David Fauser, Nadine Schmitt, André Golla, Julia-Marie Zimmer, Wilfried Mau, Matthias Bethge
Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany. E-mail: davidpeter.fauser@uksh.de
DOI: 10.2340/16501977-2767

Objectives: To analyse the association between self-reported prognosis of employability and health-related measures, and to clarify which determinants influence the intention to apply for medical rehabil-itation.
Design: Cross-sectional study of a random sample of German employees.
Participants: A total of 6,654 participants (58% female) aged 45–59 years with back pain during the last 3 months.
Results: Out of a total of 6,654 persons, 4,838 had a positive self-reported prognosis of employability. Persons with positive and negative prognoses clearly differ with regard to health-related measures. Of 1,816 persons who reported a negative prognosis, 26% stated an intention to apply for rehabilitation. Intention was determined mainly by perceived
social support from family and friends (odds ratio (OR) 1. 87; 95% confidence interval (95% CI) 1. 66–2. 10), as well as physicians and therapists (OR 1. 64; 95% CI 1. 41–1. 90).
Conclusion: A negative self-reported prognosis of employability is associated with self-reported health restrictions that may determine the need for rehabilitation interventions. A considerable proportion of persons with self-reported health restrictions do not plan to use medical rehabilitation. Perceived social support is an important facilitator of intention to apply for rehabilitation. However, this study needs to be replicated in other populations combining self-reported and administrative data.

The approval of medical rehabilitation services in Germany is linked to personal requirements, including a significant reduction in work ability due to illness. The subjective prognosis of employability has been shown to be an indicator to operationalize these requirements. Application for medical rehabilitation presupposes an intention to apply for rehabilitation. This study, with over 6,000 German employees with back pain, indicated that a negative subjective prognosis of employability is associated with self-reported health restrictions that may determine the need for rehabilitation interventions. One out of 4 persons with a negative subjective prognosis of employability do not intend to use rehabilitation ser-vices. Intention to apply for medical rehabilitation was determined by social support experienced from family and friends or physicians and therapists, negative outcome expectations, and previous use of medical rehabilitation services. This indicates important facilitators to improve access to rehabilitation in employees with back pain.

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