Rehabilitation最新文献

Purpose: Despite the increasing importance of occupational rehabilitation in chronic diseases, its role in the medical rehabilitation of patients with inflammatory bowel disease (IBD) is still limited. The aim of this study was to test a work-related concept for IBD patients with work-related problems and its acceptance by patients and rehabilitation staff. Improvements in work-related and psychosocial parameters of rehabilitants should be determined.

Methods: In a prospective, multicentre, single-arm cohort study, IBD patients aged between 18 and 63 were screened for work-related problems at the start of their rehabilitation. Participants with work-related problems took part in rehabilitation with a stronger vocational focus and completed a questionnaire at the beginning, end and 6 months after rehabilitation. Restriction in social participation and level of work-related problems were defined as primary outcomes. Satisfaction with the new concept and barriers were assessed in two focus groups with rehabilitation staff after implementation.

Results: Complete data were available for 114 (Ø 46.9 years, 55.3%  female, 56.1%  Crohn's disease) out of 156 participants. 6 months after rehabilitation significant improvements were observed in experienced participation limitations (p<0.001) and work-related problem areas (p<0.001). In 12 out of 27 work-related problem areas, current workload was significantly reduced. This included the areas of 'fatigue' (p<0.001) and 'reduced performance' (p<0.001). Work-related rehabilitation was rated positively by rehabilitation staff and participants. Limited human and time resources were identified as barriers.

Conclusion: The patients' perception of the work-related rehabilitation and the changes in work-related and health-related parameters 6 months after the rehabilitation indicate a successful implementation of occupational content. Despite the promising results and high acceptance, more resources are needed for a systematic implementation in routine care. It is not possible to say whether the positive effects can be causally attributed to participation in vocational rehabilitation. Further research and randomised controlled trials are needed.

Purpose: High levels of physical and psychological stresses experienced by those in the care profession can have a negative impact on their health. The pilot project "Health Check for Carers in the region of Karlsruhe" offered nurses aged 45 and above - based on their self-assessed ability to work using the Work Ability Index (WAI) - the opportunity to participate in a job-related health check, based on their work ability index result. This study looks at the occupational and health situation of older carers, the (subjective) need for a Ü45 health check and draws a comparison between particpants and non-participants.

Methods: 1,466 nurses between 45 and 52 years of age were invited to participate in an Ü45 occupational health check and were surveyed in writing afterwards. 202 questionnaires formed the data basis (49 participants and 153 non-participants in the health check). A descriptive analysis was carried out and group differences were analyzed using Chi2- and rank sum tests.

Results: The main stress factors of the caregivers were organizational circumstances, high work intensity and insufficient remuneration. Illnesses or health problems of the musculoskeletal system and the psyche were the most widespread of all issues. 18.6% of the respondents were rather or very dissatisfied with their current state of health. 39.1% considered their physical health and 27.6% their mental health to be at high or very high risk from their current job. 25.9% of the care workers considered it very unlikely and 32.4% as rather unlikely that they would be able to work in nursing until they reached retirement age. A need for health check was expressed by 63.0%. Group differences between participants and non-participants were shown by a significantly higher burden due to musculoskeletal disorders (p=0.0002), health satisfaction (p=0.0053), subjective need for a health check (p<0.0001) and occupational stress factors, which included physical working activities (p=0.0035), managing many tasks simultaneously (p=0.0380), dealing with cognitively impaired patients (p=0.0095) and suffering/dying patients (p=0.0164).

Conclusion: Care workers reported a high level of stress at work and frequent health impairments. There is a clear need for an occupational health check for this age group in this field of work.

Considering the variety of research questions, perspectives, and disciplines involved, qualitative studies have become an integral part of rehabilitation sciences. To ensure and estimate their quality and thus the significance of their results, criteria are needed for both researchers and recipients. Due to the specific nature and the heterogeneity of qualitative research approaches, there is still disagreement regarding appropriate universally valid quality criteria. In this article, core criteria that can be used to plan, conduct and receive qualitative studies are presented and discussed with reference to national rehabilitation research. For this purpose, the specific characteristics of rehabilitation research are taken into account and the application of quality criteria is illustrated using concrete examples from the research practice of rehabilitation sciences.

