This article examines discontinuities that occur within measures related to vocational rehabilitation services (Leistungen zur Teilhabe am Arbeitsleben, LTA). It explores how these discontinuities are experienced and managed by rehabilitation participants, and how service providers - such as Vocational Training Centers (Berufsförderungswerke, BFW) and Vocational Training Centers for Mental Health (Berufliche Trainingszentren, BTZ) - respond to such disruptions. The study identifies individual and organizational patterns of interpretation and coping strategies and derives recommendations for a biographically sensitive rehabilitation practice.This article is based on findings from two research projects that addressed the issue of discontinuities in vocational rehabilitation using mixed-methods designs and different methodological perspectives. Data collection methods included qualitative interviews with rehabilitation participants, expert interviews, focus groups, standardised surveys, and routine monitoring. The analyses were conducted using qualitative content analysis (Kuckartz, Mayring), Grounded Theory (Glaser & Strauss), and descriptive statistical methods.Discontinuities in the rehabilitation process occur frequently and in various forms. These included pre-existing experiences brought into the program, such as episodes of illness, psychological crises, premature termination of previous measures, or changes in internships. While BFW had to rely more heavily on continuous and standardised procedures due to their institutional mandate, BTZ responded with greater flexibility. Participants perceived these discontinuities ambivalently, viewing them both as obstacles and as opportunities for reorientation.Discontinuities reflect heterogeneous forms of individual coping with life and illness before, during, and after participation in vocational rehabilitation programs. Rather than being regarded as deviations from expected standard trajectories, they should be seen as challenges that call for a constructive, biography-oriented approach to dealing with setbacks, breaks, and detours. This approach can create space for individual development processes, which may contribute to more successful vocational rehabilitation outcomes.

The aim of this study was to examine whether rehabilitation outcomes for back pain, operationalized as pre-post changes, in Germany have improved since 1990 and whether they have reached clinically relevant thresholds. Studies reporting changes in pain intensity, depression, catastrophizing, vitality, functional capacity, and days of incapacity for work across at least two measurement points were included. Meta-analyses using standardized mean differences were performed according to the random-effects model, distinguishing between short-, medium-, and long-term effects. Additionally, mean differences were standardized to the scale widths of the respective instruments and combined meta-analytically. A threshold of 15% of the scale width was used to define clinically relevant change. Subgroup analyses explored whether studies published after 2004 demonstrated better rehabilitation outcomes than earlier studies. Meta-regressions with publication year as a moderator variable pursued a similar aim. A total of 80 studies involving 19,844 participants were included, of which 57% were controlled studies and 5 used usual care as the control group. Meta-analyses showed mild to moderate improvements with high heterogeneity and medium study quality, but - except for a short-term increase in vitality - without achieving clinical relevance. More recent studies reported significantly better short-term improvements in functional capacity compared to older studies (0.21 vs. 0.38, p=0.014). Meta-regressions confirmed this finding. The heterogeneity of the results was considerable and could not be explained by characteristics of the studies, such as baseline status, the age of participants, or the number of study centres. The inconsistency introduces substantial uncertainty into the findings. Furthermore, it points to a deficiency in the uniformity of rehabilitation delivery. Despite substantial efforts to enhance structural and procedural quality, there is no evidence that the effectiveness of back pain rehabilitation in Germany has improved beyond marginal levels since 1990. Outcomes remain predominantly below the threshold of clinical relevance. There is a persistent lack of robust randomized controlled trials (RCTs) evaluating the absolute effectiveness of these programs.

