Rehabilitation最新文献

The aim of this article was to present post COVID-19 patients' experiences in illness and rehabilitation 12 months after their medical rehabilitation. In addition, the experiences and perspective of members of rehabilitation teams on the perceptions, problems, and needs of COVID-19 rehabilitation patients were analysed.About 12 months after cardiac, pulmonary, and neurological COVID-19 rehabilitation, we conducted guided interviews (n=15) to collect patients' experiences. Additionally, three group discussions and five expert interviews with staff members (MA) from collaborating rehabilitation clinics were carried out and analysed using the content analysis method of Kuckartz.Even 12 months after rehabilitation, patients described substantial distress and limitations in daily life due to post COVID-19 syndrome (PCS). This stemmed from persistent symptoms, biographical disruptions, and changes in self-perception. A continuous fight for recognition of their condition and adequate care was evident. Besides undergoing physical therapy, patients required strategies for self-management and disease management. The experiences of staff members indicated changes from primarily physical to neurocognitive, psychosomatic, and socio-medical needs in post COVID-19 patients. Key topics included social medicine inquiries, existential and future anxieties, as well as coping with work-related challenges and disability.In expanding rehabilitation concepts, it is crucial to incorporate social medicine aspects, provide strategies for coping with persistent symptoms in daily life, and support the processing of the illness. Approaches such as outpatient and tele-rehabilitation, continuous prescriptions of therapeutic interventions, and reconsideration of inpatient rehabilitation measures can serve as strategies to address the multifaceted and persistent needs.

The World Health Organization (WHO), through its "Call for Action - Rehabilitation 2030," has emphasized the importance of strengthening the collaboration between research and practice in rehabilitation. Since 2017, the working group "Innovation Workshop Science Circle," followed by the DGRW Commission "Communication, Innovation, and Transfer," has been fostering dialogue between researchers and practitioners. From 2017 to 2023, key obstacles were investigated and six "consented imperatives" were formulated as a result. These six imperatives highlight the shared responsibility for research as follows: (1) taking into consideration stakeholder needs across all study phases, (2) recognizing the importance of structured communication, and (3) facilitatation by researchers. Rehabilitation research has a special obligation to ensure knowledge transfer (4) and requires long-term funding strategies to enable participatory and application-oriented approaches (5). Moreover, research should be recognized as a quality indicator for rehabilitation facilities (6). These principles aim to promote sustainable collaboration between research and practice, improving the overall rehabilitation system through effective communication, resources, and quality assurance. Initiatives such as the discussion forum at the 32nd Rehabilitation Science Colloquium 2023 and the new "KIT-Space" format, will advance these approaches. A stronger integration of the perspectives of rehabilitants remains a key objective.

The COVID-19 pandemic forced rehabilitation centres to adapt their daily care routine and their organisational processes to the corresponding circumstances. In this context, digitally supported services were expanded and further developed. This study aims to systematically take stock of digitally supported rehabilitation services in Germany, including factors hindering or facilitating their implementation.The nationwide explorative quantitative online survey explores a so-far understudied topic. Using a self-developed questionnaire based on the Consolidated Framework for Implementation Research constructs, we surveyed the uptake and type of digitally supported rehabilitation services in medical rehabilitation departments, including implementation hindrances and facilitators.A total of 452 departments participated in the study and about half reported using digitally supported services in medical rehabilitation, with digital training and telerehabilitation aftercare being the most common. The primarily reported implementation hindrances were technology-related work interruptions and cost coverage/reimbursements uncertainties. Managerial support and the usefulness of the digitally supported services were perceived as particularly conducive for the implementation process, as was the staff involvement.The study provides a first overview of digitally supported services used in medical rehabilitation in Germany, and a better understanding of the factors hindering or facilitating their implementation.