Patients with polytrauma and other severe musculoskeletal injuries often suffer from permanently impaired functionality and quality of life. This results in long-term damage with high costs for the social system. A narrative review will show the impact of targeted coordination in the rehabilitation process from early rehabilitation to long-term case management on patients with severe musculoskeletal injuries. A systematic database search of MEDLINE and the Cochrane Library identified studies of multiple injuries that compared the outcome of early rehabilitation and rehabilitation management with other types of care. Studies of predominantly neurologic injury types, soldiers, and mild injury types with an ISS less than 9 or AIS less than 3 were excluded. Four studies were included and analyzed. They looked at functionality, quality of life, psychological impairment, and costs. While treatment and total costs were higher for early rehabilitation and rehabilitation management, no better results for improved function, psychological condition and quality of life could be demonstrated in the group comparison. An effect estimate is possible due to small group differences and the small number of individual studies included. There are insufficient studies to draw conclusions about the effectiveness of the early interventions. Future studies are needed that take into greater account structures of standard care and national differences in social security systems, as well as the chosen rehabilitation management interventions.

Objective: Comprehensive psychological support is a distinctive feature of vocational retraining centers, pivotal in stabilizing the health of the rehabilitants, reducing dropout rates and facilitating return to work. For optimal resource planning within the vocational retraining centers, and thereby ensuring the best possible psychological support during vocational rehabilitation, it is crucial to be able to estimate the number of appointments of the rehabilitants in advance. Even though routine data is available, predictions using regression analysis have not been undertaken previously.

Methods: To predict the number of appointments in the psychological service, a hierarchical linear regression analysis with 25 potential predictors was conducted using retrospective routine data from 404 rehabilitants. In specifying the regression model, data-driven methods and theory were combined. The Andersen healthcare utilization model served as the theoretical background.

Results: The final regression model accounted for 39.5% of the variance in the utilization of the psychological service. Ten variables predicted a higher number of appointments: female gender, boarding status, low resilience, desire for psychological support, past psychological treatment, intake of psychotropic drugs, absence of two specific professional fields, Federal Employment Agency/Jobcenter as the paying institution, and non-participation in a specific preparatory course.

Conclusion: The routine data available at the beginning of vocational rehabilitation in a vocational retraining center is generally suitable to predict the number of appointments in the psychological service. As such, it can be utilized for resource planning. Various factors prove to be informative, suggesting that a focus on single factors (e. g., the presence of an ICD-10 F-diagnosis) seems disadvantageous. Limitations of the regression-analytic approach are highlighted.

Purpose: Assistive devices are essential in neuropediatrics, but the database on the self-assessed use by and supply of medical aids to those affected with hereditary ataxia is small. The present work aims to examine the individual perspective of those affected by the use and supply of aids and to discuss them in the field of tension between physiological and psychosocial development and symptom progression.

Methods: The research project represents a cooperation with the German Heredo-Ataxia-Society following the "patients as partners in research" approach. The data was collected via online questionnaires and focus group surveys and analyzed quantitatively and qualitatively using a mixed methodological approach.

Results: Based on the present sample of affected adolescents and adults (n=47 online questionnaires, n=6 focus group surveys), a fundamentally positive assessment of the use of medical aids was evident. In contrast, for the individual evaluation of access and supply of assistive devices, four main problems were identified, some of which can be extrapolated to other diagnoses but amplified in children and adolescents due to the low prevalence of hereditary ataxia. Especially in these age groups, the lengthy process leading up to the diagnosis and the associated gap in the indication for assistive devices poses a serious problem. Moreover, there is lack of evidence for justifying prescription of age-group-specific assistive devices.

Conclusion: In addition to the necessity of improvement in the care process, there are significant gaps in the knowledge about an association between self-confidence and coping with the disease, on the one hand, and the acceptance of aids, on the other, in children and adolescents with rare diseases characterized by symptom progression. In addition, there is an urgent need to improve the evidence base for specific tools, especially their importance for promoting independence according to age and developmental phase.

