Rehabilitation最新文献

Objective: Comprehensive psychological support is a distinctive feature of vocational retraining centers, pivotal in stabilizing the health of the rehabilitants, reducing dropout rates and facilitating return to work. For optimal resource planning within the vocational retraining centers, and thereby ensuring the best possible psychological support during vocational rehabilitation, it is crucial to be able to estimate the number of appointments of the rehabilitants in advance. Even though routine data is available, predictions using regression analysis have not been undertaken previously.

Methods: To predict the number of appointments in the psychological service, a hierarchical linear regression analysis with 25 potential predictors was conducted using retrospective routine data from 404 rehabilitants. In specifying the regression model, data-driven methods and theory were combined. The Andersen healthcare utilization model served as the theoretical background.

Results: The final regression model accounted for 39.5% of the variance in the utilization of the psychological service. Ten variables predicted a higher number of appointments: female gender, boarding status, low resilience, desire for psychological support, past psychological treatment, intake of psychotropic drugs, absence of two specific professional fields, Federal Employment Agency/Jobcenter as the paying institution, and non-participation in a specific preparatory course.

Conclusion: The routine data available at the beginning of vocational rehabilitation in a vocational retraining center is generally suitable to predict the number of appointments in the psychological service. As such, it can be utilized for resource planning. Various factors prove to be informative, suggesting that a focus on single factors (e. g., the presence of an ICD-10 F-diagnosis) seems disadvantageous. Limitations of the regression-analytic approach are highlighted.

Purpose: Assistive devices are essential in neuropediatrics, but the database on the self-assessed use by and supply of medical aids to those affected with hereditary ataxia is small. The present work aims to examine the individual perspective of those affected by the use and supply of aids and to discuss them in the field of tension between physiological and psychosocial development and symptom progression.

Methods: The research project represents a cooperation with the German Heredo-Ataxia-Society following the "patients as partners in research" approach. The data was collected via online questionnaires and focus group surveys and analyzed quantitatively and qualitatively using a mixed methodological approach.

Results: Based on the present sample of affected adolescents and adults (n=47 online questionnaires, n=6 focus group surveys), a fundamentally positive assessment of the use of medical aids was evident. In contrast, for the individual evaluation of access and supply of assistive devices, four main problems were identified, some of which can be extrapolated to other diagnoses but amplified in children and adolescents due to the low prevalence of hereditary ataxia. Especially in these age groups, the lengthy process leading up to the diagnosis and the associated gap in the indication for assistive devices poses a serious problem. Moreover, there is lack of evidence for justifying prescription of age-group-specific assistive devices.

Conclusion: In addition to the necessity of improvement in the care process, there are significant gaps in the knowledge about an association between self-confidence and coping with the disease, on the one hand, and the acceptance of aids, on the other, in children and adolescents with rare diseases characterized by symptom progression. In addition, there is an urgent need to improve the evidence base for specific tools, especially their importance for promoting independence according to age and developmental phase.

The "Representative Survey on the Participation of People with Disabilities" (Participation Survey), commissioned by the German Federal Ministry of Labour and Social Affairs, aims to work in conjunction with participation reporting to assess the social participation of people with disabilities. Both the participation reporting and the Participation Survey claim to operationalize impairment and disability in accordance with the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization (WHO). A critical analysis of the measurement concept reveals methodological problems: 1) The measurement concept is not consistently ICF-oriented because it does not clearly conceptualize impairments, does not adequately take into consideration environmental factors in the determination of disability and sees impairment as causal for disability. 2) Distinction made between impairment and disability is mainly pragmatic, without any coherent conceptual justification. 3) The chosen operationalization cannot ensure the desired international comparability. In order to achieve a stronger ICF orientation and better international comparability, it is proposed in this study to integrate the "Model Disability Survey", developed by the WHO and the World Bank, into the German Participation Survey's data collection tools. An alternative measurement proposal, which can be implemented with the available data, is to categorize groups solely according to the severity of impairment, forgoing the a priori distinction between impairment and disability. This approach embraces the fundamental idea of the ICF, which views disability as a situational rather than a personal characteristic.

Purpose: The Covid-19 pandemic has posed new challenges to actors in vocational rehabilitation (VR) for people with disabilities. In this study, we were interested in the following: How did actors like service providers and financers of VR (here: German Federal Employment Agency (FEA)) experience the Covid-19 pandemic, which process changes and delays have occurred, and what impact will this possibly have on the future of vocational rehabilitation for people with disabilities?

Methods: Between July 2020 und July 2021, a total of 29 persons from service providers of VR programs (n=16) and representatives of the FEA (n=8) were asked about their experiences during the Covid-19 pandemic in the course of 24 guided expert interviews. The interviews were recorded, transcribed, coded in MAXQDA; the analyses of the transcribed material are based on a system developed from inductive and deductive categories.

