Rehabilitation最新文献

{"title":"[Recommendations for the standardized assessment of manifest osteoporosis with vertebral fractures in disability law].","authors":"Nils Schulz, Karin Mahn, Björn Buehring, Antje Dominok, Uwe Lange, Uwe Maus, Christopher Niedhart, Michael Pfeifer, Monika Reuß-Borst, Petra Simonetti, Martin Gehlen, Philipp Klemm","doi":"10.1055/a-2880-8297","DOIUrl":"https://doi.org/10.1055/a-2880-8297","url":null,"abstract":"<p><strong>Purpose: </strong>Osteoporosis is among the most prevalent chronic conditions, affecting millions of individuals and associated with a substantial fracture burden. Osteoporotic vertebral fractures lead to structural damage, functional impairment, pain, loss of mobility, reduced social participation, and increased mortality. Despite the clinical and social-medical relevance of this condition, standardized recommendations for disability assessment within the German Social Compensation Law have been lacking. The aim of this study was to develop nationally uniform, ICF-oriented criteria for determining the degree of disability (GdB) in individuals with manifest osteoporosis and vertebral fractures.</p><p><strong>Methods: </strong>Criteria were developed using a modified Delphi process comprising three survey rounds. A national steering committee coordinated data collection and defined consensus thresholds. The expert panel included osteologists, rheumatologists, orthopedic surgeons, geriatricians, social and rehabilitation medicine specialists, and a patient representative. Items from the ICF domains body structures, body functions, and activities and participation were evaluated; consensus was defined as ≥70% agreement.</p><p><strong>Results: </strong>Clearly defined four-tiered criteria were established that could be matched to the abstract severity categories of the German \"Versorgungsmedizin-Verordnung\" (VersMedV). These criteria comprehensively capture key structural and functional characteristics of vertebral fractures as well as everyday functional and participation-related aspects. The agreed-upon criteria constitute the first operationalized system for GdB assessment based on valid and reproducible measurement instruments.</p><p><strong>Conclusion: </strong>This work provides the first ICF-oriented, operationalized framework for the social-medical assessment of osteoporosis with vertebral fractures and establishes a foundation for nationwide standardized, objective, and reproducible GdB determination.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The subjective experience of employment of young adults with rheumatoid arthritis on the general labour market - A qualitative study].","authors":"Lena Lorenz, Christian Walter-Klose","doi":"10.1055/a-2892-2078","DOIUrl":"https://doi.org/10.1055/a-2892-2078","url":null,"abstract":"<p><strong>Purpose: </strong>The search for inclusion and participation of people with disabilities is increasingly becoming the focus of research in the context of demographic development and the associated labour shortage. The research situation in the context of chronic diseases is considered to be low in the national area. This applies in particular to rheumatoid arthritis (RA) in young adulthood. Existing work points to the importance of adaptations in the field of work and working time.</p><p><strong>Methods: </strong>As part of the study, 17 individual interviews were conducted with young adults aged 18 to 35. These were transcribed and analyzed using the content-structuring qualitative content analysis.</p><p><strong>Results: </strong>As a result of the relapsing disease activity, physical limitations occurred in the affected persons in their daily work routine. These were aggravated by accompanying symptoms of the disease. With regard to the work situation, it was evident that a lack of flexible working hours, work breaks and places as well as the lack of ergonomic workplace design and accessibility at the workplace could contribute to the physical limitations of the disease. Socio-psychological challenges, such as incomprehension and prejudices on the part of colleagues and/or managers with regard to a chronic illness, led to further psychosocial difficulties in those affected.</p><p><strong>Conclusion: </strong>The present study provides initial insights into the individual-specific and work-related challenges of young adults with rheumatic disease. With reference to the multilevel model of occupational inclusion, the individual problems of the affected employees can be traced back to multiple influencing factors.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Exercise therapy in the medical rehabilitation of German Pension Insurance: Healthcare provision in the context of the Covid-19 pandemic].","authors":"Lukas Born, Silke Brüggemann","doi":"10.1055/a-2858-9627","DOIUrl":"https://doi.org/10.1055/a-2858-9627","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to examine exercise therapy in medical rehabilitation provided by the German Pension Insurance (DRV) in 2022 and assess possible impacts of the COVID-19 pandemic.</p><p><strong>Methods: </strong>We analyzed routine data from 2022 and 2023, collected within DRV's rehabilitation quality assurance and coded the data using the Classification of Therapeutic Services (KTL). Scope, distribution, and formats of exercise therapy (sports and exercise therapy, physiotherapy, recreation therapy) were evaluated across eleven indications. Data from 2007 and 2014 served as historical comparators.