Rehabilitation最新文献

The aim of this study was to identify measures relevant for the successful implementation of Operational Integration Management (OIM) in schools. The goals of sick school employees or OIM-participants, on the one hand, and OIM-supporting school principals, on the other, associated with the procedure were investigated, as were factors contributing to success or obstacles to the implementation of the procedure.As a prelude to an ongoing evaluation process, guided interviews were conducted in 2018 with 11 school employees (6 school principals, 1 head of seminar, 3 teachers, 1 pedagogical specialist) from Rhineland-Palatinate with experiences in OIM that stem from procedures the study participants have gone through, have accompanied or have rejected. The interview material was analysed with techniques of qualitative content analysis in 2022 according to the aim of this study.The school principals and OIM-participants mentioned the central goals pursued by OIM procedures as the return to work and the reflective or accepting handling of illness. Important parameters were the explicit willingness of those involved to return or support the OIM and a high degree of self-reflection. The perceived ability to act was also important. This was supported by available procedural information and (in)formal support resources. OIM-participants and school principals must be prepared to pursue common goals and not insist simply on their own rights. The involvement of other actors with their specific competencies can be helpful and necessary if the participants reach their limits of negotiation in the intra-school relationship.OIM procedures and in particular, measures for stepwise reintegration are valued by OIM-participants and school principals as support measures that can facilitate the permanent return to work. Those involved in OIM reach their limits where expectations are unreasonable. In this respect, the procedure itself can ultimately be nothing more (and nothing less) than an opportunity to consistently follow the path to a common compromise. A trusting cooperation also helps to reduce widespread uncertainties in dealing with illness. The participation of OIM experienced actors from different areas of expertise can bring resources to light and promote the development of solutions.

With the decline in the mortality of severely injured patients, the scientific question and the perspective in clinical practice have changed in the direction of qualitative outcome parameters. This long-term survey of patient-reported out-comes is intended to support the argument of structured follow-up care and seamless trauma rehabilitation.Patients were surveyed ten years after a serious injury with an Injury Severity Score of 16 points using the Polytrauma Outcome Chart. Thanks to its modular structure, consisting of the European Quality of Life Index, Short-Form-36 and Trauma Outcome Profile, the health-related quality of life of those affected could be systematically analyzed as a multidimensional construct.From 1 January 2019 to 31 December 2019, the health-related quality of life of 78 patients treated for a serious injury between 2007 and 2009 was surveyed. Even ten years after treatment, the state of health and quality of life of those affected were significantly lower compared to the normal German population. Age, overall injury severity, level of education, occupation, and relevant restrictions in social interaction as well as pain and symptoms of depression, anxiety and post-traumatic stress disorder were found to be predictors.Psychosocial factors seem to play an important part in the assessment of health-related quality of life over the long term. A needs-oriented and interdisciplinary rehabilitation process offers the chance of continuing professional and social participation.

The aim of this study was to investigate the implementation of the statutory operational integration management (OIM) among the older workforce in Germany.Since 2011, the representative lidA cohort study (www.lida-studie.de) has been investigating work, health and employment among the socially insured working population, born in 1959, 1965, and (since 2022/23) in 1971 in Germany. The recent assessment wave 2022/2023 included a newly developed OIM module.Of 7,335 employed participants, 819 (11.2%) reported more than 30 days sickness absence in the past 12 months, thus indicating eligibility to OIM. Of those, 282 (34.4%) had received an OIM offer proactively by their employer. Higher odds of receiving an offer were found for those with longer sickness absence, in larger enterprises, in enterprises which value the workers' health, and among those who, during the COVID-19 pandemic, had used the option to work from home. About a third of those who had received an offer declined it, mainly because they felt no need for it; 132 of the 819 OIM eligible participants (16.1%) reported they had been offered and had accepted at least one measure implemented by the enterprise, most often "stepwise reintegration", followed by "regular feedback talks with the superior". Among them, 114 (90.8% of 132) rated the measures implemented as "somewhat", or "very helpful".Twenty years after the legal introduction of OIM, it is still insufficiently implemented, although - where measures have been implemented - these are almost always rated as helpful by those who have received them. The barriers to implementation of this obviously useful instrument in enterprises and proposals as to how to overcome them need to be investigated more intensively. National stakeholders in Occupational Safety and Health, the statutory occupational health insurance, labour authorities, and the statutory health insurances, as well as the statutory pension insurance could contribute in raising awareness in the course of their consultation activities in the enterprises.