People with health impairments often face significant barriers to participation in the labor market, which increases the risk of long-term unemployment, social exclusion, and deteriorating health. In response, the German Pension Insurance launched a pilot project in two regions to test an Entry Incentive Payment (Einstiegsprämie, ESP). The ESP is an unconditional financial benefit granted to insured individuals re-entering the workforce. The accompanying survey study aimed to evaluate this innovative intervention from the recipients' perspective and to complement administrative analyses of reintegration outcomes with a person-centered view.During the intervention period (January 2020 to March 2023), 485 individuals received the ESP. Survey data were available for 310 participants (response rate: 63.9%). In total, 279 questionnaires from time point t1 (1st-3rd month of ESP receipt) and 205 from time point t2 (9th-13th month) were included in the analysis.Participants had a mean age of 48.2 years (t1), and approximately one-third were female. Somatic diagnoses were reported by 93.4% and psychological diagnoses by 36.9% of respondents. Based on the Work Ability Index, 77.2% had only moderate to critical work ability. The ESP was rated as helpful for job entry by 95% of women and 84% of men, with no significant differences between subgroups defined by gender, region, age, or diagnosis type. Regarding job retention, women rated the ESP significantly more positively than men (Mann-Whitney U test: U=3844.5; p=0.026; r=0.15). Overall health-related quality of life did not change significantly over the first year of employment; however, significant declines in individual domains were observed in some subgroups.The ESP is largely perceived as an effective measure to support (re)integration into employment among individuals with health limitations. The findings highlight the potential relevance of employment grants in return-to-work strategies. Furthermore, the data illustrate the vulnerability of this population with regard to health stability and work ability.

This study examined the acceptance, feasibility, and sustainability of an individualized family coaching intervention designed to promote behavior modification among children and adolescents with obesity and persons accompanying them during inpatient rehabilitation. The primary aim was to enhance motivation for behavior modification in both patients and their accompanying persons, and to improve the sustainability of rehabilitation outcomes by increasing the involvement of the accompanying persons.This qualitative study was conducted within a single-group pre-post-follow-up design. The study included 31 patients (ages 10-13, 61% female, BMI percentile≥97) and their caregivers. The intervention consisted of three 60-minute family coaching sessions based on the principles of Motivational Interviewing. Thirteen post-intervention focus group interviews with experts, accompanying persons, and patients as well as coaching protocols were analyzed using qualitative content analysis.The coaching was positively evaluated by all participants. Experts perceived that supplementary family coaching helped reduce resistance within families and foster greater personal responsibility compared to group education alone. The accompanying persons reported improved communication with their children and clearer goal setting. Patients appreciated the opportunity to address difficult topics, such as obesity-related behaviors and family conflicts. In the course of the coaching, the accompanying persons demonstrated increasing levels of mobilizing change talk and active engagement. Patients showed an increased intention for behavior change in the course of the coaching.The qualitative findings support the acceptance and feasibility of family coaching in inpatient rehabilitation settings. Implementing a standardized coaching approach could help to sustain rehabilitation outcomes in pediatric obesity. However, sustainable integration requires structural adjustments to ensure frictionless implementation within rehabilitation routines. Future controlled studies should investigate the short- and long-term rehabilitation success of family coaching.

Return to work is one of the most important aims in the context of psychosomatic rehabilitation. Studies from outside of Germany have reported that high self-efficacy positively influences time to return to work. In this study, the impact of self-efficacy on return to work was investigated after inpatient treatment in a psychosomatic rehabilitation facility of those with mental health disorders.In a longitudinal study, the participants (N=180) were asked about their return to work self-efficacy, depression symptoms, length of employment prior to rehabilitation, and other demographic variables. Insurance data were used to calculate time to return to work after 12 months. Cox regression analyses were used to identify relevant factors. Additionally, pre-post analyses and correlative relationships regarding self-efficacy and depression were conducted.Higher return to work self-efficacy and longer employment prior to rehabilitation increased the chance for return to work. The treatment showed changes in depressiveness (d=0,97) and return to work self-efficacy (d=|0,36|).In the course of psychosomatic rehabilitation, self-efficacy is important in the process of return to work among employees with mental health disorders.