The "Representative Survey on the Participation of People with Disabilities" (Participation Survey), commissioned by the German Federal Ministry of Labour and Social Affairs, aims to work in conjunction with participation reporting to assess the social participation of people with disabilities. Both the participation reporting and the Participation Survey claim to operationalize impairment and disability in accordance with the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization (WHO). A critical analysis of the measurement concept reveals methodological problems: 1) The measurement concept is not consistently ICF-oriented because it does not clearly conceptualize impairments, does not adequately take into consideration environmental factors in the determination of disability and sees impairment as causal for disability. 2) Distinction made between impairment and disability is mainly pragmatic, without any coherent conceptual justification. 3) The chosen operationalization cannot ensure the desired international comparability. In order to achieve a stronger ICF orientation and better international comparability, it is proposed in this study to integrate the "Model Disability Survey", developed by the WHO and the World Bank, into the German Participation Survey's data collection tools. An alternative measurement proposal, which can be implemented with the available data, is to categorize groups solely according to the severity of impairment, forgoing the a priori distinction between impairment and disability. This approach embraces the fundamental idea of the ICF, which views disability as a situational rather than a personal characteristic.

Purpose: The Covid-19 pandemic has posed new challenges to actors in vocational rehabilitation (VR) for people with disabilities. In this study, we were interested in the following: How did actors like service providers and financers of VR (here: German Federal Employment Agency (FEA)) experience the Covid-19 pandemic, which process changes and delays have occurred, and what impact will this possibly have on the future of vocational rehabilitation for people with disabilities?

Methods: Between July 2020 und July 2021, a total of 29 persons from service providers of VR programs (n=16) and representatives of the FEA (n=8) were asked about their experiences during the Covid-19 pandemic in the course of 24 guided expert interviews. The interviews were recorded, transcribed, coded in MAXQDA; the analyses of the transcribed material are based on a system developed from inductive and deductive categories.

Results: VR programs had to be conducted remotely, digital possibilities had to be created. As a result, VR was also forced to evolve technologically, revealing opportunities (in the provision of programs) and limitations (e. g. acquisition of social skills or assessment of mental health). Thus, continuous additional support by the service providers was indispensable to contain psychological crises, to ensure the understanding of the program contents and to avoid dropouts. Just like schools, the employment agencies and job centers closed their doors for a long time and VR and general vocational counseling did not take place nor did assessment procedures carried out at the medical and psychological services of the FEA for determining VR needs. A decline in access to VR had been apparent for some time, but it became increasingly evident, particularly for 2021/22. Individuals from poor households were more likely to be affected because they were more difficult to keep in touch with.

Conclusion: Even though VR has experienced a major digital boost, experience from the pandemic has shown that programs in face-to-face formats with social contact are particularly important for young people and people with mental disabilities. Nevertheless, VR must change with the working environment in order to prevent people with disabilities from being left behind even further.

Purpose: Research indicates that the implementation of work-related medical rehabilitation (WMR) is characterized by pronounced heterogeneity and that the requirements defined by the German Pension Insurance are not consistently met. The study aimed to investigate the implementation of the WMR guideline in patients with musculoskeletal disorders with regard to the identification of a need for WMR as well as the assessment of the individual demands of work.

Methods: 317 rehabilitation facilities authorized for 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: Although most facilities reported that nearly all patients receive WMR if they have a need for it, the proportion of WMR measures provided was below ten percent in the majority of cases. With regard to work demands, respondents demanded greater involvement of employers in order to strengthen validity.

Conclusion: The findings indicate that WMR is largely implemented in accordance with the WMR guideline. The main challenges include meeting the need for WMR and strengthening the involvement of employers in the assessment of work requirements.

In order to treat and research the development, progression, therapy and prevention of cardiological and psychosomatic disorders and their interactions, the field of psychocardiology has been established in recent years and now offers several treatment options.The well-known somatic risk factors for cardiovascular diseases such as smoking, diabetes mellitus, arterial hypertension and acquired or congenital lipid metabolism disorders, lack of exercise, malnutrition and sleep-related disorders are often related to psychosocial risk factors. Conversely, mental illnesses such as depression and post-traumatic stress disorder can also be viewed as independent risk factors for cardiovascular diseases.Somatic illnesses can, in turn, result in significant psychological reactions that have a severely negative impact on the course of the disease, participation and quality of life.In addition to the scientific research into these connections, psychocardiology offers a clinical specialty that questions, diagnoses and provides treatment for psychosocial connections in cardiovascular patients.The aim of this article is primarily to convey clinical and practical aspects of psychocardiology and the most important psychological comorbidities in connection with heart disease. In addition, it should be shown which therapeutic offers are available in the medical care structures and how therapy can be carried out. Psychotherapy and exercise therapy are preferred for the treatment of these comorbid disorders. The possibility of psychopharmacological therapy for cardiovascular patients is also presented, especially because of possible problematic medication interactions.