1、Christoph KorallusInnovation in Vocational Rehabilitation职业康复中的创新职业康复中的创新by Hanover Medical School Department of Rehabilitation MedicineContentsJobRehab VW/Post 复工康复Need-based rehabilitation 基础康复需求Fit for Work and Life 适应工作及生活Hanover medical schools health management program汉诺威医学院健康管理项目 JobFit 适岗（对工
2、作的岗位的适应及回归）1 week intensive vocational rehabilitation1周集中职业康复Projects of PRM Department: 康复科项目BackgroundStandard“ medical Rehabilitation is in many cases not sufficient to achieve return-to work. 标准-医疗康复很多情况下不足以实现回归工作的目的Problems: Rehabilitation programs are not adapted to the actual workplace, the p
3、atient should return to.康复内容与实际将回归的工作不能对接Occupational physician is not involved in rehabilitation process 操作医师在康复进程中墨守成规Ideas for solution:解决方法Occupational Rehabilitation measures 开展职业康复措施Need-based Rehabilitation 1-6 weeks, inpatient/oupatient基础康复Providing workplace information to the rehab向康复中心提供工
4、作场所信息Providing rehab information to the company/physicians向公司/医生提供康复信息内容Performing FCE and adapting training on the results在前基础上提供对接训练Doing one day of Rehab AT the company 公司内一日康复训练Challenges 挑战Muskuloskeletal Pain tends to chronification, when not treated appropriately and early.若治疗不适当或未尽早，肌肉骨骼疼痛会转
5、变成慢性损伤Former healthy workers get an effective treatment, when work ability is heavily affected.当工作能力受到严重影响时，工作者应得到有效治疗German health insurance system is complicated and different agencies can be in charge for funding a rehab measure.德国健康保险系统可以完美覆盖，并且不同机构对康复措所需费用负责Occupational physician 专职专职医医师师Rehabi
6、litation physician 康复医康复医师师Employee with complaints被被投投诉诉雇雇员员Information of employees雇雇员员信息信息Company公司公司Health insurance健康保健康保险险Pension insurance养老保养老保险险Prevention预预防防 Level 11 weekRehabilitation Level 2-outpatient3 weeksRehabilitation Level 2-inpatient3 weeksWorkplace information工作地信息工作地信息Short dis
7、charge report短期短期执执行行报报告告Difference in daysArithmetic mean MedianBegin of JobRehab开始复工康复开始复工康复End of JobRehab复工复工康复康复结结束束 7,4 0 0,5 0RehabilitationRehabilitation physicians perspective 康复医康复医师师前景前景 IntroducingEmployee介介绍绍雇雇员员Feedback from funding agency经费经费机构反机构反馈馈Transmission of workplace informati
8、on传递传递工作地点信息工作地点信息Receipt of short discharge Report短期短期执执行行报报告回告回执执Vocational Integration工作整合工作整合 -0,5 0 12,0 6 1,4 1 0,3 0RehabilitationRecommendationofJobRehab 推荐推荐复工康复复工康复Receipt of workplace Information工作地工作地点信息回点信息回执执Occupational physicians perspective 专职专职医医师师前景前景Primary outcome Pain Disabilit
9、y 主要结果-疼痛致残7家庭娱乐社会活动雇佣性生活自我护理日常生活活动8Indirect costs JobRehab pre-post 间接花费 复工康复前后IGCGFit for Work and Life 适应工作生活Governments recommendation for corporate health programs 政府推荐企业健康项目Project for occupational health management by Hanover medical School. 汉诺威医学院专职健康管理项目As established in JobRehab need-based
10、 health supporting offers. 将为复工康复所需的基础健康提供支持作为既定方针Easy access to wheather preventive or rehabilitativ measures 便捷的连接预防与康复措施Measures for workplace health promotion gain importance工作地点推进健康的重要措施Particular strains in an university hospital 大学医院内的特殊菌株Development and implementation of Fit for Work and Lif
11、e“ (FWaL) at Hannover Medical School (HMS) in order to:改进并执行适应工作生活以达到如下目的：- restore, 恢复- improve, 改善- or preserve 或者维持the employees work ability. 雇员的工作能力. as established in JobRehab need-based health supporting offers. 作为复工康复基础健康支持的既定方针Fit for Work and Life 适应工作生活11Payer: Public Health Insurance, Pe
12、nsion FundsPayer: HMSRegistration & QuestionnairePhysicianRehabilitative measures Preventive measures Diagnostic & TherapyEmployees of HMSAfter completionAccording to indicationvoluntarilySports medicine treatmentPhysical trainingJobFit (1 week + mTT)JobRehab IIa+s (3 Weeks)JobRehab III (Casemanagem
