The Importance of Participation Oriented Rehabilitation for Regaining the Ability to Work

One of the main purposes of medical rehabilitation is to regain or preserve the ability to work [1]. In addition to financial security, work and employment also have a significant impact on people’s physical, mental and social health. Work offers the opportunity to achieve success and to develop oneself further, which in turn increases wellbeing. In addition, occupational work promotes social status, self-esteem, a time structure and social contacts, whereby the loss of work has a significant negative impact on mental health of previously mentally healthy people [2,3]. For example, unemployment is also strongly interrelated with depression, but also with diseases such as coronary heart disease due to obesity, diabetes, hypertension and dyslipidemia [4].

At the same time, however, it is also essential to recognize potential negative effects of work-related stress or overwork at an early stage and actively work on reducing them. Work is also increasingly being experienced as a strain on health, e.g. due to pressure to succeed and time pressure [3]. Nevertheless, the positive effects of meaningful work have been described as a reduction in psychiatric symptoms, increased competence and self-confidence as well as changes in social behavior and performance [5,6].

Through meaningful work and the resulting social interaction with appropriate guidance and support from healthcare providers, institutions and employers, people can significantly improve their quality of life [7]. In addition, the social security system can be relieved by reducing dependency on state transfer payments and the independence of the individual is supported. A functioning working society is a stabilizing factor for the society as a whole [8]. Pre-rehabilitation health programs, occupational physicians and other healthcare providers can play an important role in identifying problematic health progressions at an early stage, screening patients for specific programs and directing them to the right services with a comprehensive view of their bio-psycho-social health [9,10].

For patients who are at risk of losing their ability to work due to acute or chronic illnesses, it is therefore important that the rehabilitation programs and therapies required to regain or maintain their ability to work are tailored to the patient’s specific occupational requirements from the outset [11]. One effective measure can be specialized medical occupational rehabilitation, which the authors consider to be one of the fundamental obligations of a healthcare provider responsible for rehabilitation. The aim of this medical rehabilitation program is to maintain or restore earning capacity as far as possible, so that rehabilitants of working age with a problematic occupational situation receive precisely the therapy and training compositions that are necessary for reintegration into their personal working life. In order to achieve this goal, specific job-related diagnostics by evaluating functional capacity, a detailed workplace analysis and, in summary of the findings and results, a specific rehabilitation therapy program with an optional psychological offer are fundamental elements [12]. In addition to taking into account any existing psychological stress, it is essential that the therapy is focused on maintaining or restoring the physical and mental skills required for the job. In order to be able to train the specific movement routines required in the respective workplace, work simulation training is essential, in which the occupational situation can be reproduced as accurately as possible in specialized rehabilitation facilities with trained medical staff and be simulated as part of the therapy [13].

The medical occupational oriented therapies are provided by a multi- and interdisciplinary therapeutic, nursing and medical rehabilitation team. A joint definition of an overall rehabilitation goal at the occupational participation level in alignment with the bio-psycho-social model of the International Classification of Functioning, Disability and Health (ICF)[14-16], is the fundament of this special program. Therapies and education always require active cooperation and willingness to work towards the agreed goals, a high level of motivation and the will to return to work, as well as the assumption of personal responsibility on the part of the patient [17].

From a holistic perspective, medical occupational rehabilitation with its individual health promotion can fulfill essential social and economical functions and should be given greater consideration in health and social policy discussions. Demographic changes and the resulting need to ensure the financial sustainability of pension and healthcare systems require measures to promote people’s health and ability to work. Rehabilitation in general and, in particular, medical occupational rehabilitation could play a key role in the early and long-term reintegration into the employment process and thus prevent early occupational disability.

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