Information package: Benefit evaluation of Kela’s rehabilitation services
This information package provides an overview of the results of an evaluation of the outcomes of Kela’s rehabilitation services. The evaluation has been conducted using the model that Kela applies to the evaluation of its rehabilitation services.
Data collected on rehabilitation
Kela evaluates the outcomes of its rehabilitation services based on data it collects systematically from clients, service providers and official registers. The annual report published by Kela’s research function provides data on the benefits of rehabilitation organised by Kela and highlights development needs. Kela applies the following four indicators when evaluating the outcomes of its rehabilitation services:
- Work capacity evaluation
- WHOQOL-BREF, a qualify of life indicator
- Beck Depression Inventory (BDI 21)
- The GAS method for defining and evaluating goals for rehabilitation
In addition, rehabilitation service providers are asked to provide an evaluation of the benefits and timely administration of rehabilitation services. Register data are used to establish clients’ employment status and life situation typically one year prior to rehabilitation, during the year they undergo rehabilitation and one year after rehabilitation.
The evaluation covers a variety of rehabilitation services ranging from occupational and discretionary rehabilitation to intensive medical rehabilitation. Table 1 shows the rehabilitation services subject to reporting.
A better quality of life and improved capacity for work and study
Quality of life and the capacity for work and study improved among clients who completed rehabilitation in 2021 while depressive symptoms decreased. Positive changes were observed in all service groups examined as part of the evaluation.
Compared with previous years, more positive outcomes were observed among clients who took part in Nuotti coaching or rehabilitation services for informal caregivers while positive outcomes decreased among those who participated in mental health courses.
Six out of ten rehabilitation clients achieved or exceeded their personal rehabilitation goals. However, clear differences were observed between different rehabilitation services, both in clients’ achievement of their goals and in the metric data used in evaluating rehabilitation outcomes.
The first report on clients who completed rehabilitation in 2021 looked at changes in clients’ capacity for work and study across twelve service groups. The report was based on data on 9,522 clients.
| Service group | Goal not achieved, n (%) | Goal achieved, n (%) | Goal exceeded, n (%) |
|---|---|---|---|
| Vocational rehabilitation | |||
| Vocational rehabilitation assessment (AKSE) (n=856) | 350 (40.9) | 238 (27.8) | 268 (31.3) |
| Nuotti coaching (n=1,417) | 439 (31.0) | 299 (21.1) | 679 (47.9) |
| Employment-promoting vocational rehabilitation (TEAK) (n=502) | 149 (29.7) | 120 (23.9) | 233 (46.4) |
| Kiila rehabilitation (n=562) | 223 (39.7) | 110 (19.6) | 229 (40.7) |
| Discretionary rehabilitation | |||
| Mental health courses (n=338) | 136 (40.2) | 80 (23.7) | 122 (36.1) |
| Tules rehabilitation courses (musculoskeletal disorders) (n=2,109) | 1,005 (47.7) | 494 (23.4) | 610 (28.9) |
| Tules rehabilitation courses for persons not in working life (n=218) | 94 (43.1) | 52 (23.9) | 72 (33.0) |
| Other diagnosis-based courses (n=507) | 197 (38.9) | 135 (26.6) | 175 (34.5) |
| Informal caregivers (n=256) | 93 (36.3) | 69 (27.0) | 94 (36.7) |
| Rehabilitation services for the elderly (n=391) | 133 (34.0) | 142 (36.3) | 116 (29.7) |
| Individual rehabilitation (n=1,266) | 502 (39.7) | 337 (26.6) | 427 (33.7) |
| Intensive medical rehabilitation | |||
| Multidisciplinary individual rehabilitation (n=265) | 75 (28.3) | 101 (38.1) | 89 (33.6) |
Kela rehabilitation helps clients stay in or enter working life
Among those who participated in employment-promoting vocational rehabilitation (TEAK) and completed it in 2021, the percentage who found work or enrolled in school grew by 30% from the year preceding rehabilitation to the year after rehabilitation.
The percentage of young Nuotti coaching participants who were employed or enrolled in school also increased. Half of all young adults who took part in Nuotti coaching were employed or enrolled in school one year after the end of their coaching, while one in ten were unfit for work and two in ten were unemployed.