Purpose: The particular relevance of mental disorders for society and the economy is highlighted in the context of work participation. Based on representative routine data from the pension insurance from 2017, the aim of the study was to describe a group of psychosomatic rehabilitation patients recruited on the basis of selected characteristics, examine the return to work (RTW) rates, to assess individual progression after rehabilitation and to identify possible influencing factors.

Methods: Work participation was operationalized both as a monthly state up to 24 months after rehabilitation and as a rate of all people who were employed 12 or 24 months and the 3 preceding months (stable work participation). For the analysis of the influencing factors on stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months.

Results: A total of 122,623 data sets were included in the analysis (including depressive episode (DE): n=28,497, 23.2%, recurrent depressive disorders (RD): n=42,573, 34.7%; reaction to severe stress, and adjustment disorders (BR): n=19,122, 15.6%; dissociative disorders (AS): n=9,716, 7.9% and somatoform disorders (SO): n=8,564, 7.0%). The mean age was 50 years, 64% were female. There were different courses depending on the indication, with stable employment rates after 12 months of 69% in the BR group; 62% in the DE group; 61% in the SE group; 57% in RD up to 52% in the SO group. Factors influencing stable employment after one year were the duration of incapacity for work in the year before rehabilitation, the existence of an employment relationship and a high income.

Conclusion: Since the relevant changes became apparent in the first six months after rehabilitation, further support services for people with mental illnesses after medical rehabilitation should ideally begin as early as possible after rehabilitation.

Purpose: The REHA-KNOWS study explores the perceptions of practice representatives of rehabilitation facilities in Southwest Germany regarding (healthcare) research and shows benefits and barriers in knowledge transfer from the perspective of practice. For this purpose, an instrument with 12 5-level items was developed, which is exploratively examined in this paper. The instrument includes statements on the benefits, costs and added value of rehabilitation research projects as well as on the framework conditions in the facilities. Between March and May 2023, data were collected from representatives of 206 rehabilitation facilities in Baden-Wuerttemberg and Saarland using an online questionnaire.

Methods: A descriptive analysis of distribution properties was performed. Furthermore, an exploratory factor analysis using Horn's parallel analysis and Velicier's Minimum Average Partial was conducted to determine the underlying factor structure and unidimensionality. In addition, Mann-Whitney U tests were calculated to determine differences in responses between representatives in the fields of medicine, nursing and therapy and personnel with administrative and management tasks.

Results: Overall, the instrument had few missing values with acceptable scatter and low item difficulty. Floor and ceiling effects were negligible but did occur for three items. Differences in response patterns between occupational groups were found descriptively for items 2, 10, and 12. After p-value correction for multiple testing, they became insignificant. Four items were excluded from the factor analysis due to poor fit, which then yielded a single-factor solution with 31% variance resolution. The fit of the overall model was not satisfactory. The identified factor is best described as "attitude toward the usefulness of research for practice". Responses to the open-ended question about previous experience with research activities provided evidence that further items should be generated to cover the cost-benefit ratio with a focus on monetary compensation for the (human) effort involved.

Conclusion: The newly developed instrument lays the foundation for systematically recording the attitudes of representatives of rehabilitation facilities towards (healthcare) research. Further research is needed to improve the measurement tool to elucidate this complex issue.

The "Climate and Sustainability" working group of the German Society for Rehabilitation Sciences was founded in March 2023. The members represent research, practice, and service providers in rehabilitation. The aim is to make rehabilitation in Germany sustainable and to focus on climate protection and the health consequences of climate change. Dealing with these issues should become the new social norm for all stakeholders in rehabilitation. Therefore, existing knowledge is used, and new findings are developed that are passed on directly to and support the quality-assured transformation in the facilities. The focus of current activities is on two fields of action: promoting climate protection through the ecological transformation of rehabilitation facilities and promoting climate resilience through further development of rehabilitation services and social medicine. Activities to date include specialist publications and research, statements and submissions, events, and training courses as well as dissemination, networking, and public relations work to establish sustainability concepts in rehabilitation.

Work-related medical rehabilitation is a multimodal, interprofessional program that reduces health-related discrepancies between job capacities and demands in order to support work participation of patients who are at an increased risk of failing to return to work (e. g. due to long-term sickness absence). The review outlines screening for patients who should be reached, diagnostics and treatments during work-related medical rehabilitation and evidence on the effectiveness of these programs. Moreover, tools supporting implementation of work-related medical rehabilitation are discussed.