The aim of this study was to identify measures relevant for the successful implementation of Operational Integration Management (OIM) in schools. The goals of sick school employees or OIM-participants, on the one hand, and OIM-supporting school principals, on the other, associated with the procedure were investigated, as were factors contributing to success or obstacles to the implementation of the procedure.As a prelude to an ongoing evaluation process, guided interviews were conducted in 2018 with 11 school employees (6 school principals, 1 head of seminar, 3 teachers, 1 pedagogical specialist) from Rhineland-Palatinate with experiences in OIM that stem from procedures the study participants have gone through, have accompanied or have rejected. The interview material was analysed with techniques of qualitative content analysis in 2022 according to the aim of this study.The school principals and OIM-participants mentioned the central goals pursued by OIM procedures as the return to work and the reflective or accepting handling of illness. Important parameters were the explicit willingness of those involved to return or support the OIM and a high degree of self-reflection. The perceived ability to act was also important. This was supported by available procedural information and (in)formal support resources. OIM-participants and school principals must be prepared to pursue common goals and not insist simply on their own rights. The involvement of other actors with their specific competencies can be helpful and necessary if the participants reach their limits of negotiation in the intra-school relationship.OIM procedures and in particular, measures for stepwise reintegration are valued by OIM-participants and school principals as support measures that can facilitate the permanent return to work. Those involved in OIM reach their limits where expectations are unreasonable. In this respect, the procedure itself can ultimately be nothing more (and nothing less) than an opportunity to consistently follow the path to a common compromise. A trusting cooperation also helps to reduce widespread uncertainties in dealing with illness. The participation of OIM experienced actors from different areas of expertise can bring resources to light and promote the development of solutions.

With the decline in the mortality of severely injured patients, the scientific question and the perspective in clinical practice have changed in the direction of qualitative outcome parameters. This long-term survey of patient-reported out-comes is intended to support the argument of structured follow-up care and seamless trauma rehabilitation.Patients were surveyed ten years after a serious injury with an Injury Severity Score of 16 points using the Polytrauma Outcome Chart. Thanks to its modular structure, consisting of the European Quality of Life Index, Short-Form-36 and Trauma Outcome Profile, the health-related quality of life of those affected could be systematically analyzed as a multidimensional construct.From 1 January 2019 to 31 December 2019, the health-related quality of life of 78 patients treated for a serious injury between 2007 and 2009 was surveyed. Even ten years after treatment, the state of health and quality of life of those affected were significantly lower compared to the normal German population. Age, overall injury severity, level of education, occupation, and relevant restrictions in social interaction as well as pain and symptoms of depression, anxiety and post-traumatic stress disorder were found to be predictors.Psychosocial factors seem to play an important part in the assessment of health-related quality of life over the long term. A needs-oriented and interdisciplinary rehabilitation process offers the chance of continuing professional and social participation.

The aim of this study was to investigate the implementation of the statutory operational integration management (OIM) among the older workforce in Germany.Since 2011, the representative lidA cohort study (www.lida-studie.de) has been investigating work, health and employment among the socially insured working population, born in 1959, 1965, and (since 2022/23) in 1971 in Germany. The recent assessment wave 2022/2023 included a newly developed OIM module.Of 7,335 employed participants, 819 (11.2%) reported more than 30 days sickness absence in the past 12 months, thus indicating eligibility to OIM. Of those, 282 (34.4%) had received an OIM offer proactively by their employer. Higher odds of receiving an offer were found for those with longer sickness absence, in larger enterprises, in enterprises which value the workers' health, and among those who, during the COVID-19 pandemic, had used the option to work from home. About a third of those who had received an offer declined it, mainly because they felt no need for it; 132 of the 819 OIM eligible participants (16.1%) reported they had been offered and had accepted at least one measure implemented by the enterprise, most often "stepwise reintegration", followed by "regular feedback talks with the superior". Among them, 114 (90.8% of 132) rated the measures implemented as "somewhat", or "very helpful".Twenty years after the legal introduction of OIM, it is still insufficiently implemented, although - where measures have been implemented - these are almost always rated as helpful by those who have received them. The barriers to implementation of this obviously useful instrument in enterprises and proposals as to how to overcome them need to be investigated more intensively. National stakeholders in Occupational Safety and Health, the statutory occupational health insurance, labour authorities, and the statutory health insurances, as well as the statutory pension insurance could contribute in raising awareness in the course of their consultation activities in the enterprises.

Purpose: The particular relevance of mental disorders for society and the economy is highlighted in the context of work participation. Based on representative routine data from the pension insurance from 2017, the aim of the study was to describe a group of psychosomatic rehabilitation patients recruited on the basis of selected characteristics, examine the return to work (RTW) rates, to assess individual progression after rehabilitation and to identify possible influencing factors.

