[Stepwise occupational reintegration after orthopedic rehabilitation--participants, realization, effectiveness, and optimization requirements].

This paper presents research results on stepwise occupational reintegration in patients with orthopaedic diseases, predominantly back pain. A retrospective questionnaire study was performed from January to May 2003. We questioned 534 insurants of the LVA (statutory pension insurance institute) in Schleswig-Holstein who had completed orthopaedic rehabilitation between 1999 and 2001 and had been recommended for stepwise occupational reintegration. The participant rate was 47% (n = 250 completed questionnaires). The standardized survey included demographic as well as illness-, rehabilitation- and job-related information. Particularly, information about the beginning and implementation of the stepwise occupational reintegration programme, its evaluation by the insurants, and their reintegration into working life was gathered. Stepwise occupational reintegration was recommended for 4.5% of the rehabilitation patients; 57% of them acted on this suggestion. The results show a positive appraisal of the stepwise occupational reintegration programme in general and high rates of reintegration (more than 80%) at mid-term. However, the dropout rate of 15% is quite high. The results suggest a necessity for optimization especially regarding initiation of the stepwise occupational reintegration programme, patient motivation, and better support for patients during the programme. Thus, a close linkage of stepwise occupational reintegration with accompanying rehabilitation programmes offers promising perspectives for purposive occupation-orientated rehabilitation programmes.