Purpose: Although work-related medical rehabilitation (WMR) has been established as a component of the rehabilitative care system for some time, particularly in patients with musculoskeletal disorders, studies indicated strong heterogeneity regarding the implementation of the guideline for WMR in Germany. This study is the first to examine the implementation of work-related functional capacity training and the preceding work-related diagnostics based on a nationwide survey of WMR health care professionals.

Methods: Rehabilitation facilities (n=317) authorized to carry out WMR in patients with musculoskeletal disorders were invited to participate in a nationwide survey. 86 of 317 facilities responded to the self-developed questionnaire and met the inclusion criteria.

Results: 67% of the WMR facilities described a systematic use of functional capacity evaluation (FCE) at the beginning of rehabilitation in at least 50% of the rehabilitants. 70% stated that they systematically matched abilities and work demands. Furthermore, 57% reported that profile comparisons were used to tailor training of work-related functional capacity. The training itself was provided to at least every second rehabilitant with a total duration of 360 minutes or more in about every second facility. The FCE procedures and the work-related functional capacity training were primarily carried out by occupational therapists.

Conclusion: Work-related diagnostics and the work-related functional capacity training are often but not yet always implemented in line with the guideline for WMR. Promoting interdisciplinarity seems to be a promising approach regarding the further development of WMR.

Purpose: Over the past four years, medical rehabilitation providers and their staff have developed strategies to adapt to a new reality of care during the COVID-19 pandemic. The aim of this qualitative survey was to assess patients' expectations from and perceptions of rehabilitation in times of pandemic. The results can contribute to the development of recommendations on how pandemic-related challenges in rehabilitative care can be overcome.

Methods: In order to gain insights into the perspective of (potential) applicants and rehabilitation patients, 33 guided, individual telephone interviews were conducted. The interview partners were recruited via two cooperation facilities, social media and a network-based snowball approach. The interviews were transcribed and analysed by means of qualitative content analysis in a multi-stage process based on the procedure recommended by Kuckartz.

Results: Potential applicants and rehabilitation patients commented on expected challenges and opportunities during rehabilitation and on the needs for rehabilitative care during the pandemic. On the one hand, restrictions on therapy and leisure time activities were reported. They also reported psycho-social challenges such as feelings of loneliness and isolation due to contact restrictions. On the other hand, potential patients also perceived opportunities during rehabilitation. They perceived the protective and hygiene measures in the facilities, lower clinic utilisation and smaller group sizes as well as the opportunity to make use of health services and social contact as positive aspects.

Conclusion: The results show that rehabilitation can be perceived as relieving and health-promoting even in times of a pandemic, despite protective measures that can be restrictive. For some respondents, it is the protective measures that are decisive for the success of and health maintenance during rehabilitation. Whereas the strategies used by the facilities during the COVID-19 pandemic imposed restrictions on patients, their measures to prevent infections and at the same time ensure patient-centered health care brought positive effects and sustainable opportunities for rehabilitation.

Compared to patients with coronary heart disease, patients with PAD have a poorer attitude towards general practitioners with regard to the frequency of prescribing rehabilitative measures and controlling risk factors. The patients themselves do not perceive the increased cardiovascular risk and thus the need for lifestyle changes and compliance to the same extent as patients with coronary heart disease.The "Rehabilitation clinic with vascular expertise" certificate defines the criteria for fulfilling the specific structural and process requirements for vascular medicine.Due to the paradigm shift and the increasing importance of conservative therapy for patients with intermittent claudication, vascular rehabilitation can be the start of or support for the implementation of conservative therapy and thus ensure long-term patient compliance with regard to the implementation of drug therapy, lifestyle changes and the sustainability of gait training. For hospitalized patients, vascular rehabilitation closes the gap to more sustainable aftercare.Increasing demand will promote the development of vascular medical rehabilitation and increase awareness on the part of payers. This process is being scientifically monitored.The goal should be a care structure for patients with PAD that is regulated on an outpatient basis as part of a separate or adapted DMP program, that includes the quality standards of the "Interdisciplinary Vascular Centers" on an inpatient basis and that includes vascular medical rehabilitation with subordinate vascular sports groups.From the point of view of rehabilitation, the aim is for vascular rehabilitation to be recognized as an independent specialist area by the payers.