Rehabilitation最新文献

Return to work is one of the most important aims in the context of psychosomatic rehabilitation. Studies from outside of Germany have reported that high self-efficacy positively influences time to return to work. In this study, the impact of self-efficacy on return to work was investigated after inpatient treatment in a psychosomatic rehabilitation facility of those with mental health disorders.In a longitudinal study, the participants (N=180) were asked about their return to work self-efficacy, depression symptoms, length of employment prior to rehabilitation, and other demographic variables. Insurance data were used to calculate time to return to work after 12 months. Cox regression analyses were used to identify relevant factors. Additionally, pre-post analyses and correlative relationships regarding self-efficacy and depression were conducted.Higher return to work self-efficacy and longer employment prior to rehabilitation increased the chance for return to work. The treatment showed changes in depressiveness (d=0,97) and return to work self-efficacy (d=|0,36|).In the course of psychosomatic rehabilitation, self-efficacy is important in the process of return to work among employees with mental health disorders.

During the COVID-19 pandemic, healthcare workers showed a twofold increased risk of infection. Many still report persisting symptoms a few months after initial infection such as fatigue, headaches and cognitive impairment, often resulting in incapacity to work and reduced ability to carry out tasks of everyday life. When such symptoms persist for longer than three months, it is known as post-covid-syndrome (PCS). Only a few studies have evaluated outpatient rehabilitation for post-covid conditions. The objective of this study was to assess patient experience and satisfaction with rehabilitation measures.In November 2022, insured healthcare workers were asked to participate in a retrospective cross-sectional study via paper-pencil survey. The survey included sociodemographic and job-related information, acute and persisting COVID-19 symptoms, inpatient and outpatient rehabilitation measures, and their subjective experience of those measures. Data interpretation followed a descriptive analysis, while analysis of variances was used to identify significant differences.Out of the 394 people contacted, n=211 participated in the survey (response rate: 53.6%). No or mild PCS could not be found in the sample; 4.9% showed moderate and 95.1% severe PCS. In total, n=194 people reported having undergone rehabilitation measures, with 16.5% receiving outpatient and 23.7% receiving inpatient rehabilitation; 59.8% reported rehabilitation in both settings. Of the participants, 114 (65.9%) reported subjective improvement of their symptoms following rehabilitation measures. The analysis of variance did not show a significant difference between settings (p=0.054).The findings indicate that patients still experience a high burden due to persisting symptoms, but many of them report a subjectively perceived improvement of symptoms following rehabilitation measures. In this survey, outpatient rehabilitation was used mainly as follow-up after inpatient care and was essential for maintaining any improvement achieved.

Dual rehabilitation (dR) of patients with physical and mental illnesses comprises equal care and cooperation between two specialist departments. As part of the multi-method project that aimed to evaluate dR in different indications (DUAL), we explored the acceptance from the rehabilitants' perspective.We conducted 36 semi-structured interviews with rehabilitants of different indications (psycho-gastroenterology, -dermatology, -orthopedics, -diabetology, -cardiology, -pneumology). Interviews were analyzed using qualitative content analysis. Knowledge and access, expectations, experiences, and subjective benefits were explored as indicators for acceptance.Rehabilitants reported appropriate expectations such as improvement of mental and physical complaints or open expectations. Cross-departmental aspects such as admission and ward rounds were experienced as beneficial if there was sufficient exchange and cooperation between specialist departments. In individual psychotherapeutic consultations and groups, an improved understanding of both disorders and contact with fellow patients were important which also had a positive effect outside therapies. The multimodality of the dR was perceived to be beneficial just as the therapists' behavior and offers for counseling on both diseases. Hindering experiences included a lack of interdisciplinarity/coordination between the specialist areas, a lack of individualization in therapy planning and structural aspects in almost all areas. Subjective benefits were improved self-management and symptoms of both illnesses, as well as occupational performance.Appropriate expectations, beneficial experiences with the multimodal therapy components, therapists, and fellow patients as well as perceived positive effects support rehabilitants' satisfaction and indicate a high level of acceptance. Hindering experiences and modification requests suggest ways for overcoming obstacles, for example, by increasing interdisciplinarity and cooperation between the specialist departments. Providing sufficient information and knowledge about dR available to practitioners and patients can further support acceptance and patient participation.