</p><p><strong>Results: </strong>In 2022, exercise therapy accounted for an average of 40.2% of total rehabilitation treatment time. The highest share was observed in orthopedics (49.5%), the lowest in rehabilitation for substance use disorders (13%). The average weekly duration was 8.8 hours, markedly lower than in 2014. Oncology and neurology showed the most pronounced declines, alongside reductions in group therapy time. In 2023, the share of exercise therapy increased again to an average of 45.3%.</p><p><strong>Conclusions: </strong>Exercise therapy remains a cornerstone of rehabilitation within the DRV but varies considerably across indications. The COVID-19 pandemic led to substantial reductions, particularly in group and physiotherapy services. First post-pandemic data indicate a partial recovery; further research is needed to clarify long-term effects.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to Work of People With Chronic Health Conditions After Medical or Vocational Rehabilitation During the COVID-19 Pandemic: a Qualitative Study.","authors":"Nadine Sänger, Mathis Elling, Christian Hetzel, Betje Schwarz","doi":"10.1055/a-2858-9471","DOIUrl":"https://doi.org/10.1055/a-2858-9471","url":null,"abstract":"<p><strong>Purpose: </strong>The COVID-19 pandemic had diverse impacts on various aspects of societal life. The aim of this study, part of a mixed methods project, was to examine how the pandemic affected return to work after medical or vocational rehabilitation.</p><p><strong>Methods: </strong>A total of 60 guided interviews and three focus groups were conducted. Participants included rehabilitation practitioners, occupational actors, and rehabilitees in medical or vocational rehabilitation during the pandemic. The collected data were analyzed using qualitative content analysis. A deductive category system of potential return-to-work factors, structured according to the dimensions of the International Classification of Functioning, Disability and Health, was applied, and inductive subcategories were developed. Each factor was categorized according to its pandemic influence.</p><p><strong>Results: </strong>During the COVID-19 pandemic, rehabilitees experienced health burdens, isolation, and limited access to medical treatments. The strained labor market led to fears of job loss, terminations, and difficulties in reintegration. Workplace barriers included a lack of support and high workloads, while leaders perceived as understanding and supportive organizational structures facilitated the return to work. In medical rehabilitation, reduced capacities and therapy offerings posed challenges. Vocational rehabilitation had to be delivered digitally and the transition into practical work was aggravated. Overall, factors such as self-management, digital literacy, and financial stability influenced return to work outcomes.</p><p><strong>Conclusion: </strong>Even during the pandemic, return to work was shaped by \"well-known,\" pandemic-independent factors (e. g., motivation). However, some of these factors gained particular relevance in this context (e. g., health literacy). Additionally, pandemic-specific return to work factors emerged (e. g., infection control measures). In medical rehabilitation, pandemic-independent factors such as a lack of work-related counseling or uncooperative leadership remained primary barriers to reintegration. Vocational rehabilitation, on the other hand, faced greater challenges due to the strained labor market and the necessity of digital solutions, making pandemic-specific and pandemic-moderated factors more impactful.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Migration-sensitive care strategies in inpatient rehabilitation in Austria: Results of a mixed-methods study].","authors":"Stephanie Stolz, Yüce Yılmaz-Aslan, Patrick Brzoska","doi":"10.1055/a-2858-9349","DOIUrl":"https://doi.org/10.1055/a-2858-9349","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of the present study was to investigate challenges related to the inpatient rehabilitation of people with a migration background in Austria, as well as the ways facility staff addressed these challenges. Furthermore, existing migration-sensitive care concepts or measures in Austrian rehabilitation clinics, potential supporting and impeding factors for their implementation and further development potentials were examined.</p><p><strong>Method: </strong>The study uses a mixed-methods approach. In addition to a questionnaire survey in which 18 inpatient rehabilitation facilities participated, 20 topic-guided expert interviews were conducted with members of various professional groups working in Austrian inpatient rehabilitation facilities. The survey data were analyzed descriptively, while the interviews were analyzed using qualitative content analysis.</p><p><strong>Results: </strong>The most common challenges in everyday rehabilitative care included language and communication barriers, as well as expectations and perceptions among rehabilitation patients that were not sufficiently taken into account by the facilities. Rehabilitation facilities have already implemented various migration-sensitive care measures of migration-sensitive care; however, systematic approaches and interpreting services in particular have so far only been used sporadically. The main obstacles to the implementation of migration-sensitive care strategies were financial, personnel-related and organisational challenges.