[Changes in medical rehabilitation of the German Statutory Pension Insurance Scheme]

[Medical Rehabilitation for Inflammatory Bowel Disease: Access, Process, and Results - Further Analyses of a Randomised Controlled Trial]

BACKGROUND

MERCED is a pragmatic randomised health care trial on the effectiveness and benefit of medical rehab in socially insured employees with chronic inflammatory bowel disease. After on average 8 months post rehab the intervention group showed, compared to continued routine care, a moderate but clinically relevant additional benefit in indicators of social participation, clinical and psychological status. However, no differences were observed for employment status, days off work, and subjective vocational prognosis.

METHODS

We used questionnaire-based reports and ratings of the 211 members of the intervention group on access to medical rehab, its processes and subjective global success as well as a range of health effects calculating pre-post differences.

RESULTS

Contact with three employment/work related services (focused on vocational counselling, legal advice, aftercare) were reported by 33, 48, and 23% resp. of all rehab patients. Patients with pronounced vocational problems had equally frequent contacts as those without. Compared to 12 other services the three received inferior ratings on a scale from 1 (very good) to 5 (very bad): mean 2,5 - 2,3 - 3,0 resp.

CONCLUSION

Medical rehab's relative neglect of vocational elements may partially explain its ineffectiveness in improving participation in work and employment. From MERCED's procedures and results we inferred recommendations to intensify access to medical rehab and its vocational orientation and evaluate its effects.

The Effectiveness of Actively Induced Medical Rehabilitation in Chronic Inflammatory Bowel Disease

BACKGROUND

The poor evidence base is a major problem for the German rehabilitation sector. This trial focused on testing the efficacy and benefit of inpatient medical rehabilitation compared to routine care in a single common entity, namely, chronic inflammatory bowel disease (IBD).

METHODS

This pragmatic, multicenter, randomized controlled trial with a parallel group design included gainfully employed patients with IBD who were covered by one of four statutory health insurance providers. Patients in the intervention group were actively advised regarding options for rehabilitation and given support in applying for it; patients in the control group continued with the care they had been receiving before participation in the trial. The primary endpoint was social participation, and there were various secondary endpoints, including disease activity and sick days taken off from work. All parameters were assessed by questionnaire at the beginning of the trial and twelve months later. This was trial no. DRKS00009912 in the German clinical trials registry.

RESULTS

In a complete case analysis, the intervention group (211 patients, of whom 112 underwent rehabilitation) did better than the control group (220 patients, of whom 15 underwent rehabilitation) in multiple respects. The reported limitation in social participation was reduced by 7.3 points in the intervention group and 2.9 points in the control group (p = 0.018; d = 0.23). Significant improvements were also seen in disease activity, vitality, health-related quality of life, and self-management, with effect sizes between 0.3 and 0.4. No benefit was seen in outcomes related to working capacity. Sensitivity analyses lent further support to the findings.

CONCLUSION

Rehabilitation research can be conducted with individually randomized, controlled trials. The findings of this trial indicate the absolute effectiveness of ied rehabilitation for IBD patients, as well as its additional benefit compared to routine care.

[Trends in Medical Rehabilitation : Supply Structure and Target Groups]

Medical rehabilitation in Germany has been changing continuously since its inception following the Bismarck Legislation. This article describes its development in past years and discusses quantitative and qualitative changes. Central quantitative changes are discussed using the examples of rehabilitation utilisation, spectrum of diseases, setting and follow-up rehabilitation. Important qualitative changes in medical rehabilitation pertain to multiple morbidities, the emphasis on work-related problems in rehabilitative concepts and their implementation, more flexible forms of rehabilitation, prevention, rehabilitation for people from other countries, mobile rehabilitation and rehabilitation after-care (also with new media). The article ends with an outlook on future developments within legislation, access to rehabilitation and the budget for rehabilitation, in addition to cooperation with the workplace.

A qualitative investigation of barriers and facilitators of rehabilitation success from the psychosomatic inpatients' perspective

OBJECTIVE

Psychosomatic inpatient rehabilitation aims at promoting functioning in patients with mental disorders. Although generally effective, some patients do not benefit from this rehabilitation and suffer from symptoms as well as functional impairment. This study aimed to identify patient-reported factors influencing activity and participation outcomes.

SUBJECT AND METHODS

Five focus groups with N=23 former psychosomatic rehabilitation inpatients were conducted. The discussions focused on facilitators and barriers of treatment outcome. The material was analyzed inductively according to qualitative content analysis. Categories were derived from the material.

RESULTS

Patients reported sociodemographic and clinical characteristics as well as personal factors, preparation before psychotherapy, and aspects of employment and health care as predictors of treatment success.

CONCLUSION

A wide range of possible factors that influence the course of functioning from the patients' perspective were determined. These factors can be assigned to the ICF conceptual model. Clinician and researcher perspectives may complement these factors.

Early Workplace Intervention to Improve the Work Ability of Employees with Musculoskeletal Disorders in a German University Hospital-Results of a Pilot Study

Health promotion is becoming increasingly important in work life. Healthcare workers seem to be at special risk, experiencing musculoskeletal disorders (MSD); their situation is strongly influenced by demographic changes. The aim of this study is to evaluate the feasibility and outcome of a worksite intervention. In a one-group pretest-posttest design, 118 employees of a hospital were recruited from 2010 to 2011. The raised parameters were satisfaction with the program, work ability (Work Ability Index), and sickness absence (provided by human resource management). Patient-reported questionnaire data was raised at baseline (t1) and after three months (t2). Sickness leave was evaluated in the period six months prior to and six months after the intervention. Means, frequencies, standardized effect sizes (SES), analysis of variance, and regression analysis were carried out. Participants were found to be highly satisfied. Work ability increased with moderate effects (SES = 0.34; p < 0.001) and prognosis of gainful employment (SES = −0.19; p ≤ 0.047) with small effects. Days of MSD-related sickness absence were reduced by 38.5% after six months. The worksite intervention program is transferable to a hospital setting and integration in occupational health management is recommended. The use of a control group is necessary to demonstrate the effectiveness.

[Rehabilitation after polytrauma : Definitions and treatment approaches]

After initial resuscitation and surgical reconstruction of structural damages, the functional rehabilitation is one of the critical columns of polytraumatized patient management. This programme starts as early as the initial therapy in the trauma bay and proceeds until socio-professional reintegration of the patient into his pre-traumatic environment.Thus, three phases of a rehabilitation were identified: the early rehabilitation, the post-acute rehabilitation and the continuative rehabilitation.Since the mortality after major trauma is continuously decreasing, the life quality of trauma victims came more and more into the focus of the actual scientific discussion. To improve this life quality, several rehabilitation programmes were developed and varius instruments were developed to quantify outcome results, such as the GOS or the SF-36, respectively.The aim of this review is to describe these various programmes and instruments, to improve the individual rehabilitation process for polytraumatized patients.