Rehabilitation最新文献

Mental health disorders increase the risk of early retirement and occupational exclusion. Individualized, needs-oriented aftercare that includes measures to stabilize employment following vocational rehabilitation can support affected individuals in transitioning into the workforce and mitigate these risks. Drawing on the JobProtection model project, this study investigated the impact of aftercare on sustainable workforce reintegration and the factors influencing long-term employment among individuals with mental health conditions.Anonymized routine data from the German Pension Insurance Braunschweig-Hannover (n=1464) were analyzed using logistic regression. Among the sample, 113 individuals in the intervention group participated in up to 24 months of JobProtection aftercare (2019-2023) following vocational rehabilitation. The control groups, which received standard aftercare, comprised a historical group (n=688; vocational rehabilitation measures completed between 2015 and 2017) and a parallel group (n=663; vocational rehabilitation measures completed between 2019 and 2021). Sustainable workforce reintegration was defined as at least 24 months of employment, based on data from social security contributions.The intervention group showed significantly higher chances of achieving sustainable employment. Other positive predictors of long-term workforce reintegration included older age, a longer duration of vocational rehabilitation, and the approval of a partial disability pension. In contrast, individuals granted a full disability pension or those whose pension applications were rejected had significantly lower chances of remaining employed for at least two years after vocational rehabilitation. Belonging to the parallel control group was associated with reduced chances of stable employment.The vocational reintegration of JobProtection participants was successfully supported in the long term. Accordingly, needs-oriented aftercare may serve not only as a meaningful complement to vocational rehabilitation for individuals with mental health conditions, but also as a means of addressing a previously unmet need in care provision.

Self-reported surveys are an important part of a comprehensive assessment of clinical outcome. This cross-cultural adaptation study aimed to develop a Turkish version of the Munich Knee Questionnaire (MKQ-TR).A total of 200 participants including 112 people with various knee injuries (53.9±14.3 years, 68 males) and 88 healthy participants (30.0±11.9 years, 74 males) were recruited. We analyzed criterion validity with Pearson's correlation coefficients and test-retest reliability with intraclass correlations coefficient (ICC). Standard error of measurement (SEM) and minimal detectable change (MDC) were investigated for absolute reliability.There were strong correlations between MKQ-TR and International Knee Documentation Committee (r=- 0.96, p<0.001) and Knee Injury and Osteoarthritis Outcome Score subscales (range for r=- 0.66 to - 0.96, all p<0.001). Reliability was excellent (ICC>0.90). The SEM results showed that absolute reliability ranged from good to doubtful (5.8-15.9%), hence acceptable. The MKQ-TR had an MDC of 6.14 and 29.7 as the cut-off point. The area under the ROC curve showed excellent (0.991) accuracy with 0.973 sensitivity and 0.977 specificity.MKQ-TR demonstrated excellent validity, reliability and accuracy to evaluate symptoms, pain, daily life activities, sports activities, physical function and quality of life in people with various knee injuries.

The aim of this study was to present the social law requirements for rehabilitation counseling following the Bundesteilhabegesetz (Federal Participation Act; BTHG) and to demonstrate, through questionnaire and interview data, how these aspects are currently being implemented.Using a mixed-methods study, a sociolegal analysis was conducted using the classical legal scientific methodology. We additionally used questionnaires at two time points to assess, among others, the clients' subjective appraisal of counseling. A total of 33 semi-structured expert interviews were conducted with rehabilitation counselors, clients, and social service staff from rehabilitation centers. All results were thematically structured and triangulated. Data were collected as part of the research project "Accompanying the Implementation of the Federal Participation Act within the Framework of Rehabilitation Counseling" between October 2022 and February 2024.As a result of the BTHG, requirements for rehabilitation counseling were further emphasized and specified. This particularly pertains to participation in the planning process, development and expansion of networks, early-stage information provision, the right to choose providers, and counseling in rehabilitation clinics. For example, 73% (n=75) reported that they had been informed about their rights and entitlements; however, 4 out of 17 insured individuals stated that they were unfamiliar with the term or content of the right to choose. Counseling in clinics was considered important by all interviewees. Overall, rehabilitation counseling as currently practised meets only partially the requirements specified by the BTHG.The results demonstrate the high and diverse demands that the BTHG places on rehabilitation counseling.

In a recently completed randomized controlled trial, we found that work-related medical rehabilitation (WMR) was implemented very differently in rehabilitation facilities. Its additional effects were particularly evident when the emphasis on work-related issues was clearly communicated to participants. We therefore developed practice recommendations for a structured further development of WMR in psychosomatic rehabilitation facilities.In a two-stage Delphi process, 119 recommendations were evaluated by various experts including people who had received psychosomatic WMR. The assessment of the strength of consensus followed the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF). The results of the first round were discussed with the participants before the second round.A total of 19 and 17 individuals participated in the respective votes. In the second Delphi round, 80 recommendations achieved strong consensus (74.8%) and 24 recommendations achieved consensus (22.4%). Two recommendations received majority approval. One recommendation was rejected by a majority. We reformulated the 106 remaining recommendations according to the AWMF recommendations in order to express the strength of consensus ("is to", "should", "can").The strong consensus on around three quarters of all practice recommendations suggests that the final assessment of the different groups involved was similar. The large number of recommendations that achieved strong consensus indicates the complexity of the intervention. A regular review of the practice recommendations is advisable.

