Rehabilitation最新文献

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.

The aim of the study was to determine quality criteria in rehabilitation sport from the perspective of participants and instructors.In an exploratory approach, semi-structured guided interviews were conducted with both groups (participants: n=8, instructors: n=4). Qualitative, structuring content analysis was carried out with deductive and inductive formation of categories, dimensions and expressions using the QCAmap software.Based on the interviews conducted, 3 main categories were formed: structural quality, process quality and outcome quality with a total of 10 dimensions and 15 expressions. In the context of structural quality, the interviewees emphasised quality criteria relating to the instructors, but also drew attention to spatial and other facility-related conditions. With regard to process quality, aspects of time and content were discussed, as well as the atmosphere in the course context and heterogeneity in the group. The dimensions of outcome quality were the functional ability at work and in leisure time as well as current well-being and health behaviour.This study provides information for assessing quality control in rehabilitation sport. For example, it emphasises the competence requirements for instructors, including in the methodological-didactic and expertise areas, which are underpinned by findings from medical rehabilitation. Process quality draws attention, for example, to aspects of content that have not yet been addressed in the framework agreement on rehabilitation sport. The interviewees describe the effects of rehabilitation sport in terms of individual experience. However, the need for evaluation is not mentioned.

In this pilot study, a specific, three-week, multimodal treatment programme for patients with a particularly severe course of fibromyalgia syndrome was evaluated in relation to cardiopulmonary endurance performance and the results were compared with reports in the literature.As part of the retrospective, monocentric longitudinal study, a 6-minute walking test was carried out at the beginning and end of inpatient rheumatological rehabilitation (3090 minutes of therapy in 3 weeks) and the results were compared.A total of 71 patients (age: 54.2±7.7 years; f=66, m=5) were included in the study The disease was diagnosed 7.56±7.96 years ago. They were overweight (BMI: 30.91±7.28 kg/m2), had a high level of pain (VAS: 7.43±1.6), high psychological distress (PHQ-4: 6.47±3.0) and significant fibromyalgia-specific complaints (FIQ: 65.65±15.29). Daily activities were reduced (FFbH: 63.27±18.36). Muscle strength was reduced (right hand strength: 15.24±10.76 kg; left hand strength: 13.16±9.18 kg). In all 3 subscales of the MFIS, moderate-high values for fatigue were determined (MFIS-Physical: 3.00±0.63; MFIS-Cognitive: 2.59±0.72; MFIS-Psychosocial: 2.72±0.88). In the 6-minute walk test, 464.72±93.8 m was achieved at the beginning of the rehabilitation programme and 507.61±106.5 m at the end (p<0.001), resulting in an improvement of 42.89 m.The "Fibro-Active Programme" of 3 weeks duration shows comparable or better results than the previously published programmes, which lasted 14 weeks on average.

Non-specific chronic low back pain (CLBP) restricts participation in society and employment also due to the high psychosocial burden of this condition. Thus, there is an urgent need for rehabilitation of patients with CLBP, which must be determined by a valid diagnosis of psychosocial risk factors. The subjective prognosis of gainful employment (SPE) is considered to indicate the need for medical rehabilitation for back pain. The present study investigated the association between SPE and psychosocial risk factors among individuals with non-specific CLBP undergoing inpatient multidisciplinary orthopedic rehabilitation (MOR).This cross-sectional observational study included 925 individuals aged 20 to 65 with non-specific CLBP at admission to inpatient MOR (M=52.2 years, SD=7.2; 77.5% female; ICD-10: M51/53/54). Associations of the SPE total score with psychological, pain-related, and work-related measures were examined by using correlation and regression analyses. Moreover, moderated associations of the SPE categorical score were tested using one-way analyses of variance with the independent factor self-reported prognosis of employment (favorable vs. unfavorable). Additionally, the frequency distributions of scores within the clinical range for depressive symptoms, chronic stress, and subjectively assessed work ability stratified by self-reported prognosis of employment were investigated.A less favorable self-reported prognosis of employment was predicted by higher job strain and chronic stress as well as lower pain self-efficacy and subjective physical work ability. In particular, individuals with an unfavorable self-reported prognosis of employment showed a risk pattern and were frequently in the clinical range for depressive symptoms, chronic stress, and subjective work ability.The results supported a high need for rehabilitation for this target group, especially for patients with non-specific CLBP and unfavorable self-reported prognosis of employment. Early assessment of sociomedical criteria, in addition to pain and psychodiagnosis as well as targeted referral to needs-based interdisciplinary multimodal treatment approaches could reduce the risk of further chronification of pain and the development of mental disorders.

