Work-related medical rehabilitation in neurology. Effective on the basis of individualized rehabilitant identification

Background. Evidence for the effectiveness of work-related medical rehabilitation (WMR) for a successful return to work (RTW) is lacking for neurological diseases. The aim of this study was therefore to correlate the cross-indication screening instrument for the identification of the demand of work-related medical rehabilitation (SIMBO-C) with the individualized clinical anamnestic determination of severe restrictions of work ability (SRWA) as a required access criterion for admittance to neurological WMR. A further aim was to compare the rate of successful RTW in rehabilitants with and without WMR measures 6 months after inpatient rehabilitation. Methods. On admission SRWA were routinely screened by an individualized clinical anamnestic determination with subsequent assignment to WMR or conventional rehabilitation. At the beginning of rehabilitation the SIMBO-C was applied and 6 months after the rehabilitation the RTW status was surveyed. Results. Of the 80 rehabilitants 44 (55%) received WMR. On admission they showed a higher SIMBO-C score (41.3 +/- 15.7 vs. 26.2 +/- 18.6 points, p = 0.002), on discharge more often locomotor and psychomental disorders (55% vs. 36%, p = 0.10 and 46% vs. 22%, p = 0.03, respectively) and longer incapacitation times after rehabilitation of > 4 weeks (66% vs. 33%, p = 0.02) compared to those without WMR. At 6 months follow-up after discharge the 2 groups did not significantly differ with respect to successful RTW (61% vs. 66%, p = 0.69). The SIMBO-C (cut-off >= 30 points) showed a medium correlation with the individualized clinical anamnestic determination of SRWA (r = 0.33, p = 0.01). Conclusion. The applied neurological WMR concept accomplished a comparable RTW rate between rehabilitants with SRWA by a WMR and those without SRWA and conventional rehabilitation. The SIMBO-C should only be used in combination with the individualized anamnesis to identify SRWA.