Aims: In Germany, medical rehabilitation has to be initiated by the members of health insurances. This often leads to delays in the application for and provision of rehabilitation services. Within a randomised controlled trial, a statutory health insurance evaluated a programme aimed at the prevention of activity limitations and restrictions of social participation in patients with type 2 diabetes. Firstly, potential persons with type 2 diabetes were identified. Secondly, their need for a medical rehabilitation was screened using a postal questionnaire. Thirdly, eligible participants were advised to apply for a medical rehabilitation.
Methods: Potential study participants were identified by the health insurance via diabetes-specific data on hospital stays, work disability and medical prescriptions. Eligible persons were asked for written informed consent and received a screening questionnaire assessing their need for a medical rehabilitation. Respondents indicating need for a rehabilitation according to the algorithm were randomly allocated to an intervention group (IG) or control group (CG). The IG was actively advised to apply for a medical rehabilitation together with information about their individual risks; CG members received usual care. Twelve months after baseline the participants completed a postal follow-up questionnaire on social participation (primary outcome) and subjective health status (secondary outcome). In addition, the health insurance provided data on hospital treatment and sick leave (cases, days).
Results: Of 471 insurants with type 2 diabetes who gave written informed consent, the algorithm identified 223 cases with a rehabilitation need. The follow-up questionnaire was completed by 84.5% (IG: n=91, CG: n=93). Although the attendance in medical rehabilitation was low (IG: 25%), an intention to treat analysis showed significant advantages for the IG members compared to the CG (e.g., reduced body mass index, increased disease knowledge, reduced depressive mood and eating disorders).
Conclusion: The IG members seemed to benefit at least slightly from the procedure carried out (screening plus recommendation). As in previous studies, the feasibility of randomised controlled trials to evaluate a complex public health intervention was demonstrated.