Methods: Work participation was operationalized both as a monthly state up to 24 months after rehabilitation and as a rate of all people who were employed 12 or 24 months and the 3 preceding months (stable work participation). For the analysis of the influencing factors on stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months.

Results: A total of 122,623 data sets were included in the analysis (including depressive episode (DE): n=28,497, 23.2%, recurrent depressive disorders (RD): n=42,573, 34.7%; reaction to severe stress, and adjustment disorders (BR): n=19,122, 15.6%; dissociative disorders (AS): n=9,716, 7.9% and somatoform disorders (SO): n=8,564, 7.0%). The mean age was 50 years, 64% were female. There were different courses depending on the indication, with stable employment rates after 12 months of 69% in the BR group; 62% in the DE group; 61% in the SE group; 57% in RD up to 52% in the SO group. Factors influencing stable employment after one year were the duration of incapacity for work in the year before rehabilitation, the existence of an employment relationship and a high income.

Conclusion: Since the relevant changes became apparent in the first six months after rehabilitation, further support services for people with mental illnesses after medical rehabilitation should ideally begin as early as possible after rehabilitation.

Purpose: The REHA-KNOWS study explores the perceptions of practice representatives of rehabilitation facilities in Southwest Germany regarding (healthcare) research and shows benefits and barriers in knowledge transfer from the perspective of practice. For this purpose, an instrument with 12 5-level items was developed, which is exploratively examined in this paper. The instrument includes statements on the benefits, costs and added value of rehabilitation research projects as well as on the framework conditions in the facilities. Between March and May 2023, data were collected from representatives of 206 rehabilitation facilities in Baden-Wuerttemberg and Saarland using an online questionnaire.

Methods: A descriptive analysis of distribution properties was performed. Furthermore, an exploratory factor analysis using Horn's parallel analysis and Velicier's Minimum Average Partial was conducted to determine the underlying factor structure and unidimensionality. In addition, Mann-Whitney U tests were calculated to determine differences in responses between representatives in the fields of medicine, nursing and therapy and personnel with administrative and management tasks.

Results: Overall, the instrument had few missing values with acceptable scatter and low item difficulty. Floor and ceiling effects were negligible but did occur for three items. Differences in response patterns between occupational groups were found descriptively for items 2, 10, and 12. After p-value correction for multiple testing, they became insignificant. Four items were excluded from the factor analysis due to poor fit, which then yielded a single-factor solution with 31% variance resolution. The fit of the overall model was not satisfactory. The identified factor is best described as "attitude toward the usefulness of research for practice". Responses to the open-ended question about previous experience with research activities provided evidence that further items should be generated to cover the cost-benefit ratio with a focus on monetary compensation for the (human) effort involved.

Conclusion: The newly developed instrument lays the foundation for systematically recording the attitudes of representatives of rehabilitation facilities towards (healthcare) research. Further research is needed to improve the measurement tool to elucidate this complex issue.

The "Climate and Sustainability" working group of the German Society for Rehabilitation Sciences was founded in March 2023. The members represent research, practice, and service providers in rehabilitation. The aim is to make rehabilitation in Germany sustainable and to focus on climate protection and the health consequences of climate change. Dealing with these issues should become the new social norm for all stakeholders in rehabilitation. Therefore, existing knowledge is used, and new findings are developed that are passed on directly to and support the quality-assured transformation in the facilities. The focus of current activities is on two fields of action: promoting climate protection through the ecological transformation of rehabilitation facilities and promoting climate resilience through further development of rehabilitation services and social medicine. Activities to date include specialist publications and research, statements and submissions, events, and training courses as well as dissemination, networking, and public relations work to establish sustainability concepts in rehabilitation.

Work-related medical rehabilitation is a multimodal, interprofessional program that reduces health-related discrepancies between job capacities and demands in order to support work participation of patients who are at an increased risk of failing to return to work (e. g. due to long-term sickness absence). The review outlines screening for patients who should be reached, diagnostics and treatments during work-related medical rehabilitation and evidence on the effectiveness of these programs. Moreover, tools supporting implementation of work-related medical rehabilitation are discussed.