Evaluation of a validated questionnaire to assess the need for prevention or rehabilitation by preventive health examinations: a cross-sectional study of German employees aged 45 to 59 years (Ü45-check)

Abstract

Objective: A longer life expectancy can lead to a longer working life and is therefore important for the individual and the healthcare system. Therefore, a study group established a Risk-Index Disability-Pension (RI-DP), which assesses the risk of work disability. However, a standardized and well-founded preventive health examination does not yet exist in Germany. Hence, we developed a preventive health examination conducted by physicians and compared it with a questionnaire survey to examine its differences and results in relation to the need for prevention and rehabilitation, taking into consideration the RI-DP.

Methods: In this prospective cross-sectional study, n = 1,040 participants (45-59 years) took part in a preventive health examination at the Charité - Universitätsmedizin Berlin/Humboldt-Universität zu Berlin, Germany. A questionnaire survey and preventive health examination, including anthropometric measures, anamnesis, cardiovascular examinations, and blood samples, were conducted independently to determine the need for prevention and rehabilitation.

Results: The mean age was 52.93 (sd = 4.17) years, and n = 631 (61%) were men. The questionnaire assessed n = 733 (70%) participants as needing no additional action (green), n = 215 (21%) as needing a prevention program (yellow), and n = 91 (9%) as needing a rehabilitation program (red). In contrast, physicians assessed n = 141 (14%) as 'green', n = 717 (69%) as 'yellow', and n = 181 (17%) as 'red', revealing substantial discrepancies, especially in preventive needs. The leading associations of individual factors on physicians' evaluation were BMI [OR 1.135 (1.094; 1.178)], SBP [OR 1.099 (1.009; 1.197)], smoking status [OR 1.691 (1.212; 2.366)], depressive moods [OR 2.254 (1.565; 3.254)] and physical activity 1-2 h/week [OR 0.618 (0.436; 0.874)], and on the questionnaire: gender male [OR 1.790 (1.057; 3.046)], and depressive moods (OR 4.506 [3.216; 6.322]). This underlines the complementary nature of the two approaches in evaluating health interventions. According to the RI-DP, the participants had the following risk of early retirement: low-risk n = 540 (52%), medium-risk n = 307 (30%), and high-risk n = 193 (19%).

Conclusion: The results emphasize the need for combining questionnaire surveys with preventive health examinations to assess health needs comprehensively. Notably, the preventive health examination suggests higher prevention needs compared to the questionnaire, indicating that the questionnaire may not fully capture clinical prevention needs.

Clinical trial registration: https://drks.de/search/de/trial/DRKS00030982, identifier DRKS00030982.

Keywords: disability pension; prevention; questionnaire; rehabilitation; screening; work disability; Ü45-check.

Figure 1

Flow Chart of recruitment of participants included in the Ü45 trial form 2021 until 2024. The reasons for the screening failure were, e.g., an ongoing procedure regarding a claim for a disability pension or a rehabilitation measure.

Figure 2

Predicted probability of needing prevention or rehabilitation in relation to hours of physical activity, depressive moods, and BMI based on the preventive health examination and the Ü45-Screening questionnaire; 1 = no additional action needed, 2 = prevention program suggested, 3 = rehabilitation program suggested.

Figure 3

Predicted probability of needing prevention or rehabilitation in relation to hours of physical activity, currently smoking, and systolic blood pressure based on the preventive health examination and the Ü45-Screening questionnaire; 1 = no additional action needed, 2 = prevention program suggested, 3 = rehabilitation program suggested.