The aim of this article was to present post COVID-19 patients' experiences in illness and rehabilitation 12 months after their medical rehabilitation. In addition, the experiences and perspective of members of rehabilitation teams on the perceptions, problems, and needs of COVID-19 rehabilitation patients were analysed.About 12 months after cardiac, pulmonary, and neurological COVID-19 rehabilitation, we conducted guided interviews (n=15) to collect patients' experiences. Additionally, three group discussions and five expert interviews with staff members (MA) from collaborating rehabilitation clinics were carried out and analysed using the content analysis method of Kuckartz.Even 12 months after rehabilitation, patients described substantial distress and limitations in daily life due to post COVID-19 syndrome (PCS). This stemmed from persistent symptoms, biographical disruptions, and changes in self-perception. A continuous fight for recognition of their condition and adequate care was evident. Besides undergoing physical therapy, patients required strategies for self-management and disease management. The experiences of staff members indicated changes from primarily physical to neurocognitive, psychosomatic, and socio-medical needs in post COVID-19 patients. Key topics included social medicine inquiries, existential and future anxieties, as well as coping with work-related challenges and disability.In expanding rehabilitation concepts, it is crucial to incorporate social medicine aspects, provide strategies for coping with persistent symptoms in daily life, and support the processing of the illness. Approaches such as outpatient and tele-rehabilitation, continuous prescriptions of therapeutic interventions, and reconsideration of inpatient rehabilitation measures can serve as strategies to address the multifaceted and persistent needs.

The World Health Organization (WHO), through its "Call for Action - Rehabilitation 2030," has emphasized the importance of strengthening the collaboration between research and practice in rehabilitation. Since 2017, the working group "Innovation Workshop Science Circle," followed by the DGRW Commission "Communication, Innovation, and Transfer," has been fostering dialogue between researchers and practitioners. From 2017 to 2023, key obstacles were investigated and six "consented imperatives" were formulated as a result. These six imperatives highlight the shared responsibility for research as follows: (1) taking into consideration stakeholder needs across all study phases, (2) recognizing the importance of structured communication, and (3) facilitatation by researchers. Rehabilitation research has a special obligation to ensure knowledge transfer (4) and requires long-term funding strategies to enable participatory and application-oriented approaches (5). Moreover, research should be recognized as a quality indicator for rehabilitation facilities (6). These principles aim to promote sustainable collaboration between research and practice, improving the overall rehabilitation system through effective communication, resources, and quality assurance. Initiatives such as the discussion forum at the 32nd Rehabilitation Science Colloquium 2023 and the new "KIT-Space" format, will advance these approaches. A stronger integration of the perspectives of rehabilitants remains a key objective.

The COVID-19 pandemic forced rehabilitation centres to adapt their daily care routine and their organisational processes to the corresponding circumstances. In this context, digitally supported services were expanded and further developed. This study aims to systematically take stock of digitally supported rehabilitation services in Germany, including factors hindering or facilitating their implementation.The nationwide explorative quantitative online survey explores a so-far understudied topic. Using a self-developed questionnaire based on the Consolidated Framework for Implementation Research constructs, we surveyed the uptake and type of digitally supported rehabilitation services in medical rehabilitation departments, including implementation hindrances and facilitators.A total of 452 departments participated in the study and about half reported using digitally supported services in medical rehabilitation, with digital training and telerehabilitation aftercare being the most common. The primarily reported implementation hindrances were technology-related work interruptions and cost coverage/reimbursements uncertainties. Managerial support and the usefulness of the digitally supported services were perceived as particularly conducive for the implementation process, as was the staff involvement.The study provides a first overview of digitally supported services used in medical rehabilitation in Germany, and a better understanding of the factors hindering or facilitating their implementation.