Dual rehabilitation (dR) of patients with physical and mental illnesses comprises equal care and cooperation between two specialist departments. As part of the multi-method project that aimed to evaluate dR in different indications (DUAL), we explored the acceptance from the rehabilitants' perspective.We conducted 36 semi-structured interviews with rehabilitants of different indications (psycho-gastroenterology, -dermatology, -orthopedics, -diabetology, -cardiology, -pneumology). Interviews were analyzed using qualitative content analysis. Knowledge and access, expectations, experiences, and subjective benefits were explored as indicators for acceptance.Rehabilitants reported appropriate expectations such as improvement of mental and physical complaints or open expectations. Cross-departmental aspects such as admission and ward rounds were experienced as beneficial if there was sufficient exchange and cooperation between specialist departments. In individual psychotherapeutic consultations and groups, an improved understanding of both disorders and contact with fellow patients were important which also had a positive effect outside therapies. The multimodality of the dR was perceived to be beneficial just as the therapists' behavior and offers for counseling on both diseases. Hindering experiences included a lack of interdisciplinarity/coordination between the specialist areas, a lack of individualization in therapy planning and structural aspects in almost all areas. Subjective benefits were improved self-management and symptoms of both illnesses, as well as occupational performance.Appropriate expectations, beneficial experiences with the multimodal therapy components, therapists, and fellow patients as well as perceived positive effects support rehabilitants' satisfaction and indicate a high level of acceptance. Hindering experiences and modification requests suggest ways for overcoming obstacles, for example, by increasing interdisciplinarity and cooperation between the specialist departments. Providing sufficient information and knowledge about dR available to practitioners and patients can further support acceptance and patient participation.

Mental health disorders increase the risk of early retirement and occupational exclusion. Individualized, needs-oriented aftercare that includes measures to stabilize employment following vocational rehabilitation can support affected individuals in transitioning into the workforce and mitigate these risks. Drawing on the JobProtection model project, this study investigated the impact of aftercare on sustainable workforce reintegration and the factors influencing long-term employment among individuals with mental health conditions.Anonymized routine data from the German Pension Insurance Braunschweig-Hannover (n=1464) were analyzed using logistic regression. Among the sample, 113 individuals in the intervention group participated in up to 24 months of JobProtection aftercare (2019-2023) following vocational rehabilitation. The control groups, which received standard aftercare, comprised a historical group (n=688; vocational rehabilitation measures completed between 2015 and 2017) and a parallel group (n=663; vocational rehabilitation measures completed between 2019 and 2021). Sustainable workforce reintegration was defined as at least 24 months of employment, based on data from social security contributions.The intervention group showed significantly higher chances of achieving sustainable employment. Other positive predictors of long-term workforce reintegration included older age, a longer duration of vocational rehabilitation, and the approval of a partial disability pension. In contrast, individuals granted a full disability pension or those whose pension applications were rejected had significantly lower chances of remaining employed for at least two years after vocational rehabilitation. Belonging to the parallel control group was associated with reduced chances of stable employment.The vocational reintegration of JobProtection participants was successfully supported in the long term. Accordingly, needs-oriented aftercare may serve not only as a meaningful complement to vocational rehabilitation for individuals with mental health conditions, but also as a means of addressing a previously unmet need in care provision.

Patients in cardiac rehabilitation (CR) with subjectively impaired occupational prognosis are at risk of not returning to work (RTW) in the medium term. This study aimed to explore, describe and summarise the aspects relevant in CR patients' reflections on their occupational future.A qualitative study was conducted in CR in 2021/22; 25 patients (median age 52 years; 9 women, 16 men; working in different physically demanding occupations; 20 with risk of non-RTW and 5 without by the Würzburger Screening) were interviewed and asked to reflect on their occupational future.About 6-8 months post-CR, 8 patients were re-interviewed to check the relevance of the factors identified during CR. All interviews were recorded, transcribed and thematically analysed.Aspects relevant for the reflection on subjectively perceived occupational future could be summarised into internal factors: personal aspects, health perception, heart-focused anxiety, and external factors: social circle and adjustments in work conditions. Two further themes were time-related: prior health/illness-related experiences and intended work and lifestyle changes. Especially participants with a risk of non-RTW experienced heart-focused anxiety, contemplated previous health/illness experiences and expressed a desire to RTW in the distant future, although they had no clear plan of action. Greater emphasis was placed on prioritising health and taking time for RTW, and participants often felt supported in this by their social environment. Themes were overlapping between participants with and without risk of non-RTW, yet different in relevance and detail.Overall, patients at different risk of non-RTW reflecting on their subjective perception of occupational future show similarities regarding relevant aspects and themes. However, especially patients at risk of non-RTW reflected on perceived heart-focused anxiety and the lack of concrete RTW plans for their occupational future. These aspects should be considered in individual, holistic and goal-oriented approaches to support patients on their RTW journey.