Presentation T P35

T P35 (Poster Presentation):
Predictive Validity of a Screening Instrument for Severe Restrictions of Work Ability in Patients with Musculoskeletal Disorders

Presented by: Marco Streibelt

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Streibelt M1, Egner U1, Bethge M2

  1. German Federal Pension Insurance (GFPI), Department of Rehabilitation, Berlin, Germany
  2. Medical School Hannover, Department of Rehabilitation Medicine, Hannover, Germany



Work-related medical rehabilitation (WMR) has become an integral part of rehabilitation offered by the German Pension Insurance (GPI). Studies showed the effectiveness of WMR with focus on patients with severe restrictions of work ability (SRWA). Since the identification of these patients is of great importance, a screening instrument (abbr. SIMBO) was developed. The question was whether the SIMBO can predict critical return to work (RTW) events after rehabilitation especially for patients still having an active employment.


Patients with chronic musculoskeletal disorders (CMSD) completed questionnaires at admission to rehabilitation and at the six months follow-up. The SIMBO score measured at admission ranges from 0 to 100 pts. The main outcome was failed stable occupational participation (SOP). SOP was defined as active employment with at least 12 weeks of sick leave during the follow-up. Additionally, the physician´s rating of daily work capacity in the current job at discharge of rehabilitation was used as outcome. Area Under Curve (AUC) coefficients were calculated concerning failed SOP. The optimal cut off point was defined using the Youden Index and logistic regression models tested the impact of the dichotomization concerning the outcomes.


Complete datasets were obtained from 1604 patients. The SIMBO could predict failed SOP with AUC = 0.805 (95 % CI = .785 – .824). The optimal cutoff was 32 pts with a sensitivity of 72 % and a specifity of 79 %. Patients with a SIMBO score >31 pts had 11.8 (95 % CI = 8.9 – 15.7) times higher odds of failed SOP. The odds of either unemployment or long-term sick leave were 7.8 (95 % CI = 5.4 – 11.1) times and 11.9 (95 % CI = 8.2 – 17.3) times higher. The odds of decreased capacity in the current job were 18.1 (95 % CI = 9.9 – 33.0) times higher in patients with SIMBO scores >31 points.


The study outlines the high predictive validity of the SIMBO, which qualifies it as an effective screening for access management to intensified rehabilitation measures. Following these results the SIMBO was implemented in the access management of the GPI identifying patients with CMSD and a need for WMR.

Schedule Details

Tuesday September 30
12:45 - 13:45 Poster Viewing
Session: Work capacity / ability