title: [What determines the participation in stepwise occupational reintegration on behalf of the German pension insurance? Results of the "SOR cohort study"].
abstract: OBJECTIVE
  Stepwise Occupational Reintegration (SOR) measures are of growing importance for the German statutory pension insurance. There is moderate evidence that patients with a poor prognosis in terms of a successful return to work, profit most from SOR measures. However, it is not clear to what extend these information are utilized when recommending SOR to a patient.
  
  
  METHODS
  A questionnaire was sent to 40406 persons (up to 59 years old, excluding rehabilitation after hospital stay) before admission to a medical rehabilitation service. The survey data were matched with data from the discharge report and information on the participation in a SOR measure. Initially, a single criterion was defined which describes the need of SOR measures. This criterion is based on 3 different items: patients with at least 12 weeks sickness absence, (a) a SIBAR score>7 and/or (b) a perceived need of SOR.The main aspect of our analyses was to describe the association between the SOR need-criterion and the participation in SOR measures as well as between the predictors of SOR participation when fulfilling the SOR need-criterion. The analyses were based on a multiple logistic regression model.
  
  
  RESULTS
  For 16408 patients full data were available. The formal prerequisites for SOR were given for 33% of the sample, out of which 32% received a SOR after rehabilitation and 43% fulfilled the SOR needs criterion. A negative relationship between these 2 categories was observed (phi=-0.08, p<0.01). For patients that fulfilled the need-criterion the probability for participating in SOR decreased by 22% (RR=0.78). The probability of SOR participation increased with a decreasing SIBAR score (OR=0.56) and in patients who showed more confidence in being able be return to work.
  
  
  CONCLUSIONS
  Participation in SOR measures cannot be predicted by the empirically defined SOR need-criterion: the probability even decreased when fulfilling the criterion. Furthermore, the results of a multivariate analysis show a positive selection of the patients who participate in SOR measures. Our results point strongly to the need of an indication guideline for physicians in rehabilitation centres. Further research addressing the success of SOR measures have to show whether the information used in this case can serve as a base for such a guideline.
authors: fbg forschung und beratung im gesundheitswesen, Karlsruhe.
authors: W
authors: W
authors: Bürger
authors: Abteilung Rehabilitation, Deutsche Rentenversicherung Bund, Berlin.
authors: M
authors: M
authors: Streibelt
mesh_terms: D000328:Adult; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000145:classification* / Q000534:rehabilitation*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D010358:Patient Participation / Q000706:statistics & numerical data*; D010415:Pensions / Q000706:statistics & numerical data*; D012050:Rehabilitation, Vocational / Q000706:statistics & numerical data*; D062707:Return to Work / Q000706:statistics & numerical data*; D018582:Sick Leave / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014600:Utilization Review; D055815:Young Adult