Rehabilitation最新文献

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.

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.

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.

We analyzed how people with musculoskeletal disorder who completed a rehabilitation program of the German Pension Insurance can be described before medical rehabilitation, how often work participation succeeds thereafter and which administratively available information is associated with work participation.We used the German Pension Insurance's rehabilitation statistics database. Patients with a musculoskeletal disorder who had completed medical rehabilitation in 2017 were included. The analyses were carried out for the group as a whole and stratified by diagnosis group. Work participation was conceptualized both via a monthly status variable up to 24 months after rehabilitation and as a rate of all persons who were employed 12 or 24 months after rehabilitation and the three preceding months. Multiple logistic regression models with stepwise inclusion were calculated to analyze the factors influencing stable work participation.The analysis included 335,792 completed orthopaedic rehabilitations. Two years after the end of rehabilitation, 66.2% of the patients achieved stable work participation. The most relevant factors influencing stable employment were the duration of sickness absence and the income from employment subject to social insurance contributions before the start of rehabilitation.One and two years after completing orthopaedic rehabilitation, around seven out of ten patients are in stable employment. Due to their prognostic validity, the influencing factors identified can be used to determine needs and allocate patients to work-related medical rehabilitation, graded return-to-work and, if necessary, other services for participation in working life.

Research agendas address areas, topics and contents where research is particularly needed. The aim of the study was to develop an organisation-specific research agenda for rehabilitation research in the pension insurance institution (PV), reflecting the research interests of various stakeholders in rehabilitation.The study was developed using a sequential, iterative research design with both qualitative and quantitative components. A narrative literature review and in-depth interviews were conducted with experts from the rehabilitation sector (practice, administration and science). The data generated were analysed, processed and consolidated. A subsequent Delphi survey was conducted in two rounds to identify the priority of potential research. The results were used as a basis for the final formulation of the research agenda.The Delphi survey helped to identify and prioritise a total of 116 concrete research items for inclusion in the research agenda. These were categorised, at progressively higher levels of abstraction, into 32 research topics, eleven research fields and four main research areas namely, Individual, Intervention, Institution and Interdisciplinary research.The interdisciplinary and multi-perspective development of the research agenda enabled a comprehensive exploration of the complex variety of topics/issues in rehabilitation. The research agenda will help to structure future research activities in PV and align them with the needs of the different stakeholders in rehabilitation. The methodological, theoretical and institutional foundations of rehabilitation research are also adressed to enable interdisciplinary research.

Due to the high costs of primary studies, use of existing data, so-called routine data, can be particularly suitable for answering care-related research questions in rehabilitation. Previous reviews on the use of routine data have focused on acute care within the purview of the statutory health insurance (GKV), but have largely overlooked rehabilitation and other rehabilitation-relevant service providers such as the German Pension Insurance (DRV), the German Statutory Accident Insurance (DGUV) and the Federal Employment Agency (BA). The aim is to provide an overview of the type, access, quality and data protection aspects of routine data in the context of rehabilitation research, based on existing recommendations, results of a selective literature search, and the authors' own experience. Routine data is characterized by a large number of cases, large scope of characteristics and longitudinal documentation over long periods of time. Access to routine data from the German Pension Insurance and the Federal Employment Agency is comparatively low threshold for researchers, whereas this is not yet equally the case for data of other social insurance providers and of rehabilitation clinics. Furthermore, under certain conditions, routine data can be linked with other routine data and with primary data, which can considerably expand the spectrum of possible research applications. In addition to the advantages of routine data, their limitations must also be considered. Routine data were collected for other purposes and only contain characteristics that are required for administration. A prospective study approach with routine data is possible in principle due to the continuous data collection and documentation, but randomized allocation to interventions is not feasible. In addition, the availability, generalizability and quality of data sets and individual variables must be verified. The Health Data Lab at the Federal Institute for Drugs and Medical Devices does not yet provide for the integration of GKV rehabilitation data or the linking of GKV data with data from other rehabilitation-relevant service providers. Data protection aspects must also be considered. When using pseudonymized data from social insurance providers, an application must be submitted by the data holder to the relevant supervisory authorities in accordance with § 75 Social Security Code X.

Older adults who are hospitalized for an acute illness or injury are at high risk for functional decline and other negative long-term outcomes, such as the need for long-term care and higher mortality rates. To address this need, acute geriatric units have been established to treat these patients as part of comprehensive geriatric care. In Germany, comprehensive geriatric care is referred to as complex geriatric rehabilitation therapy and classified under the Operation and Procedure Classification System (OPS) 8-550. It combines acute medical treatment with rehabilitative therapies. It involves a multidisciplinary team working together to develop individualized treatment plans to improve the patient's physical, mental, and social functioning. Treatment can often lead to an increase in functional independence, allowing older people to participate in daily life. This article outlines the aims and characteristics of the treatment and how it differs from geriatric rehabilitation without the need for acute medical treatment.