[The risk index as a predictor of the effectiveness of psychosomatic rehabilitation: do individuals with a high or moderate risk index benefit from rehabilitation?]

Abstract

The aim of this study was to examine the prognostic validity of the risk index for predicting the effectiveness of medical-psychosomatic rehabilitation treatments. Specifically, it was investigated whether the risk index contributes additional explanatory value beyond sick leave duration in the year preceding rehabilitation. Sociodemographic, clinical, and motivational differences between risk groups were also analyzed.This retrospective study was based on data from 725 patients treated at a rehabilitation center between September 2022 and December 2023. Participants were categorized by risk level (high, medium, low). Measures included depression severity (PHQ-9), work motivation (DIAMO), subjective return-to-work expectations (SPE), and social-medical assessments. Statistical analyses included ANOVAs, multiple and logistic regressions, and the Reliable Change Index.The high-risk group was older, more frequently female, and more likely to have been on extended sick leave. They reported poorer subjective and social-medical return-to-work expectations, lower work motivation, more avoidant behavior, and reduced participation capabilities. The risk index significantly predicted depression severity at discharge, though less strongly than prior depression levels and sick leave duration. It did not significantly predict return-to-work status at discharge.The risk index provides additional value in predicting psychological treatment outcomes, but not in forecasting work ability. Clinically relevant differences in motivation, participation assessment, and return-to-work expectations in the high-risk group underline the need for targeted early interventions. Conclusion While useful for identifying vulnerable groups, the risk index does not replace individualized assessments of occupational and psychological burdens. Early recognition and promotion of motivational and functional resources are essential for successful rehabilitation.