title: Return to work after surgery for lumbar disc herniation. A rehabilitation-oriented approach in insurance medicine.
abstract: METHODS
  An intervention study by the medical advisers of a social security sickness fund on a mandatorily insured patient population after open discectomy for herniated lumbar intervertebral disc. The medical advisers were randomized into two groups: a control group (n = 30) and an intervention group (n = 30).
  
  
  OBJECTIVE
  To compare a rehabilitation-oriented approach in insurance medicine focused primarily on early mobilization and early resumption of professional activities with the usual claim-based practice.
  
  
  BACKGROUND
  This study included 710 patients, with a mean age of 39.2 years, who underwent surgery for herniated lumbar disc.
  
  
  METHODS
  Medical advisers in the rehabilitation-oriented group examined the patients monthly, starting at 6 weeks after the surgical intervention. They used a newly developed protocol to motivate the patients and treating physicians toward social and professional reintegration.
  
  
  RESULTS
  At 52 weeks, 10.1% of the patients guided by medical advisers from the rehabilitation-oriented group had not resumed work in contrast to 18.1% of the patients in the control group. It was statistically proven that this effect also holds during the follow-up period.
  
  
  CONCLUSIONS
  A rehabilitation-oriented approach by the medical advisers of social security can increase the probability of a return to work for patients after lumbar disc herniation surgery.
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007354:Insurance, Major Medical; D007405:Intervertebral Disc Displacement / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D012050:Rehabilitation, Vocational / Q000379:methods*; D013123:Spinal Fusion; D014938:Work Capacity Evaluation