Southern Germany between January and December 2001. During follow-up (mean duration: 3.9 years) 117 (9%) patients received a disability pension. After adjustment for sex, age and patient outcomes, risk for early retirement was significantly increased for patients with only partial success with respect for the therapy goals pain reduction (HR 1.95), improvement in spine motility (HR 1.6) and improvement of muscle strength (HR 2.3). Patients who did not have the therapy goal were at the same risk as patients with full goal achievement. Conclusions: Clinicians’ rating of short-term therapy outcome might be of prognostic relevance of MSD patients’ long-term employment status.

Implications for Rehabilitation

• Short-term therapy success in pain therapy, spine motility and improvement in muscle strength during in-patient rehabilitation can help preserve long-term working capacity.

• Clinician’s rating is an independent predictor for long-term working capacity.

• Assessment of rehabilitation outcome is a contribution to quality control.

Keywords::

• Germany
• musculoskeletal diseases
• rehabilitation
• retirement

Declaration of Interest: This study was funded by the German statutory pension insurance scheme (Grant: #01 0997 96 21).