Promoting Rehabilitation Services for Persons at Risk of Reduced Work Capacity: A Pragmatic Randomized Controlled...

Approximately 1.75 million insurees in Germany collect a disability pension, with some 172 000 new recipients added each year. Rehabilitation services aimed at maintaining work capacity are often not utilized at all or are accessed too late. To date, there have been no established procedures for the early identification of rehabilitative needs, or for the proactive guidance of individuals toward appropriate services. We studied the impact of a risk-adapted intervention (AktiFAME) on the utilization of rehabilitation services.

On the basis of routine data from Deutsche Rentenversicherung Nord (a pension insurance carrier), 10 600 persons at increased risk of reduced earning capacity (RI-EMR ≥ 60) were enrolled in a pragmatic, 1:1-randomized controlled trial. The intervention group received a multimodal intervention, including proactive outreach and an offer of needs-based case management services to support use of rehabilitation services; the control group remained in standard care. The primary endpoint was the approval of rehabilitation services (medical rehabilitation or benefits for participation in working life) within 12 months (intention-to-treat analysis).

Of the 5300 individuals in the intervention group, 277 (5.2%) participated in case management. Within 12 months, 6.9% of persons in the intervention group received an approved participation benefit, compared with 5.4% in the control group (hazard ratio [HR] 1.28; 95% confidence interval: [1.10; 1.50]; p = 0.001). There were no intergroup differences for disability pensions (absolute risk, 2.7% vs. 2.8%; HR 0.95; [0.76; 1.20]) or for labor market-related endpoints.

The risk-adapted multicomponent strategy can increase the approval rate of participation benefits under routine conditions, but it did not increase labor market participation or improve health in the first 12 months after enrollment.