Rehabilitation最新文献

The risk index for permanent work disability (RI-EMR) can be used to identify insured persons with a high likelihood of receiving a disability pension in the next five years. To tailor more precisely proactive outreach as well as support services to these people, the study aimed to explore their specific problems and needs, and cluster them to typical case constellations.Interviews were conducted with 50 insured persons with a high RI-EMR score (≥60). Recruitment and sampling were carried out using a letter and a short questionnaire. The analysis followed a mix of sequential-narrative and category-based approach, supplemented by a systematic-contrastive case comparison. Subsequently, it was examined whether the identified case types could be found in the administrative data of the German Pension Insurance (GPI).We identified 6 case constellations that differed in terms of their illness and employment biographies and remaining earning capacity, leading to different support needs. These ranged from information, counselling, and application support regarding specific rehabilitation services, to case management, as well as the initiation of a participation plan procedure and transition support into a (permanent) work disability or (premature) old age pension. The case types could be found in the administrative data of the GPI, so that statements about their approximate proportions in the overall population could be made.Within the group of insured individuals with a high RI-EMR, types of different problems and needs can be described, and identified by using routine data. This provides concrete hints for tailored outreach and support for the target group.

In the German Pension Fund (DRV), patient-reported outcome measures (PROMs) are a key indicator of the success of rehabilitation measures. The "Reha Toolbox" provides a modular instrument for cardiology, orthopaedics, and psychosomatic medicine that enables cross-sectoral and international comparisons. For routine implementation, acceptability among rehabilitants is crucial. The aim of this study was, therefore, to examine acceptability and to identify factors associated with participation in the PROM assessments.PROMs were collected at four time points: upon receipt of the rehabilitation approval (T0), at admission (T1), at discharge (T2), and 6 months after discharge (T3). Response rates were analysed descriptively. The dataset was divided into responders and non-responders at T2 and T3, respectively. Univariate differences between responders and non-responders were assessed using appropriate parametric and non-parametric tests; independent predictors of participation were examined using multivariate logistic regression and odds ratios (ORs).Of the 4,110 rehabilitants invited to participate in the study, 198 (4.8%) participated at T0. Participation at T1 was 599 (100%), at T2 332 (55.4%), and at T3 160 (26.7%). Belonging to the psychosomatic indication group was associated with a lower likelihood of belonging to the T2 responder group (OR=0.55; p<0.01), whereas receiving a pension (OR=3.45; p<0.05) and expecting higher weekly working hours after rehabilitation (OR=1.16; p<0.05) were associated with a higher likelihood. For T3, parenthood (OR=1.70; p<0.05), higher weekly working hours (OR=1.32; p<0.05), and receiving a pension (OR=3.65; p<0.05) were positively associated with participation, whereas improvements in independence (OR=0.95; p<0.05) and working physically (OR=0.87; p<0.05) were negatively associated.Response rates, as an indicator of acceptability, varied depending on the assessment time point. Particularly low response rates were observed among rehabilitants in psychosomatic medicine, those with physically demanding jobs, and those employed full time.

People with health impairments often face significant barriers to participation in the labor market, which increases the risk of long-term unemployment, social exclusion, and deteriorating health. In response, the German Pension Insurance launched a pilot project in two regions to test an Entry Incentive Payment (Einstiegsprämie, ESP). The ESP is an unconditional financial benefit granted to insured individuals re-entering the workforce. The accompanying survey study aimed to evaluate this innovative intervention from the recipients' perspective and to complement administrative analyses of reintegration outcomes with a person-centered view.During the intervention period (January 2020 to March 2023), 485 individuals received the ESP. Survey data were available for 310 participants (response rate: 63.9%). In total, 279 questionnaires from time point t1 (1st-3rd month of ESP receipt) and 205 from time point t2 (9th-13th month) were included in the analysis.Participants had a mean age of 48.2 years (t1), and approximately one-third were female. Somatic diagnoses were reported by 93.4% and psychological diagnoses by 36.9% of respondents. Based on the Work Ability Index, 77.2% had only moderate to critical work ability. The ESP was rated as helpful for job entry by 95% of women and 84% of men, with no significant differences between subgroups defined by gender, region, age, or diagnosis type. Regarding job retention, women rated the ESP significantly more positively than men (Mann-Whitney U test: U=3844.5; p=0.026; r=0.15). Overall health-related quality of life did not change significantly over the first year of employment; however, significant declines in individual domains were observed in some subgroups.The ESP is largely perceived as an effective measure to support (re)integration into employment among individuals with health limitations. The findings highlight the potential relevance of employment grants in return-to-work strategies. Furthermore, the data illustrate the vulnerability of this population with regard to health stability and work ability.