Results: VR programs had to be conducted remotely, digital possibilities had to be created. As a result, VR was also forced to evolve technologically, revealing opportunities (in the provision of programs) and limitations (e. g. acquisition of social skills or assessment of mental health). Thus, continuous additional support by the service providers was indispensable to contain psychological crises, to ensure the understanding of the program contents and to avoid dropouts. Just like schools, the employment agencies and job centers closed their doors for a long time and VR and general vocational counseling did not take place nor did assessment procedures carried out at the medical and psychological services of the FEA for determining VR needs. A decline in access to VR had been apparent for some time, but it became increasingly evident, particularly for 2021/22. Individuals from poor households were more likely to be affected because they were more difficult to keep in touch with.

Conclusion: Even though VR has experienced a major digital boost, experience from the pandemic has shown that programs in face-to-face formats with social contact are particularly important for young people and people with mental disabilities. Nevertheless, VR must change with the working environment in order to prevent people with disabilities from being left behind even further.

Purpose: Research indicates that the implementation of work-related medical rehabilitation (WMR) is characterized by pronounced heterogeneity and that the requirements defined by the German Pension Insurance are not consistently met. The study aimed to investigate the implementation of the WMR guideline in patients with musculoskeletal disorders with regard to the identification of a need for WMR as well as the assessment of the individual demands of work.

Methods: 317 rehabilitation facilities authorized for WMR in patients with musculoskeletal disorders were invited to participate in a nationwide survey. 86 of 317 facilities responded to the self-developed questionnaire and met the inclusion criteria.

Results: Although most facilities reported that nearly all patients receive WMR if they have a need for it, the proportion of WMR measures provided was below ten percent in the majority of cases. With regard to work demands, respondents demanded greater involvement of employers in order to strengthen validity.

Conclusion: The findings indicate that WMR is largely implemented in accordance with the WMR guideline. The main challenges include meeting the need for WMR and strengthening the involvement of employers in the assessment of work requirements.

In order to treat and research the development, progression, therapy and prevention of cardiological and psychosomatic disorders and their interactions, the field of psychocardiology has been established in recent years and now offers several treatment options.The well-known somatic risk factors for cardiovascular diseases such as smoking, diabetes mellitus, arterial hypertension and acquired or congenital lipid metabolism disorders, lack of exercise, malnutrition and sleep-related disorders are often related to psychosocial risk factors. Conversely, mental illnesses such as depression and post-traumatic stress disorder can also be viewed as independent risk factors for cardiovascular diseases.Somatic illnesses can, in turn, result in significant psychological reactions that have a severely negative impact on the course of the disease, participation and quality of life.In addition to the scientific research into these connections, psychocardiology offers a clinical specialty that questions, diagnoses and provides treatment for psychosocial connections in cardiovascular patients.The aim of this article is primarily to convey clinical and practical aspects of psychocardiology and the most important psychological comorbidities in connection with heart disease. In addition, it should be shown which therapeutic offers are available in the medical care structures and how therapy can be carried out. Psychotherapy and exercise therapy are preferred for the treatment of these comorbid disorders. The possibility of psychopharmacological therapy for cardiovascular patients is also presented, especially because of possible problematic medication interactions.

Patient-reported outcome measures (PROMs) play an important role in the rehabilitation of people with major limb amputations. Patient-completed questionnaires help collect specific constructs on this patient population. The COMPASS and LEAD initiatives, carried out by the International Society for Prosthetics and Orthotics (ISPO), underscore the importance of regularly collecting high-quality PROMs. These are essential for the evaluation of rehabilitation needs, progress, and success. In the final report of ISPO's major international initiative, PROMs recommendations of the expert panel are tabulated. In Table 3.2 of the report, ISPO lists n=12 PROMs that were included in the narrow consensus process were considered to be of acceptable quality, and therefore recommended. The aim of this systematic review was to specifically search for these recommended PROMS regarding their availability in a German and validated version in order to identify potential gaps. All PROMs that were available in a German and validated version were then examined further with regard to the quality of the validation study, using the checklist of COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Through a systematic literature search, six validated German-language versions were found. Only four of these met the quality standards of the COSMIN checklist sufficiently. Overall, this review shows serious gaps in the availability in the German language of validated versions of PROMs used internationally and recommended as standard by the ISPO. This gap needs to be closed by guideline-oriented translation and subsequent validation studies in order to be able to offer and collect the PROMS recommended by the ISPO also for German-speaking patient populations.

Introduction: More than one third of cancer survivors are of working age. Return to work (RTW) with and after cancer treatment is therefore an important issue for this group - but this is often accompanied with many challenges. The aim of this systematic review was to identify predictors of RTW after cancer from the literature specifically for Germany and to place these factors chronologically in the oncological course of treatment.

