The transition from medical to vocational rehabilitation in Germany: an exploratory mixed methods study on rehabilitants' experiences.

Introduction: Medical and vocational rehabilitation are both part of the German rehabilitation system. Both aim to improve the functioning and social participation of people with chronic conditions. Vocational rehabilitation, especially, is intended to enable individuals to participate in working life. These two types of rehabilitation settings are not systematically linked, and, as is the case with other transitions of care, this often poses a challenge for rehabilitants. This study aimed to explore the experiences of individuals transitioning from medical to vocational rehabilitation in Germany. We wanted to investigate how and from whom they received information and support, and how these were tailored to meet their needs of autonomy and self-determination. Methods: We employed a convergent parallel mixed methods design, conducting a survey comprising standardized and self-developed items, as well as semi-structured guided interviews with the same topics as the questionnaire, to gather a more in-depth account of the experiences of rehabilitants. For the quantitative data, we performed descriptive analysis and calculated response frequencies and means. We analyzed the interview data using qualitative content analysis with deductive-inductive coding. The qualitative data were used to provide a more in-depth and descriptive understanding of the survey findings and to ensure that we would not exclude potentially new and relevant topics. Results: Sixty-one vocational rehabilitants (29f, 30 m, 1d) who had previously completed a medical rehabilitation completed the survey, and seven (6f, 1 m) participated in an interview. The quantitative results indicate that approximately 50% of the rehabilitants reported having been informed about vocational rehabilitation during their medical rehabilitation. Still, fewer reported having received practical support, such as assistance with the application process. General practicioners and specialized physicians were perceived as supportive by approximately 60%; previous or current employers were perceived as least supportive. Regarding autonomy, almost two-thirds of the participants felt self-determined in choosing and starting their vocational rehabilitation program. However, a few reported feeling pressured. Regarding the qualitative data, deductively developed themes included the rehabilitants' experiences of autonomy, of perceived and desired professional support, and of received information. An inductively developed recurring topic was the experience with the rehabilitation system, which required high navigation skills. Discussion: Both support and autonomy are vital for rehabilitants at the transition from medical to vocational rehabilitation. According to the participants, the federal employment agency and employers do not currently provide sufficient support. Generally, the lack of cooperation between different stakeholders and institutions complicates the transition. While many rehabilitants reported a satisfying degree of autonomy, there is still room for improvement to put the ideal of self-determination into practice.