Pulmonary embolism (PE) is the third most common cause of cardiovascular death worldwide, with a suspected high number of unreported cases. If left untreated, the mortality rate ranges from 25-30%. With treatment, it decreases to approximately 8% after one year.In addition to the acute thromboembolic event PE can have far-reaching long-term health and personal consequences for the patient including limitations in physical performance, psychosocial effects and significant impairments in health-related quality of life. There is also a significant risk of an embolism recurrence. Furthermore, chronic thromboembolic pulmonary hypertension (CTEPH) or post-pulmonary embolism syndrome (PPS) can develop.The goals of a long-term follow-up strategy - including cardiac rehabilitation (CR) - are to prevent recurrences, achieve sustained improvements in physical performance, and reduce dyspnea in patients with limitations often caused by general muscular deconditioning. Another key objective is to sustainably improve quality of life, with impacts on personal, family, and professional environment.Although PE is common, structured follow-up and rehabilitation programs are largely lacking. In contrast to other cardiovascular conditions, such as myocardial infarction, post-PE care is typically limited to a few follow-up appointments. A stronger scientific evidence base, clearly defined care pathways, and interdisciplinary CR are needed.This article presents the current state of research on CR after a PE event and highlights the specific characteristics and considerations relevant to this setting.

Case workers in a vocational support program for persons with addiction disorders ("BORA-TB") accompanied rehabilitants for up to 12 months after rehabilitation treatment. Positive return-to-work (RTW) effects were not statistically verifiable using survey data from the evaluation study. This raises the question of methodological adjustments to the assessment of outcomes. The work summarized here sought to identify and analyze the different paths along which consultation interactions progressed, including the different forms of outcomes they terminated in, to reach an understanding of how these can be influenced by or understood through individual and contextual factors.For the analysis of n=50 individual consultations, data taken from the primary documentation of services received by clients as reported by case managers were combined with statistical measures and free-hand text notes from clients' self-report questionnaires. These data were reiteratively compared within and between cases following the principles of Grounded Theory.Eleven types of consultation processes were differentiated. Each represents a specific pattern of case manager tasks and methods, forms of (possible) outcomes, and prognoses for disease management in relation to the client's situation at the start of consultation and to personal characteristics. The wide range of reported case management tasks included praise for independently achieved vocational successes, legal support, and analyses of clients' personality characteristics for (change) motivation. Outcomes differed depending on client´s life situation and needs, yet is always defined as greater participation in vocational and social environments. Prognoses for each type taking into consideration variation in consultation processes and forms of outcomes suggest hypotheses about suitable disease management.Alternative approaches to the evaluation of outcomes in caseworkers' support of persons with addiction disorders appear feasible with available data on consultation processes. They also seem appropriate given the heterogeneity of affected persons' situations. A validation of the approach used here and a quantitative analysis of type distributions could yield more suitable instruments for measuring treatment outcomes in addiction research.

Stroke remains one of the leading causes of premature mortality or long-term disability. Hospital and rehabilitation treatment are meanwhile at a high level. Ensuring successful treatment and reducing the consequences can only be achieved with tailored long-term healthcare in the outpatient sector. The aim of the study described here was to prevent 30% of all stroke recurrences by implementing case management.The main evaluation of the intervention was conducted as a quasi-experimental study and was based on claims data. In addition, non-comparative analyses based on primary medical data and health-related quality of life as well as a process evaluation were carried out. All comparative outcomes were test-based. In addition, the three central outcomes of recurrence, mortality and costs were analyzed using regression methods. The primary data was analysed by using descriptive statistics. The process evaluation was carried out in a two-step process using qualitative expert interviews and a related quantitative questionnaire to measure physician acceptance.1,167 patients per intervention group (IG) and control group ( CG) were included in the final analysis. No significant influence of the intervention on the risk of stroke recurrence or mortality was determined (p>0.05). For the secondary outcome costs, the study groups differed significantly in favour of the controls (p<0.05). In addition, the IG had a significantly higher chance of receiving guideline-based secondary pharmaceutical prevention (p<0.05). The primary data indicated an increase in health-related quality of life over the study period. The physicians reported good integration of the stroke case managers into the care structures.A widespread adoption of the STROKE OWL intervention in standard healthcare cannot be recommended based on current findings. The results indicate that for successful integration into standard care, the study population should be selected more specifically and target groups that could particularly benefit from individual case management should be addressed in line with the core principle of case management.