13、ent)According to indicationAfter completioncontinuationIf indicatedStress-management training/ smoking cessationAccording to indicationEvaluationBoard of advisors 顾问委员会预防措施康复措施Methods 方法Accompanying evaluation of FWaL 附带评估“适应生活工作”Data assessed by questionnaire before and at the end of the interventi
14、on as well as three, six and 12 months after beginning the intervention 在执行开始前、后、开始后三、六、十二个月分别进行调查问卷评估数据Primary outcomes: Work Ability Index (WAI), duration of sick leave 主要结果-工作能力指数，病假时间Secondary outcomes: Quality of Life (SF-36) 第二结果-生活质量12Sample characteristics 样本特征nMean (SD) or %Age, mean (SD) 年
15、龄20745.7 (8.7)Gender: female, % 性别20760.4 %Work ability (WAI), mean (SD) 工作能力20036.1 (7.2)Very low/ low work ability (WAI), % 极差/差工作能力百分比20048.0 %Sick leave (previous three months): yes, %病假（前三个月）20641.3 %Duration of sick leave (weeks), mean (SD)病假周数804.3 (4.1)Assigned intervention: preventive measu
16、res, %进行干预：预防措施20774.4 %13Primary Outcomes 主要结果1400.10.20.30.40.50.60.70.80.9Sick leave (RI; n = 50)Sick leave (PI; n = 150)Sick leave (n = 200)Work Ability Index (RI; n = 51)Work Ability Index (PI; n = 145)Work Ability Index (n = 196)Standardized effect sizes (95% CI)PI = Preventive intervention; R
17、I = Rehabilitative intervention预防康复预防康复Results 结果FWaL started in July 2013 适应工作生活项目开始于2013.7550 employees registered for participation 550人注册参与207 participated in the survey three months after beginning the intervention 207人于干预开始后3个月参与调查Assignment to interventions needs-based 进行对基于需求的干预Our idea of h
18、ealth management has effects on sick leave and workability even with in preventive interventions 我们关于健康管理的创意对病假和可操作性甚至对预防性干预产生有效影响First analysis shows, that its cost-effective! 前期分析表明-此法经济有效15JobFit 1 week intensive rehabilitation 适岗-一周集中康复BackgroundDeveloping a rehab measure that is: 改进康复方法L：starti
19、ng very early in the process of a disease 在疾病超早期开始cost efficient 经济有效adapted to the workplace 调整至工作地点long-term follow-up (f.e training, physiotherapy) 长期随访Giving feedback to occupational physician 给专职医师反馈Making recommendations for ergonomic workplace adjustment (f.e. height adjustable desk, computer
20、 mouse) 给出符合人体工程学工作地点调整的建议16Schedule 时间表17Diagnostics 诊断Ergonomic analysis 人体工程学分析FCE 履职能力评估Training routine 常规训练Psychological screening 心理筛查Massage 按摩Chiropractic 椎骨疗法Stress reduction traininig 减压练习Progressive Muscle Relaxation 逐步肌肉放松Sauna 桑拿Aqua 水疗2x Team-Sessions 团队会议Functional capacity evaluatio
21、n (FCE)履职能力评估18Lifting Repetitive rotation while sittingStanding bent forwardJobFit Training adapted to workplace activities工作适应性训练转换至工作场所活动20JobFit our Bestseller“适岗康复-我们的“最佳员工” Used in pilot project JobRehab for: 运用复工康复项目试点：German Postal Services 德国邮政Volkswagen 大众公司Follow-up project JobRehab MHH 跟
22、进项目复工康复 MHHHanover medical schoolFit for work and life Hannover medical school healt management program适应工作生活-汉诺威医学院健康管理项目Sold to other german companiesTV (car mechanics)stra (public traffic)Etc.DiscussionFurther improvements for cooperation between Rehab and occupational physician necessaryLong-ter
23、m follow-up in training measures, Motivation/EducationHow to implement ICF in need-based allocationSo far implementation studies, RCTs are missingWhat about China? Who is paying for Rehabilitation?How to apply for Rehab?How long is the approval process?Therapeutic network for follow-up measures?2122Contact: Briest.julianemh-hannover.deThank you for your attention!