Methods: A systematic search was performed using PubMed in June 2022. Included were all papers original published in German or English between 2000 and 2022 and referring to a German sample, regardless of study design.

Results: From a total of 8,381 hits in the meta-database, 30 publications were finally considered in the synthesis of results. Higher age, lower education, lower socioeconomic status, higher disease stage, more progressive disease course, more severe side effects of treatment, (more severe) fatigue, higher psychological distress, worse health status, occupational status as a blue collar worker and manual labor, unemployment prior to diagnosis, more negative perceptions of the work(place) environment, and lower intention to work and lower work ability/ subjective prognosis of employability were associated with lower likelihood of RTW after cancer in the literature. Treatment type and use of rehabilitation were also found to be associated with RTW.

Discussion: Sociodemographic, disease-related, psychosocial, and work-related predictors of RTW after cancer in Germany were identified. The results may help to develop targeted support measures that can be applied in specific phases of treatment. The comparability of the literature on predictors for RTW is limited due to a high heterogeneity in the operationalization of RTW and methodological approaches. There is need for further standardization in this area.

Purpose: Social workers are part of the interprofessional rehabilitation team. However, evidence for the effectiveness and a theoretically compatible description of their work are lacking. The aim of the research project "Sozialarbeiterischer Wirkmechanismen in der medizinischen Rehabilitation (SWIMMER)" was the development of a programme theory of social work in medical rehabilitation.

Methods: In this qualitative research project, we conducted interviews with social workers and leading staff, recorded counselling sessions, and made participant observation in rehabilitation facilities. Sampling and analysis were based on grounded theory.

Results: Data from 42 interviews, 14 counselling sessions and 140 hours of participant observations were analysed. Three core categories of a programme theory regarding practice of social work were developed: (i) work types (e. g., information work and supporting applications), (ii) interaction settings (exchange with rehabilitants, the rehabilitation team and external actors) and (iii) tasks of social services (e. g., development of vocational perspectives or professional/social participation, financial and social security). The consequences of social work practice were differentiated into output (e. g., number of applications submitted or options mentioned for a return to work) and outcome factors (e. g., participation in the society or a perspective on this and the well-being of the rehabilitants). A central characteristic is presented (co-production with the rehabilitants).

Conclusion: The hypotheses of the mechanisms of action are grounded in the data and should be explored in further studies. In addition to being useful for practitioners, the model is also suitable for classifying the results of scientific studies.

Purpose: Suicidality is rarely assessed in patients treated in German rehabilitation centers, although individuals with physical and mental impairments have an increased risk for suicidality. The item 9 of the 9-item depression module of the Patient Health Questionnaire (PHQ-9) asks about the desire to be dead or to harm oneself and could be used as a possible screening for suicidality. The Columbia Suicide Severity Rating Scale (C-SSRS) is a standardized interview to assess suicidality. We assessed the prevalence of suicidality in orthopedic and cardiac rehabilitation using the C-SSRS and the PHQ-9, examined the diagnostic accuracy of the item 9 of the PHQ-9 and of the PHQ-9 total score for identifying suicidality and surveyed the acceptance of the suicidality assessment by the rehabilitants.

Methods: Study participants were screened with the PHQ-9 and subsequently interviewed using C-SSRS. Sensitivity and specificity of the item 9 of the PHQ-9 and the PHQ-9 total score were tested for the presence of suicidality assessed with the C-SSRS and in a sensitivity analysis for the presence of nonspecific active suicidal ideation (item 2 of the C-SSRS). We calculated the area under the curve (AUC) to predict the ability of the PHQ-9 to discriminate between individuals with and without acute suicidality. Screening and interview were evaluated by the rehabilitants.

Results: Among 405 study participants, the prevalence of acute suicidality measured by the C-SSRS was 0.5%. 4% reported nonspecific active suicidal ideation on the C-SSRS. 10.4% reported suicidal ideation on item 9 of the PHQ-9. The sensitivity of item 9 and the PHQ-9 total score for identifying acute suicidality was only 50.0% (95% CI: 1.3% to 98.7%). However, item 9 was sensitive (81.3%, 95% CI: 54.4% to 96.0%) and specific (92.5%, 95% CI: 89.5% to 95.0%) for identifying nonspecific active suicidal ideation. Estimators for sensitivity were highly uncertain because of the low prevalence of acute suicidality. Addressing suicidality was rated as useful and helpful by study participants.

Conclusion: If the response to item 9 is positive, the immediate risk of suicide is low. However, PHQ-9 is suitable for identifying patients with non-specific suicidal thoughts. A conspicuous score on the item 9 of the PHQ-9 should be further clarified by a psychotherapist.