[Integrated occupational work capacity evaluation in medical rehabilitation--experiences and prospects exemplified by psychosomatic rehabilitation].

Psychosomatic rehabilitation is often initiated when lasting work disability, loss of job, and pension application have occurred. After a review of the relevance of vocational strains and of predictors for reintegration, we present a model of an integrated work hardening programme in Psychosomatic Rehabilitation. Results for 64 patients are illustrated by case vignettes. Especially when lasting work disability and unemployment have undermined the patients' sense of competence and endurance, work hardening promotes return to work, realistic self-appraisal and vocational reorientation. The social and medical assessment and the coordination of vocational rehabilitation measures are improved. The implementation of a work hardening programme requires the provision of a variety of (unpaid) work opportunities, independent assessment of work performance by supervisors and social worker, psychological support and close cooperation with rehabilitation services.