Sick leave due to mental disorders is a world-wide problem. The key issue for work ability is a good person-job-fit, i. e., work demands and coping capacities must fit together. Employees with mental disorders perceive similar work demands like mentally healthy employees, but have problems with work-coping. Until now it is not well described which concrete work-coping and problem-solving capacities are similar or different in employees with and without mental disorders.A convenience sample of 372 employed people from heterogenous professions (average age 39 years, range 18-66, 55% female, 30.9% mental disorders) filled in an online questionnaire. Participants were asked about work-related characteristics and socio-demographics, mental disorders, and filled in self-rating questionnaires on psychological capacities (Mini-ICF-APP-S), work demands (Mini-ICF-APP-W), work anxiety (WPS), work coping (JoCoRi) and problem solving (12-WD scale).Employees with and without mental disorders described similar work demand levels. Employees with mental disorders perceived themselves weaker in nine out of thirteen psychological capacity dimensions, reported higher work-anxiety, lower person-job-fit, and longer sick leave duration. Employees with mental disorders were weaker in self-regulation, i. e., stress and symptom management. In contrast, there were no differences in general problem solving: both groups were similarly convinced about their ability to handle tasks, colleagues and supervisors.Support for employees with mental health problems (in prevention and reintegration) should be directed to their individual specific needs. Education in self-regulation of problems might be more in need than general problem solving education.

Whether people carry out an intention, e. g. return to work after psychosomatic rehabilitation, depends, among other things, on action control strategies. The current action (AO) or state orientation (SO) or affect regulation determines strategy efficiency. The Reha-Integrative model project focused on treatment of inhibiting contextual factors with a double psychotherapy dose, as these complicate treatment of psychological symptoms in psychosomatic rehabilitation. The RCT study with repeated measures investigated whether therapy dose had an effect on self-regulation and subjective contextual burden and the relationship between action control, contextual burden, dose and (in-)direct rehabilitation success. 483 rehabilitants aged 18-64 years, 48% of whom were women, who completed psychosomatic rehab at Rehazentrum Oberharz between 2020-22 were examined.Intra-individual changes were mapped by the Reliable Change Index. Contribution and sickness benefit periods were taken from the accounts of Deutsche Rentenversicherung Braunschweig-Hannover exactly 1 year after rehabilitation. Regressions and moderator analyses according to Hayes were calculated.The mean increase in AO on discharge did not fall below baseline 1 year after rehabilitation. Descriptively, there was a decrease in depression and subjective contextual burden. Regressions showed a weak dose effect for AO at discharge, but not one year after rehab and not for subjective contextual burden. Moderator analyses showed a medium effect of SO at admission for depression reduction. AO benefited slightly from dose increase. AO and low contextual burden at discharge showed a medium association with more contribution months and fewer sickness benefit months. SO with high contextual burden resulted in an average 3 fewer months of contributions and 1.8 more months of sickness benefit receipt with a weak effect size.In line with action control theory, the results point to the importance of individual differences in volitional aspects and subjective contextual burden in relation to (in-)direct rehab success. Volitional differences and promotion of self-regulation skills should be given more attention in the therapeutic setting of psychosomatic rehabilitation and in personalized case management.

Employees can benefit from multimodal work-related intervention strategies. This randomised controlled trial tested the effectiveness of an integrative diagnostic service used to clarify intervention needs of employees with endangered work participation (German Clinical Trials Register: DRKS00027577).Employees with health restrictions and limited work ability were included and received an initial consultation with their occupational health physician. With computer-generated allocation lists, they were randomised to the treatment arms. The intervention group (IG) immediately attended a two-day assessment in a rehabilitation centre and then received follow-up consultations at the workplace. The control group (CG) started the two-day assessment six months after randomisation. Questionnaire data were collected from participants at their initial consultation and after six months. The primary outcome was the subjective work ability of the participants (Work Ability Score; 0-10 points). Secondary outcome measures included working conditions and sick leave duration.Data from 61 participants (IG: n=32) were analysed. A clinically important but statistically nonsignificant difference was found between IG and CG, including a moderate effect size for work ability (difference=1.15: 95% CI: -0.05 to 2.35; p=0.061). Clinically relevant differences were observed for sick leave duration in weeks (difference=-4.00: 95% CI: -7.49 to -0.51; p=0.025) and job insecurity (difference: -16.40; 95% CI: -29.82 to -2.99; p=0.017).Our results suggest that the intervention led to a reduction in sick leave and improvements in job security and work ability. The effectiveness of the intervention depends largely upon whether the needs of individuals and the requirements of workplaces are taken into consideration. Participants could be selected by occupational physicians on the basis of the occupational skill level. Further research should consider the long-term effects and health economic analyses and structural requirements for a nationwide implementation, as well as employers' perspectives.