The SEMpsych project offered the "Blaufeuer" counselling service for people with psychological impairments and work-related stress. Firstly, this study investigated whether the recognisably high variability in the work-related problem areas can be explained by statistically and quantitatively determinable profile types. Secondly, it was investigated whether typical patterns of individual problem constellations in the course of life and habitual imprints (latent basic convictions) of Blaufeuer counselling participants, which are associated with psychological stress, can be reconstructed in their interaction.A convergent-parallel mixed methods approach was used. A latent profile analysis (LPA) was carried out statistically and quantitatively with 457 participants in the Blaufeuer programme. Qualitatively, 16 guided individual interviews were analysed using a combination of grounded theory and narrative analysis.The LPA revealed seven profiles of characteristic work and occupational problems. The qualitative analysis identified six latent basic beliefs and individual problem constellations that can contribute to the description of vulnerability risks.Both typifications provide guidance for the high variability of work-related stressors. Specifically, the qualitative findings show the necessity to consider latent basic beliefs as well as individual life events and everyday stresses in addition to the types of work-related stressors for counselling.

An innovative case management intervention in the city of Hamburg provides an open facility for individuals at high risk of permanent work disability, offering tailored guidance and support, regardless of the nature and extent of needs and legal jurisdiction. The intervention aims on preserving or restoring employability and preventing chronicity of illnesses or impending disability. Our process evaluation examined the implementation of the intervention.Data were collected in 2021 as part of a mixed-methods study. A questionnaire survey was conducted at the start and after 12 months to analyze changes in health status, employment, and satisfaction with the intervention. Additionally, semi-structured, problem-centered interviews were conducted with stakeholders and participants to analyze the dose given and dose received. We also examined the population reached.Out of 145 eligible participants, 56% completed the initial questionnaire, and 28% successfully filled out the second questionnaire. Over 85% of the participants remained employed within a year. The Work Ability Score increased by an average of two points (p=0.001, n=36). There was a significant decrease in depression and anxiety scores. Participants expressed high satisfaction with all of the intervention components. Nine stakeholders and four participants were interviewed about the dose given and dose received. Stakeholders named services focusing on health and social stabilization to maintain of employability. This was intended to be realized through a cross-sectoral, low-threshold, and coordinating counseling approach. The participants mentioned support to ensure their employability and the opportunities for professional reorientation as offers.A new intervention was implemented to provide support for individuals with health impairments and at high risk of permanent work disability. Despite high initial levels of depression and anxiety, case management support had a positive impact. The Work Ability Score significantly improved. It was observed that the participants' employment situations were largely stabilized. The project will continue and be evaluated through a mixed-methods observational study (https://www.hgua-hamburg.de/).

Patients covered by the German Pension Insurance Braunschweig-Hannover (DRV BS-H) are offered participation in a case management program after completing medical rehabiliation. The aim of the present study was to compare and identify differences along several parameters between those who took up the offer of CM and those who refused participation in this program.For this cross-sectional study, between 2021 and 2023, members of the DRV BS-H with a recommendation for CM were included in a retrospective survey, that contained items on their disease burden, professional situation and work ability as well as on the evaluation of the medical rehabilitation undergone and the CM. Non-participants were also asked about the reasons for their refusal to particpate. In addition, administrative data of the DRV BS-H were used as a supplement. Group comparison was executed with t-test, Chi²-tests and Mann-Whitney U tests. Predictors were determined using binary logistic regression. Satisfaction with the CM and the reasons for refusal were evaluated descriptively.In many aspects, significant differences were found between participants and non-participants although the effects were mainly small. Non-participants were more likely to suffer from mental illness. They generally considered themselves to be in poorer health, were less likely to be employed and had a poorer prognosis regarding work ability. Participants experienced better outcomes from the retrospective evaluation of medical rehabilitation than non-participants. The evaluation of the CM was consistently positive. The most common reason for rejecting participation in CM was a wish to find a solution themselves. A performance level of less than six hours during the last professional activity increased the probability of participation in CM; however, the regression model had a very low explanatory power.The CM of DRV BS-H is an offer taken up by patients with diverse diagnoses after completing medical rehabilitation, and can be considered as a suitable service for members with complex support needs.