The transition from medical to vocational rehabilitation in Germany: an exploratory mixed methods study on rehabilitants' experiences.
Eileen Wengemuth, Lukas Kühn, Lara Kleist and 1 others
Among 61 German vocational rehabilitants, most got information about vocational programs during medical rehab but more than half got no help applying.
They describe navigating the system largely on their own. This is a descriptive, system-level finding, not evidence that any specific intervention improves outcomes.
Key findings
1Almost half of survey participants reported receiving information about vocational rehabilitation options during their medical rehabilitation stay, but more than half denied receiving any support in actually applying for a program.
297% of participants perceived their employer as unsupportive, 80% perceived the federal employment agency as not very supportive, and 94% perceived accident insurances as not supportive, while roughly 60% found their physician helpful.
3Almost two-thirds of participants felt self-determined in starting their vocational rehabilitation program, but around 25% reported feeling they had no influence over which program they started or felt pressured to begin.
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What it does not show
Convenience sampling from a single German region (Berlin-Brandenburg); findings may not generalise to other countries or regions. Only 7 interviews; the authors state the data are not fully saturated. Only vocational rehabilitants who had already successfully completed the transition were included; those whose applications were rejected or who struggled were excluded, so the experience of the most vulnerable patients is unknown. All data are retrospective; participants were recalling past experiences, introducing memory bias. The survey used mostly self-developed, non-validated items; no inferential statistics or group comparisons were possible due to the small sample. Participants may have portrayed themselves as more self-reliant and active than they actually were, to protect their self-esteem. The 13 medical rehabilitants who completed the survey were excluded from analysis, so the prospective perspective on the transition is absent.
Declared interests
Funded by the German Pension Fund Berlin-Brandenburg (grant 10-R-40.07.05.07.022). The German Pension Fund is one of the two major funders of medical rehabilitation in Germany and a funder of some vocational rehabilitation programs, making it a direct stakeholder in the system the study describes. No other conflicts of interest are declared.
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