Insofar as discretionary rehabilitation courses for persons with musculoskeletal disorders and mental health rehabilitation courses were concerned, the percentage of participants who were employed or enrolled in school grew and that of participants who were unfit for work decreased during the observation period. Among clients who participated in Kiila rehabilitation, which aims to improve working capacity, the percentage of participants who were employed or enrolled in school remained high throughout the observation period.
Self-evaluations of work and study capacity that were completed at the end of vocational rehabilitation correlated with clients’ later employment status.
The second report on clients who completed rehabilitation in 2021 (in Finnish) looked at changes in their employment status. The register data used in the report encompassed 8,478 clients.
Nuotti coaching brought clarity to the employment options and life situations of young adults
Among all clients who completed rehabilitation in 2020, the highest increase in the percentage of those who were employed or enrolled in school was observed among rehabilitation clients who underwent employment-promoting vocational rehabilitation. Nuotti coaching brought clarity to participants in terms of their employment options and life situations. The percentage of mental health rehabilitation clients who were employed or enrolled in school also grew, and the percentage of those who were unfit for work decreased during the observation period.
The experiences of clients who underwent multidisciplinary intensive medical rehabilitation were included in the report for the first time in 2020. These clients faced more challenges related to their work capacity, and this showed as a higher incidence of inability to work and retirement.
The employment status and life situation of clients who completed rehabilitation in 2020 (in Finnish) (n=5,441) were examined in a separate report. Altogether nine service groups were tracked during the four-year observation period.
Impact of the Covid-19 pandemic on rehabilitation services
The Covid-19 pandemic impacted different rehabilitation services in different ways (in Finnish). Out of clients who completed rehabilitation in 2020, the pandemic’s impact was felt most acutely among clients who participated in mental health courses or employment-promoting vocational rehabilitation. Some rehabilitation courses were cancelled or rescheduled for later. The option of remote rehabilitation, however, seemed to alleviate the harmful impact of the pandemic for clients.
The Covid-19 pandemic also impacted the employment status and life situations of clients who completed rehabilitation in 2019. The percentage of participants who were employed or enrolled in school after rehabilitation increased only by a small margin among participants in vocational rehabilitation and remained unchanged or decreased among participants in discretionary rehabilitation. Meanwhile, the percentage of unemployed participants grew across several of the services. Previous years’ reports showed more significant growth in the percentage of participants who were employed or enrolled in school even in the year after rehabilitation.
Among clients who completed rehabilitation in 2020, however, perceived quality of life improved across almost all rehabilitation services examined. Positive impacts were reported especially in terms of physical and mental quality of life. Clients who had participated in mental health courses, Tules courses or IKKU courses exhibited changes in all four areas of their quality of life.
The report for 2020 (in Finnish) evaluated the benefits of rehabilitation in eleven reporting groups encompassing 6,242 clients. New services covered in the report (in Finnish) were Nuotti coaching, IKKU courses for the elderly and multidisciplinary individual rehabilitation offered under intensive medical rehabilitation. In addition, the report looked at the impact of the Covid-19 pandemic across six rehabilitation services.
Fewer than 50% of clients benefited from a vocational rehabilitation assessment
Positive changes were observed during rehabilitation in the work and study capacity of clients who completed rehabilitation in 2019. Clients' physical and mental quality of life also improved, and the percentage of participants experiencing depressive symptoms decreased. Overall, more than half of all clients achieved the goals they had set for their rehabilitation at least to the degree expected. However, clear differences were observed between service groups, both in clients’ achievement of their rehabilitation goals and in the metric data used in evaluating rehabilitation outcomes.
According to the evaluation provided by service providers, only 43% of clients benefited from a vocational rehabilitation assessment (AKSE) to a great or significant degree. Furthermore, the majority of clients who service providers evaluated to have benefited from their rehabilitation only somewhat or not at all (24%) were clients who underwent a vocational rehabilitation assessment. Service providers also evaluated that only about half of participants (54%) had undergone a vocational rehabilitation assessment at the appropriate time.
The report for 2019 (in Finnish) covered nine reporting groups. The report was based on data on 7,305 clients. Employment-promoting vocational rehabilitation (TEAK) and the vocational rehabilitation assessment, which are categorised under vocational rehabilitation services, were examined as independent services for the first time in the report for 2019.
The percentage of employed participants more than doubled in employment-promoting vocational rehabilitation
The report for 2019 also looked at the employment status of clients who had completed rehabilitation in 2018 (n=6,118) based on register data.
