Rehabilitation最新文献

Aim of the study: The aim of this study was to identify current challenges faced by service providers (SPs) as well as those likely to arise in the future and the coping strategies to deal with them. Challenges are requirements externally imposed on the SPs and perceived by them as central to their work. We focus on SPs that offered disability-specific programs financed by the Federal Employment Agency in December 2016.

Method: The study is based on a mixed-methods design. In summer 2017, a quantitative online survey of SPs (n=266) was conducted, as well as in-depth qualitative guided interviews (44 representatives at 32 SPs) until mid 2019. Factor analysis (STATA) and analyses in the sense of Grounded Theory (MaxQDA) were carried out.

Results: The experts at the SPs addressed three main challenge contexts or types: 1. competitive framework conditions (such as decreasing numbers of participants, increasing price competition or rising cost pressure), 2. changes in the structure of participants (such as decreasing educational competencies, more participants with behavioral problems, mental illnesses or multiple disabilities) and 3. changing demands of the labor market (such as increasing importance of computer-based activities, higher demands on qualifications or decrease in simple tasks). For the first two types, SPs had clear and overarching strategies. For example, SPs responded to the first type by changing their facility portfolio or opening up to target groups. Concerning the second type, SPs responded - according to their specific contexts of action - with further training of the staff, arrangement of permanent positions or hiring of new staff (especially psychologically trained staff) as well as negotiations with the financers of vocational rehabilitation. The third type, however, presented a very broad picture with few clear, tangible, overarching strategies. In general, SPs also looked upon financers as having an obligation to further optimize the rehabilitation process, in particular, to adequate allocation of programs and the provision of more flexible and individualized program concepts.

Conclusions: There is no one-size-fits-all response to current and future challenges. However, the COVID-19 pandemic has shown that strategies for expected developments - such as the need to further develop digitization - must not be put on the back burner.

Purpose: Diseases of the digestive system such as Crohn's disease (CD) or ulcerative colitis (UC) are associated with problems in occupational participation, but they only make up a very small part of all rehabilitation services provided by the German Pension Insurance. Rehabilitation is a very good treatment option, but its effectiveness is largely unclear. So far, several studies exist on the return to work after medical rehabilitation. However, representative findings and the relevant influencing factors are still lacking. This is the aim of the present analysis.

Methods: We used the rehabilitation statistics database of the German Pension Insurance. Patients were included with completed medical rehabilitation due to a disease of the digestive system in 2017. The analyses were carried out for the entire group as well as differentiated according to the diagnosis groups CD, UC, diverticular diseases (DI) as well as pancreatic diseases (PA). Occupational participation was operationalised both via a monthly information up to 24 months after rehabilitation and as a rate of all persons who were employed after 12 or 24 months in the survey month and the 3 preceding months. For the analysis of the influencing factors on stable occupational participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months.

Results: A total of 8,795 data sets were included in the analysis (CD: n=1,779, 20%; UC: n=1,438, 16%; DI: 1,282, 15%; PA: n=761, 9%). The average age in the groups ranged from 44 (CD) to 54 (DI) years; the proportion of women ranged from 28% (PA) to 57% (CD). Between 16% (DI) and 32% (PA) of the rehabilitation participants had sickness absences of 6 or more months in the year before rehabilitation. Two years after rehabilitation, the return-to-work rates were 69% (CD), 71% (UC), 68% (DI) and 58% (PA). The strongest influencing factors on stable occupational participation were time of sick leave and wage before rehabilitations well as work ability at admission.

Conclusion: Two years after gastroenterological rehabilitation in Germany, 6 to 7 out of 10 affected persons return to stable work participation. Relevant influencing factors are the time of sick leave and the level of remuneration. The results support an expansion of rehabilitation concept to include work-related aspects.

Background: Considering the growing rehabilitative care requirements, good interprofessional cooperation is of central relevance for health care professions and is increasingly demanded. Interprofessional cooperation does not yet play a significant role in health professions' education, despite the fact that it is considered an important element of success in outcome- and patient-centered health care. The field of rehabilitation lacks interprofessional teaching concepts and material.

Methods: An interprofessional team of instructors developed the didactic and thematic concept for the module. The module focuses on rehabilitation and discharge management. The learning objectives were developed based on the National Competency-Based Catalogue of Learning Objectives for Medicine. The formative evaluation was based on a questionnaire filled out by the students and the learning guides.

Results: 47 participants took part in three runs. The results of the formative evaluation demonstrate that the module was overall well received. The trainees rated the module more favorably than the medical students. While participants emphasized the good practical eye-to-eye interaction between the professions and the honest feedback conversation, they also pointed to the contrast they perceived to their everyday practice. They also wished for more time having verbal interprofessional exchange. The medical students criticized that interprofessional modules were only offered in their final year.

Conclusion: To the author's knowledge, this is the first publication of an interprofessional module on rehabilitation and discharge management including piloting and positive evaluation for the three professional groups of medicine, nursing and physical therapy. Improvement suggestions of the participants led to modifications that will be realized in the next version of the module. The course sets important impulses for the further development of interprofessional cooperation and the teaching of rehabilitation-related skills. The modular package is available to other lecturers in a free online platform for rehabilitation-related teaching materials.

Objective: The quality of socio-medical expert opinions, which are prepared for the German Pension Insurance (GPI) in the context of applications for reduced earning capacity pension due to mental disorder, has hardly been investigated so far. The aim of the present study was to investigate to what extent expert medical reports on post-traumatic stress disorder (PTSD) comply with the guideline of the GPI on socio-medical reports for mental and behavioral disorders.

Methodology: To examine the quality of expert opinions, 52 socio-medical expert opinions in which a diagnosis of post-traumatic stress disorder (PTSD) was assigned and a performance capacity of less than three hours was determined were analyzed. The quality of the expert opinions was assessed both quantitatively by calculating quality points and qualitatively by analyzing the content. Percent agreement and Cohen's kappa were calculated for two raters to examine rater agreement based on a subsample (n=11).

Results: The analyzed appraisals scored an average of 36.1 (SD=7.4) out of a possible 92 quality points (range 22/56). In most of the expert opinions, the descriptions of participation limitations, epicrisis, and sociomedical conclusion were unsatisfactory.

Conclusion: The inadequate presentation of the functional and participation limitations in the expert opinions may not do justice to the actual facts of the case, so that the evidence of a health disorder with the corresponding participation limitations cannot be provided beyond doubt. Accordingly, measures to improve the quality of expert opinions such as training and regular quality reviews are necessary.