Open Access Open Badges Study protocol

Evaluation of an internet-based aftercare program to improve vocational reintegration after inpatient medical rehabilitation: study protocol for a cluster-randomized controlled trial

Rüdiger Zwerenz1*, Katharina Gerzymisch1, Jens Edinger1, Martin Holme2, Rudolf J Knickenberg3, Sieglinde Spörl-Dönch4, Ulrich Kiwus5 and Manfred E Beutel1

Author Affiliations

1 Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany

2 German Statutory Pension Insurance Rehabilitation Centre for Orthopaedics, Clinic Weser, Bad Pyrmont, Germany

3 Clinic for Psychosomatic Rehabilitation, Rhön-Klinikum AG, Bad Neustadt/Saale, Germany

4 Clinic for Prevention and Rehabilitation of Cardiovascular Diseases, Haus Franken GmbH, Bad Neustadt/Saale, Germany

5 German Statutory Pension Insurance Rehabilitation Centre for Cardiovascular Diseases, Clinic Wetterau, Bad Nauheim, Germany

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Trials 2013, 14:26  doi:10.1186/1745-6215-14-26

Published: 25 January 2013



Mental disorders are the main reasons for rising proportions of premature pension in most high-income countries. Although inpatient medical rehabilitation has increasingly targeted work-related stress, there is still a lack of studies on the transfer of work-specific interventions into work contexts. Therefore, we plan to evaluate an online aftercare program aiming to improve vocational reintegration after medical rehabilitation.


Vocationally strained patients (n = 800) aged between 18 and 59 years with private internet access are recruited in psychosomatic, orthopedic and cardiovascular rehabilitation clinics in Germany. During inpatient rehabilitation, participants in stress management group training are cluster-randomized to the intervention or control group. The intervention group (n = 400) is offered an internet-based aftercare with weekly writing tasks and therapeutic feedback, a patient forum, a self-test and relaxation exercises. The control group (n = 400) obtains regular e-mail reminders with links to publicly accessible information about stress management and coping. Assessments are conducted at the beginning of inpatient rehabilitation, the end of inpatient rehabilitation, the end of aftercare, and 9 months later. The primary outcome is a risk score for premature pension, measured by a screening questionnaire at follow-up. Secondary outcome measures include level of vocational stress, physical and mental health, and work capacity at follow-up.


We expect the intervention group to stabilize the improvements achieved during inpatient rehabilitation concerning stress management and coping, resulting in an improved vocational reintegration. The study protocol demonstrates the features of internet-based aftercare in rehabilitation.

Trial registration

International Standard Randomised Controlled Trial Number Register (ISRCTN:ISRCTN33957202)

Internet-based intervention; Medical rehabilitation; Premature pension; Rehabilitation aftercare; Stress management; Work disability; Work stress