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 aim of the study was to investigate the acceptance and satisfaction of the hybrid rehabilitation concept among psychosomatic rehabilitation patients and rehabilitation clinic staff. The aim was to identify facilitators, barriers, potential for improvement and strategies for successful implementation.The hybrid concept was developed and tested in a psychosomatic rehabilitation clinic from June 2021 to December 2022. It consists of a 4-week inpatient phase followed by a fifth rehabilitation week at home ("bridge week") with digital therapy units and self-exercises. The qualitative evaluation is based on 34 longitudinal interviews (before and after the outpatient week and after 6 months) with 12 rehab patients using the hybrid rehab and two focus groups with 8 rehab staff. The data were analysed according to Mayring.The hybrid rehab patients were mostly satisfied with the concept, especially with the outpatient week, which eased the transition from rehab to everyday life. The flexibility of the therapy process and the therapeutic support during the return to everyday life were particularly positive. The direct transition to the outpatient week and technical difficulties posed challenges. A home environment with few disruptive factors, sufficient opportunities for retreat and a supportive social environment were identified as important success factors. There was also a high level of acceptance from the rehabilitation staff. The initial additional administrative workload was reduced once the processes were optimised and established. A motivated team was crucial for successful implementation. The staff felt that the hybrid rehab was up to date and met their needs, so they were in favour of continuing with the concept.Hybrid rehabilitation with a digital bridge week is a promising, needs-based alternative to traditional inpatient psychosomatic rehabilitation that has met with a high level of acceptance among both rehabilitants and rehabilitation staff. By selecting suitable rehabilitation patients and ensuring optimal technical and organisational conditions, the concept shows potential to improve the transfer of rehabilitation content into everyday life. However, further studies are needed to evaluate its long-term effectiveness.

The aim of the present study was to compare outpatient vs. inpatient work-related medical rehabilitation (WMR) with regard to treatment dose of work-related interventions and promotion of work participation.The rehabilitation statistics database of the German Pension Insurance was used. Patients were included if they had completed WMR for musculoskeletal disorders in 2018 or 2019 and were aged up to 63 years. The implementation of WMR was measured based on work-related interventions documented in the discharge report.The sample consisted of 46,276 rehabilitants. Work-related interventions were documented with an average total duration of 8.2 (outpatient WMR) and 9.3 (inpatient WMR) hours. In 25.7% of the outpatient and 37.1% of the inpatient rehabilitants, the minimum total duration of 11 hours was met. With regard to the promotion of occupational participation, no significant difference was observed between inpatient and outpatient WMR (OR=0.96, 95% CI [0.90, 1.03], reference: inpatient WMR), suggesting a potentially comparable benefit.The need for WMR measures was not consistently met in either outpatient or inpatient rehabilitation. In both settings, people assigned to WMR predominantly received less work-related interventions than intended. The promotion of return to work was achieved with comparable effectiveness in both outpatient and inpatient WMR.

The rehapro model project 'Employment Entry Incentive' (ESP), a bonus scheme designed to encourage individuals with long-term health impairments to take up regular employment. This qualitative study examined the effects of the ESP from the perspective of its recipients. Additionally, it explored the specific challenges for return to work faced by this target group.Between February 2021 and July 2022, qualitative interviews were conducted with 22 ESP recipients and analyzed using a Grounded Theory approach. A total of 11 women and 11 men from the jurisdictions of the German Pension Insurance (DRV) Braunschweig-Hannover (DRV BS-H) and DRV Mitteldeutschland (DRV MD) were interviewed by telephone. The study was conducted using a mixed methods design.The ESP primarily had a stabilizing function and facilitated transition into new employment by mitigating short-term financial constraints. It was frequently used for mobility and unforeseen expenses, contributing to planning reliability in everyday life. All participants were motivated to take up employment regardless of the ESP. No adverse incentives were identified. A crucial factor in job search was the alignment of the employment conditions with the individual's health situation and the prospect of long-term professional integration.The ESP provides low-threshold financial support that facilitates return to work and contributes to stabilizing individuals' life situations in the initial months of employment. Its flexibility allows for needs-based application. The alignment of employment conditions with existing health limitations is critical for successful reintegration. The potential of the ESP as a labor market reintegration measure lies in its positive effects on participation and stability across various aspects of life.