[Return to Work between the Conflicting Priorities of Work and Health Orientation].

Objective: The basic aim of this study was to analyse health-related exit processes from working life and their conditional constellations. It focused on biographical coping in the context of professional reorientation and Return to Work (RTW). The aim was to describe, among other things, phases, characteristics and mechanisms of coping with a double-folded biographical disruption, i. e. coping with the chronic disease and the vulnerable occupational situation.

Methods: The study focused on 6 women and 4 men between 25 and 57 years of age who were interviewed (episodically-narrative) at 2 different points in the survey period from 2011 to 2014: during their medical respectively vocational rehabilitation (t1) and again about one year later (t2). The overall characteristic of all cases was the initiated or already faced health-related occupational biographical disruption caused by a chronic musculoskeletal disease partly accompanied by psychosomatic issues or triggered by a mental illness. This study followed the methodological approach and research style of the Grounded Theory 1.

Results: A health-related exit from working life is usually gradual and is caused by complex risk constellations. Only in the interplay of personal and contextual factors does a framework for the double-folded biographical disruption develop. The resulting social, biographical and health challenges lie in the areas of private and working life. RTW is experienced as an experimental phase to return to everyday working life under limited health conditions. A key finding of this study is the recognition that the transformation of the importance of health is taking place in exit and reorientation processes. This paper focuses on its significance for the rehabilitation and RTW process.

Conclusion: The applied perspective on biographical processes makes it possible to describe health-related breaks as a change in status from healthy to sick, from high performance to limited performance. Professional stakeholders in medical and rehabilitative settings should be made more aware of the identity-building processes, individual professional biographical crises and disease management processes of those affected. It is important not only to evaluate RTW as the one and only success, key outcome and end of the rehabilitation process, but to understand RTW as a continuing process of occupational reorientation under limited health conditions and to design it as a participatory process.