The effectiveness of digital and conventional rehabilitation and prevention programs: Impact on work ability, physical and mental health in orthopedic and occupational contexts

Demographic change and population ageing pose major challenges for health and social systems in Germany. The increasing prevalence of chronic diseases, particularly musculoskeletal and cardiovascular conditions, threatens both health systems and the sustainability of the workforce. Within this context, the German Pension Insurance plays a central role, guided by its principles of “rehabilitation before pension” and “rehabilitation before care”, making prevention and rehabilitation essential instruments to maintain employability. However, conventional programs face persistent challenges such as limited access, declining adherence after discharge, and waning treatment effects. Digital programs have emerged as potential solutions that may overcome barriers of time and place, provide scalable support, and sustain long-term engagement. Yet, there is still a lack of robust empirical evidence in Germany comparing the effectiveness of digital and conventional formats with respect to work ability, physical health, and mental health.
A decade of international studies has highlighted the potential of digital health interventions, but the field remains in an early phase of evaluation within the German rehabilitation and prevention context. ... mehrEvidence from other countries cannot be directly transferred due to the structural particularities of the German system, where the pension insurance is the largest rehabilitation provider. This is why the overarching aim of this dissertation was to systematically compare
digital and conventional programs in prevention and rehabilitation aftercare. The analyses focused on work ability, physical health, and mental health, with particular emphasis on the sustainability of intervention effects and the role of moderating factors such as age, gender, and employment status.
This dissertation comprises three empirical studies. The first study compared a digital prevention program with the conventional RV Fit program among employees with initial impairments. Both programs improved work ability and mental health, although no significant changes were observed in physical health. Younger employees benefited more strongly from the digital format, whereas older participants improved more under the conventional program. The second study evaluated digital versus conventional rehabilitation aftercare (digIRENA vs. IRENA) for orthopedic patients,
with a control group receiving no structured aftercare. Results showed improvements in physical and mental health across all groups, with the most pronounced gains in the digital format, although effects declined once structured support ended. The third study focused on work ability in the same population, demonstrating that all groups improved over time but that the digital format led to steeper early gains. These advantages were particularly evident among younger and unemployed patients, highlighting the role of individual characteristics in shaping intervention
effectiveness.
Taken together, these studies demonstrate that digital programs are at least as effective as conventional ones in prevention and rehabilitation, and in some respects superior, particularly for mental health and early improvements in work ability. However, the sustainability of effects remains a challenge for both formats, pointing to the need for hybrid and personalized models that integrate digital flexibility with interpersonal support. The dissertation highlights the
importance of tailoring interventions to demographic subgroups, especially regarding age, gender, and employment status, and suggests that hybrid models could maximize the reach and effectiveness of services across heterogeneous populations.
In conclusion, this dissertation contributes to closing critical evidence gaps in the German rehabilitation and prevention system. It provides robust comparative data that not only advance scientific understanding of digital versus conventional formats but also inform the practical design of rehabilitation services. The findings underline the potential of digital interventions to support the mission of the German Pension Insurance in preserving work ability and health in the face
of demographic change. At the same time, they call for continued innovation in hybrid approaches and long-term support strategies to sustain treatment effects and ensure equitable access across all population groups.