The most common symptoms of PCS are persistent fatigue and cognitive impairment, which significantly affect participation in work and daily life. There is increasing evidence for the effectiveness of rehabilitative treatment approaches. Nevertheless, voices are being raised, especially in the social media, that negatively evaluate rehabilitation for PCS. The aim of this study was to objectify the subjective success of treatment and the satisfaction of inpatients with PCS with the rehabilitation.As part of a prospective multicentre cohort study (n=1028), the subjective treatment success and patient satisfaction (ZUF-8) at the end of PCS rehabilitation were examined (PCS rehabilitation indications: Dual rehabilitation, psychosomatics, neurology and pneumology). Frequency analyses, mean value comparisons, correlation analyses and regression models were used.The subjective success of treatment was rated as good to very good across all PCS rehabilitation indications. Approximately 62% of PCS patients experienced improvement in physical symptoms, about 58% improvement in mental well-being. The general State of health and performance improved in 62% and 47% of patients, respectively. If all categories of treatment success are considered together, at least one area improved in 87.5%. Around 90% of PCS patients would recommend rehabilitation to others or return for treatment. Comparable results also showed that the treatment met the patients' needs. The vast majority of PCS patients (around 90%) would recommend the rehabilitation programme to others or return for treatement. Global patient satisfaction correlated to r=-0.727 (p<0.001) with the subjectively experienced psychological relief, but not with the 6-minute walking test (6MWT) as a somatic surrogate parameter. Regression analyses showed that only improvement in depression had a significant influence on patient satisfaction and subjective treatment success, but not improvement in walking distance or the socio-medical assessment (general labour market performance).PCS rehabilitants were satisfied with the therapy programme across all indications examined and experienced successful treatment. The vast majority of PCS rehabilitants found a multimodal rehabilitation program to be helpful.

Participatory research is increasingly being promoted in rehabilitation sciences. It is now recommended that this type of research be consistently considered in funding applications for rehabilitation research. However, the structural paradoxes and other challenges associated with participatory research are still neglected. There is also a lack of systematic evaluations of whether and to what extent participatory research fulfills the epistemological and democratic expectations associated with it. Against this background, the implementation of a participatory research style in a research project will be presented and how participatory research can contribute to more meaningful findings and empowerment will be critically reflected upon and contextualized.In the ANSAB research project, a participatory research style in the sense of advisory participation was implemented and vocational rehabilitants were involved in the project advisory board. They were also included in the design of the interview guidelines and the interpretation of the results. In addition, narrative interviews were conducted with seven of the participating rehabilitants and analyzed using content analysis. The insights gained in this way and the empirical material made it possible to achieve results on the implementation of participatory rehabilitation research.The results showed that the participating vocational rehabilitants felt empowered by their work on the advisory board and would also like to empower other people in a similar situation. Furthermore, they were actively involved in the research process and thus contributed to the application-oriented acquisition of knowledge.On the one hand, the results are encouraging with regard to the expectations associated with participatory research, but on the other hand, they also point to the challenges and limitations of this style of research. Based on our findings and the results of other research projects that pursue a participatory research style, recommendations for implementation should be revised again, considering the different areas of application in the rehabilitation sciences.

Chronic kidney disease (CKD) affects approximately 7% of the German population, leading to increased morbidity, mortality and subjective symptoms that significantly impact quality of life. In Germany, approx. 86000 individuals rely on renal replacement therapies with a median waiting time of nearly eight years for a kidney transplant. The initiation of dialysis often results in limitations of functional and physical capabilities, as well as reduced participation in daily activities. The development of frailty during this period is a strong negative predictor of mortality. Thus, patients with CKD can benefit from multimodal rehabilitation programmes.Research initiatives are exploring the effects of prehabilitation measures on the outcome of kidney transplantation. Most patients benefit from transplantation; however, both the early and late phases post-transplant are characterized by various potential complications. Following a kidney transplant, patients experience increased needs for medical, psychological, nutritional, physiotherapeutic and social counseling and support.In cases of living kidney donation, donor recovery is typically rapid, although some individuals may experience prolonged recovery times. Registry data indicate that a portion of patients may encounter transient worsening of fatigue symptoms post-donation. Given the unique circumstances surrounding kidney donation and transplantation, intensive follow-up care focusing on renal risks and psychological aspects is essential to ensure optimal patient outcomes and quality of life. This comprehensive approach is crucial for addressing the multifaceted needs of patients throughout their treatment journey.

Patients in cardiac rehabilitation (CR) with subjectively impaired occupational prognosis are at risk of not returning to work (RTW) in the medium term. This study aimed to explore, describe and summarise the aspects relevant in CR patients' reflections on their occupational future.A qualitative study was conducted in CR in 2021/22; 25 patients (median age 52 years; 9 women, 16 men; working in different physically demanding occupations; 20 with risk of non-RTW and 5 without by the Würzburger Screening) were interviewed and asked to reflect on their occupational future.About 6-8 months post-CR, 8 patients were re-interviewed to check the relevance of the factors identified during CR. All interviews were recorded, transcribed and thematically analysed.Aspects relevant for the reflection on subjectively perceived occupational future could be summarised into internal factors: personal aspects, health perception, heart-focused anxiety, and external factors: social circle and adjustments in work conditions. Two further themes were time-related: prior health/illness-related experiences and intended work and lifestyle changes. Especially participants with a risk of non-RTW experienced heart-focused anxiety, contemplated previous health/illness experiences and expressed a desire to RTW in the distant future, although they had no clear plan of action. Greater emphasis was placed on prioritising health and taking time for RTW, and participants often felt supported in this by their social environment. Themes were overlapping between participants with and without risk of non-RTW, yet different in relevance and detail.Overall, patients at different risk of non-RTW reflecting on their subjective perception of occupational future show similarities regarding relevant aspects and themes. However, especially patients at risk of non-RTW reflected on perceived heart-focused anxiety and the lack of concrete RTW plans for their occupational future. These aspects should be considered in individual, holistic and goal-oriented approaches to support patients on their RTW journey.

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.

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/).