</p><p><strong>Conclusion: </strong>The results provide up-to-date insights into the reality of rehabilitative care of people with a migrant background in Austria and show that facility representatives are aware of the individual care needs arising from the increasing intercultural diversity of rehabilitation patients. They also point to structural and organizational deficits, as well as opportunities for improvement in the context of current health policy challenges.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cooperation in vocational rehabilitation - partnerships and networks as quality indicators].","authors":"Dieter Röh, Silke Werner, Anna-Lena Bühne, Kyung-Eun Choi, Sina Jädicke, Stella Lemke, Silke Tophoven, Eileen Wengemuth","doi":"10.1055/a-2832-2501","DOIUrl":"10.1055/a-2832-2501","url":null,"abstract":"<p><strong>Purpose: </strong>This article examines various aspects of networks and cooperation in the field of vocational rehabilitation as quality characteristics.</p><p><strong>Methods: </strong>Four different research projects were used for the study. Statements on the experience of cooperation between rehabilitation patients, rehabilitation specialists, and rehabilitation counsellors were generated from the qualitative material of three studies. These were supplemented by a quantitative evaluation of the frequency of contact between social workers and service providers of vocational rehabilitation.</p><p><strong>Results: </strong>Obstacles and facilitating factors were identified at three levels, from which concrete suggestions for quality improvement were derived. The three levels comprised the counselling dyad, the team and stakeholder level, and the extended organisational level.</p><p><strong>Conclusion: </strong>The institutions examined demonstrate well-developed networks and cooperation from an intra-organisational perspective. The potential of good networking and cooperation to improve quality within the rehabilitation system has not yet been fully exploited. There is a clear need for further development in inter-organisational cooperation between service providers and the health and social system.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":"65 3","pages":"167-175"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tasks and Roles of Social Work in Vocational Rehabilitation].","authors":"Nadja Freymüller, Julia Seefeld, Silke Werner, Ruth Enggruber, Dieter Röh, Silke Tophoven, Tobias Knoop, Harald Zellner, Kathrin Ebener-Holscher, Sina Jädicke, Thorsten Meyer-Feil","doi":"10.1055/a-2698-4432","DOIUrl":"10.1055/a-2698-4432","url":null,"abstract":"<p><strong>Purpose: </strong>Social work is part of the interprofessional rehabilitation team and, for example, provides services in the context of so-called special aids in vocational rehabilitation. However, compared to the field of medical rehabilitation, there is still relatively little research on the practice of social work in vocational rehabilitation. The three research projects Tasks and Use of Social Work in Vocational Rehabilitation (ANSAB), Networks and Cooperation in Vocational Rehabilitation (NEKOBERE) and Social Work in Vocational Rehabilitation (SABER) aimed to address this gap by identifying the tasks and roles of social work in this field.</p><p><strong>Methods: </strong>The analysis was based on the qualitative study components of the three projects and an online survey of 109 professionals conducted as part of the ANSAB project. Initially, each research team analyzed its own data. Subsequently, a synthesis of the findings was conducted using a best fit framework synthesis approach. The theoretical framework was based on Dahrendorf's role theory.</p><p><strong>Results: </strong>Professionals working in the field of social work perform a wide range of tasks and take on various roles. Among others, the identified roles included Thread-Holder, Rehabilitation Process Companion, \"Motherly\" Carer and Networker. Tasks could be assigned to these roles. Professionals perceived tasks linked to the roles of the Thread-Holder and Rehabilitation Process Companion (e. g. individual rehabilitation progress discussions) as particularly frequent and important. A potential for role conflict between these two roles was also identified. This may occur, for example, when rehabilitants perceive professionals as representatives of the funding agency, which can lead to reluctance to disclose psychosocial concerns.</p><p><strong>Conclusion: </strong>The results of the three research projects highlight the central importance of professionals working in the field of social work. Building on these findings, practice-oriented recommendations will be developed to support professionalization and further define the competence profile of these professionals.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"176-184"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Discontinuities in Vocational Rehabilitation: Institutional Frameworks and Biographical Trajectories in Vocational Training Centers (BTZ) and Vocational Rehabilitation Centers (BFW)].","authors":"Niklas Tibbe, Nathalie Glamann, Verena Kakuschke, Stefan Dreßke, Regina Weißmann, Ernst von Kardorff, Joachim Thomas, Heike Ohlbrecht","doi":"10.1055/a-2821-0529","DOIUrl":"10.1055/a-2821-0529","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"157-166"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Conformance, Completeness and Plausibility of the Service Classification of Vocational Rehabilitation for Educational Services: A Routine Data Analysis].","authors":"Christian Hetzel, Tobias Knoop, Nadja Freymüller, Mathis Elling, Thorsten Meyer-Feil, David Bühne","doi":"10.1055/a-2804-0879","DOIUrl":"10.1055/a-2804-0879","url":null,"abstract":"<p><strong>Purpose: </strong>In 2017, the service classification of vocational rehabilitation (LBR) became mandatory for vocational rehabilitation centres as part of the German Pension Insurance's (DRV) quality assurance process. This joint study aims to determine the quality of LBR data by analysing routine data on conformance, completeness and plausibility, using vocational training services in vocational retraining centers as an example.