The data showed that, across the entire dataset, the percentage of participants who were employed or enrolled in school grew by five percentage points from the year before the completion of rehabilitation to the year after completion. The most significant changes were observed among participants in employment-promoting vocational rehabilitation, where the number of employed participants more than doubled during the observation period.
Mental health improved among mental health course participants and users of other services
Improvements in work and study capacity and physical and mental quality of life were reported for clients who completed rehabilitation in 2018. Depressive symptoms decreased even among clients who participated in rehabilitation courses that did not primarily focus on mental health issues.
More large-scale positive changes were reported for clients who participated in mental health courses than for those who underwent other forms of rehabilitation. Improvements were observed in estimated work capacity during rehabilitation among women who participated in mental health courses and among participants of both sexes in other courses.
The evaluation of rehabilitation outcomes among clients who completed rehabilitation in 2018 (in Finnish) covered seven reporting groups. The data encompassed 6,995 clients.
Employment and school enrolment rates doubled among clients in vocational rehabilitation
The report for 2018 also looked at the employment status of clients who had completed vocational rehabilitation in 2017 (n=792) based on register data.
The data showed that the percentage of clients who were employed or enrolled in school doubled from the year before rehabilitation to the year after among those who underwent vocational rehabilitation. Clients whose mental quality of life improved during rehabilitation were more likely to be employed or enrolled in school in the year after they had completed rehabilitation than clients whose mental quality of life did not improve during rehabilitation.
Over 50% of clients achieved their rehabilitation goals
Over half of all clients who completed their rehabilitation in 2017 achieved their rehabilitation goals at least to an expected degree. Among clients who participated in vocational rehabilitation or Tules courses, the achievement of the client's rehabilitation goals seemed to correlate with their self-evaluation of their work capacity and whether they believed they can stay in work in the long term.
The report for 2017 (in Finnish) evaluated the benefits of rehabilitation across four reporting groups encompassing 3,895 clients.
Clients’ employment status and life situation improved
The report for 2017 also looked at the employment status of clients who had completed rehabilitation in 2016 (n=1,403) based on register data.
Among clients who completed their rehabilitation in 2016, a larger percentage were employed or enrolled in school one year after rehabilitation than had been a year before rehabilitation. Altogether 20% of all participants who were unemployed or unfit for work in the year they underwent rehabilitation were employed or enrolled in school one year after rehabilitation. Positive changes were observed in all age groups.
The benefits of rehabilitation were evaluated for the first time among clients who completed rehabilitation in 2016
Clients who underwent vocational or discretionary rehabilitation and completed their rehabilitation in 2016 rated their work and study capacity more positively at the end of rehabilitation than at the beginning. Similarly, clients gave their general quality of life a higher rating at the end of rehabilitation and were more satisfied with their health than at the beginning. Clients also reported experiencing fewer depressive symptoms at the end of rehabilitation than at the beginning.
The reported experiences of good health, improved quality of life and an absence of depressive symptoms correlated with a positive self-evaluation of the client’s capacity for work.
The results of the report on clients who completed rehabilitation in 2016 (in Finnish) cannot be generalised to apply to all clients of all rehabilitation services subject to reporting because the sample is too limited (n=794). However, the report does give some indications for considering how rehabilitation can successfully help maintain and improve functional capacity and capacity for work and study.
Separate study on employment-promoting vocational rehabilitation
In 2024, a separate study was also conducted to evaluate the benefits of employment-promoting vocational rehabilitation (TEAK) (in Finnish). The study looked at aspects such as the positive impacts of TEAK services on the participants’ employment status over a three-year observation period following the end of their rehabilitation.
The research project on the costs and benefits of rehabilitation also encompasses rehabilitation services that have previously been excluded from the scope of reporting on benefit evaluation. The study will examine the benefits conferred by key rehabilitation services in the longer term and conduct a cost-benefit analysis of these rehabilitation services.
Research project on the effectiveness of rehabilitation launched by Kela
At the beginning of 2022, Kela launched a research project on the effectiveness of rehabilitation, which examines the impact and effectiveness of Kela’s vocational, discretionary and intensive medical rehabilitation services from different perspectives. The project encompasses studies on the implementation and effects of telerehabilitation, the effects of employment-promoting vocational rehabilitation (TEAK) on employment and the impact of Tules courses on work capacity. The fourth substudy looks at speech therapy provided in the form of intensive medical rehabilitation to children with developmental language disorders.
