Back to Work Without Cardiophobia – “AmPULS” is testing a program that supports a return to the workplace following cardiovascular disease and rehabilitation
The lakeshore behind the clinic invites for a walk. The resin scent of the nearby forest, the fresh wind blowing across the water – those who come to Rüdersdorf for rehabilitation can take a deep breath. But that’s exactly what many of the patients have to learn again. They usually come directly from the hospital, following acute treatment for a heart attack, for example, or after a serious operation, or, increasingly more often, due to the long-term effects of a COVID-19 infection. “Initially, they only make it around the building once,” Prof. Völler reports. “It's like someone is standing on their chest, like their heart is in chains,” the cardiologist describes their condition.
Prof. Dr. med. Heinz Völler is Executive Medical Director of the "Klinik am See", which specializes in internal medicine. He also holds the professorship for rehabilitation medicine at the Brandenburg Faculty of Health Sciences. He is one of the professors who have been working in this still new joint project of the University of Potsdam with the Brandenburg Medical School and the Brandenburg Technical University Cottbus-Senftenberg from the very beginning. One of the most important goals that the faculty has incorporated into its founding documents is the direct transfer of the latest research results directly into practice, thereby improving medical care for patients. Professor Völler combines both sides in one single person. Questions on which he conducts research originate from medical practice and, if answered scientifically, they can have a retrospective impact on the practical field: from individually tailored rehabilitation to supported reintegration at the workplace.
Gradually returning to normal work life after a serious heart disease is not always successful, as the physician knows. The aim of a current intervention study is to identify decisive factors that facilitate a return to work. The project with the evocative name “AmPULS” (on the pulse) is led by PD Dr. Annett Salzwedel from the University of Potsdam, who is collaborating with the University of Lübeck and six rehabilitation clinics for this project.
Staying in touch
The shared objective is to support patients during the period following cardiac rehabilitation. And to do this over the phone. Once a month, they are called by the clinics’ social psychology service to discuss health and work-related matters. This also helps identify any obstacles to a return to work. Three to six months after rehabilitation, the participants in the intervention return to the rehab clinic for another five days to address lingering issues such as so-called cardiac anxiety, stress management and their own health behavior. Once their professional performance has been diagnosed, they are therapeutically supported to develop strategies that will enable them to better cope with work-related stress in the future. Workplace training, psychological and social counseling are also provided to help them reintegrate into their previous job or transition into a new one. After the current pilot phase, the effectiveness of this intervention will be tested in a randomized controlled trial, Prof. Völler says. For this purpose, 3,000 people will be tested for the risk of unsuccessful professional reintegration during cardiological rehabilitation, which directly follows hospitalization.
Those who are in such a special problematic occupational situation receive an invitation to participate in the study. A total of 560 people are then randomly assigned to either an intervention or a control group. The plan is to survey both groups at the end of rehabilitation and again one year later about their health situation and their return to work. The group that will undergo the intervention will also be asked whether and, if so, how the phone calls and the second phase of rehab helped them. “We want to increase the proportion of those who reintegrate into work from the current 45 % to 60 %,” Völler states the clearly formulated goal. “If we succeed with our model, it could become a job-oriented support program that does not yet exist in this form for cardiological patients,” he says.
Chances for a fresh start
One result of the intervention could also be that those affected fundamentally change their life plans. Once the heart is out of rhythm, it sometimes doesn't seem sensible to return to the old daily routine, which is perceived as stressful. “Most people want to go back to work, but differently. They want a fresh start,” says doctoral student Nataliia Brehmer, who conducted qualitative interviews with 25 patients. “Those who did not face particularly problematic situations in their jobs did not want to change anything and went back to work, also for financial reasons. For the others, however, the sudden illness was a shock. They don’t know what their future looks like, but they are relatively sure that things can’t simply continue as before.” The crucial question, she says, is whether they will manage to incorporate the relaxation techniques, physical exercises, and dietary habits they learned during rehabilitation into everyday life. Will they manage to gradually increase their exertion without fearing that their heart will give up again? “Psychosocial aspects may play a greater role here than medical ones,” says the scientist, whose work aims to identify the determining factors of subjective acquisition prospects.
Turning off the tap
Nataliia Brehmer is pursuing a doctorate at the Chair of Rehabilitation Medicine, although she is not a physician. As a graduate of the master's program “International Relations” with professional experience in health economics, she contributes a completely different professional perspective. She was born in Ukraine, studied in Poland and looks at the German healthcare system with an unbiased view. “I’ve always wondered why it’s called a health care system when it deals with diseases,” she says, searching for a figurative comparison that expresses her lack of understanding. "It’s like water overflowing and you wipe and wipe instead of turning off the tap.” She rather wanted to work where the tap was being turned off and decided to pursue rehabilitation science.
The qualitative interviews gave her the opportunity to listen carefully to the patients and get to the bottom of their “occupational problems”. According to Brehmer, the issue often involves less of a problem and more of a desire to change one’s own lifestyle and work situation, to obtain qualifications, to retrain, or to switch from heavy physical work to a desk job. Such decisions, however, need time, reflection, and stimulation. This makes a holistic interprofessional approach and supportive aftercare, as it is currently being tested in the pilot phase of “AmPULS”, all the more important in cardiological rehabilitation.
AmPULS – Program to support occupational reintegration after cardiological follow-up rehabilitation, funded by the Federal Ministry of Labor and Social Affairs within the federal program “Innovative Ways of Participating in Working Life – rehapro”
Collaboration: Deutsche Rentenversicherung Berlin-Brandenburg; Deutsche Rentenversicherung Nord; Klinik am See, Rüdersdorf; Mühlenbergklinik Holsteinische Schweiz, Bad Malente-Gremsmühlen; University of Lübeck; Institut für Qualitätssicherung in Prävention und Rehabilitation GmbH
Prof. Dr. med. Heinz Völler is a medical specialist for internal medicine, cardiology, and social medicine. He is Professor for Rehabilitation Medicine at the Brandenburg Faculty of Health Sciences of the University of Potsdam and Medical Director of the rehabilitation center for internal medicine “Klinik am See” in Rüdersdorf.
Nataliia Brehmer is research assistant and doctoral student at the Chair for Rehabilitation Medicine of the Brandenburg Faculty of Health Sciences of the University of Potsdam as well as lecturer in health economics and business administration.
This text was published in the university magazine Portal Wissen - One 2023 „Learning“ (PDF).