</p><p><strong>Methods: </strong>This analysis is based on a scientific use file 'Completed rehabilitation in the insurance history 2015-2022', as well as data on the LBR and the assignment to rehabilitation centres. Following the selection of vocational training services (i. e., qualification and integration measures in vocational retraining centres), 35,878 measures from rehabilitants who ended their rehabilitation from 2018 to 2022 were evaluated. The documented LBR codes were analysed descriptively, as well as using logistic and linear regression models.</p><p><strong>Results: </strong>Regarding the conformance of the LBR, the analyses showed that the documentation met the structural and content-related requirements. A review of the completeness of the LBR documentation revealed that the documentation increased over the years, but to date (2022), approximately 25% of the measures were still undocumented. The decision regarding documentation depends largely on the rehabilitation centre. Plausibility analyses revealed that the documented duration varied considerably between institutions. Furthermore, it was revealed that expectations regarding the association between personal characteristics (e. g., age, sex) or measure (e. g., termination of measure, scope of rehabilitative assistance) and the documented duration of LBR were only confirmed in part in an exemplarily selected subset of the data (with services relating to health literacy and therapeutic services).</p><p><strong>Conclusion: </strong>Overall, the results of the analyses allow a positive conclusion to be drawn about the quality of the LBR data with regard to conformance and completeness. In terms of plausibility, however, the results are inconclusive. It has not yet been possible to take any external evaluation standards into account. These should be developed in the next step.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"185-195"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Shaping Transitions: Access and Pathways in Vocational Rehabilitation].","authors":"Verena Kakuschke, Nathalie Glamann, Eileen Wengemuth, Niklas Tibbe, Regina Weißmann, Stefan Dreßke, Kyung-Eun Choi, Ernst von Kardorff, Joachim Thomas, Heike Ohlbrecht","doi":"10.1055/a-2742-5589","DOIUrl":"10.1055/a-2742-5589","url":null,"abstract":"<p><strong>Purpose: </strong>Transition from medical to vocational rehabilitation not only mark the change from one institution or programme to the next, but are also biographically significant and vulnerable phases for the rehabilitants. The organisation of this transition is therefore of great importance. The present study analyses transitions from medical to vocational rehabilitation from the perspective of four research projects. The article addresses key hurdles, control mechanisms and subjective experiences in the transition process.</p><p><strong>Methods: </strong>The data basis comprises qualitative interviews, focus groups, document analyses, as well as standardised and open questionnaire surveys in various vocational rehabilitation institutions (BFW and BTZ) and medical rehabilitation institutions. The evaluation was conducted using a combination of qualitative content analysis (Kuckartz, Mayring), grounded theory (Glaser & Strauss), and descriptive statistical methods.</p><p><strong>Results: </strong>The results can be grouped into four thematic focus areas that chronologically describe the transition process: 1) the path to vocational rehabilitation, 2) information and support for vocational rehabilitation, 3) access to and referral to vocational rehabilitation, and 4) the start of and arrival in vocational rehabilitation. It became evident that the transitions were characterized by institutional fragmentation, information deficits and unclear responsibilities. It was often the case that individuals seeking vocational rehabilitation services did so on an opportunistic basis, or through their own personal initiative. The coordination of counselling services was suboptimal, and the formal referral processes appeared to lack transparency and were sometimes arbitrary. Vulnerable groups, such as those grappling with addictions or other mental health problems, were particularly susceptible to the impact of these barriers. However, there were documented instances of successful transitions, particularly when early, continuous counselling was provided, and individual circumstances were given due consideration.</p><p><strong>Conclusions: </strong>Successful transition management requires clear responsibilities, standards for counselling and referral, and better integration of medical and vocational rehabilitation. It is crucial to integrate institutional routines within the rehabilitants' biographies.</p>","PeriodicalId":54504,"journal":{"name":"Rehabilitation","volume":" ","pages":"147-156"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}