Rehabilitation最新文献

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.

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.