Rehabilitation最新文献

Purpose: In the pilot project 'Coordination of individual participation: needs assessment and service provision from a single source', a case management (CM) concept was implemented and evaluated in vocational rehabilitation counseling (RC) at nine German Pension Insurances (DRV).

Methods: A sequential approach was designed as an iterative mixed-methods design in which the individual survey phases are linked instrumentally. Interviews were conducted with managers of the DRV (n=17) and counselors (n=11), who carried out CM after completing additional training, and online surveys were conducted with the latter (t1: n=47, t2: n=50). The surveys focused on the evaluation of CM and its organisation-specific implementation, changes since the introduction of CM, and prerequisites for its continuation. In addition, questionnaire surveys were conducted with participating insured persons at the beginning and end of the CM (t1: n=586; t2: n=329) and the standardised needs assessment of the case documentation was evaluated (n=820). This provided information on their characteristics and participation needs as well as their assessments of CM.

Results: CM was viewed mostly positively by managers and counselors, i. a., as an important pillar for the professionalisation of RC. Counselors considered the increased time available per case and the changed work and counseling routines to be particularly significant. Managers perceived a higher quality of counseling. Sufficient resources and stringent intra-organisational embedment were identified as prerequisites for the continuation of CM. CM was successful in reaching insured persons with multiple chronic conditions and greater needs for support. Insured persons rated the counseling as mainly positive.

Conclusion: The results indicate that CM is a promising approach for reaching and supporting insured persons with complex support needs for whom conventional services for participation in working life are insufficient. CM also strengthens needs orientation and person-centredness in vocational rehabilitation. However, there are significant differences between providers in the extent of CM implementation and the motivation to continue it. With the inclusion of CM in the German social law, questions about implementation, intra-organisational embedment and inter-organisational quality assurance have taken on new relevance.

Purpose: To compare a specific and graded exercise program (shoulder school) to the standard care protocol provided in the physiotherapy units of Spanish primary care centres to patients with rotator cuff-related shoulder pain (RCRSP).

Methods: A cluster randomised controlled trial was designed. Seven primary care centres participated in the study and were randomised into the shoulder school group (SSG) or the standard care group (SCG). Eighty-seven participants with RCRSP were included (SSG: n=47; SCG: n=40). Both groups underwent 16 sessions over eight weeks. The primary outcome was shoulder pain assessed using a 0-10 VAS over the last three days and during arm elevation. Secondary outcomes were disability (SPADI and DASH), active range of motion, isometric strength, quality of life (WORC), and patient satisfaction (GROC). Outcomes were measured by blinded examiners at baseline (T0), post-intervention (T1), and after 3 months (T2).

Results: Significant differences between-groups were found favouring the SSG for the primary outcome of pain intensity over the last three days at T1 (Mean difference [MD]=-2.44, 95% CI -3.18 to -1.69) and T2 (MD=-4.03, 95% CI -4.89 to -3.17), and during arm elevation at T1 (MD=-2.80, 95% CI -3.87 to -1.72) and T2 (MD=-4.03, 95% CI -5.20 to -2.85), as well as for the secondary outcomes of disability, range of motion, isometric strength, quality of life and patients' satisfaction (T1: p<0.01; T2: p<0.01). Changes in pain intensity, disability, quality of life and patient satisfaction were higher than the minimal clinically important difference at T1 and T2, favouring the SSG.

Conclusion: The implementation of shoulder school in primary care physiotherapy units proved to be statistically and clinically more effective than the standard protocols in the short- and medium-term, in patients with RCRSP.

Purpose: The aim of the present study was to develop and test a mobile and outpatient rehabilitation program for individuals with cognitive and/or multiple impairments as part of a feasibility study. The therapies were delivered both in the clinic and in the social environment (e.g., residential settings, sheltered workshops, public swimming pools). The objective of this qualitative analysis was to examine barriers to accessing rehabilitation that participants generally encounter, how they experienced their participation in the newly piloted mobile outpatient rehabilitation program, which factors contributed to goal achievement, and how participants assessed the sustainability of the intervention.

Methods: Semi-structured face-to-face interviews were conducted with all 15 project participants at the end of their participation. The interviews were transcribed and analyzed using structured qualitative content analysis according to Kuckartz and Rädiker.

Results: Participants reported numerous barriers to accessing medical rehabilitation, including rejected rehabilitation applications and structural barriers within facilities. The SIMRE intervention was evaluated positively. Factors supporting goal achievement included sufficient therapy time, adequate staff resources, and the combination of mobile and outpatient therapy. A comprehensive needs assessment within participants' living and working environments was found to be essential for individualized planning of rehabilitation measures. Concurrently, participants articulated concerns regarding the sustainability of achieved improvements, citing the lack of appropriate follow-up options as well as personnel and structural resources in routine care.

Conclusion: The findings indicate that a mobile and outpatient rehabilitation approach for individuals with cognitive and/or multiple impairments is both feasible and capable of contributing to improved participation. Additionally, the findings highlight the necessity for individualized rehabilitation and subsequent follow-up care to ensure the stability of the achieved outcomes.

Purpose: Racial discrimination directed at employees can significantly affect their well-being, job satisfaction, and professional development. In the German healthcare system, there is a lack of systematic research on the experiences of staff members who are affected by racism, particularly in rehabilitation facilities, where collaboration among staff and patients poses social challenges. This study aims to examine the extent and nature of such experiences and to assess existing complaint and prevention structures.

Methods: Between October and November 2024, 1,322 inpatient rehabilitation facilities were invited to participate in an online survey, to which 144 facilities responded. The survey addressed managers as well as quality and complaints officers. It assessed the frequency and context of racial discrimination by supervisors, colleagues, patients, or relatives, as well as existing institutional measures for prevention and intervention. Data were analyzed descriptively.

Results: Around one tenth of the reported complaints were related to racial discrimination. Most frequently, incidents were reported involving patients or their relatives; less commonly, incidents among colleagues were described. In 86.1% of the facilities, racist complaints were investigated immediately. 76.4% of the facilities provided support services for affected employees. Only a few of the surveyed institutions reported cooperating with external counseling services or legal advisors. Preventive measures varied in terms of their implementation: reporting systems for discrimination incidents were in place in 42.4% of the facilities, and regular trainings on cultural sensitivity were conducted in 35.4% of the facilities.

Conclusions: Racial discrimination against staff is a relevant issue in inpatient rehabilitation facilities. Institutional structures for complaint management and prevention are in place but are not yet comprehensively established. The findings indicate a potential need to further develop cooperations with external counselling services and to strengthen the sensitization of managerial staff. The study thus provides initial empirical evidence to inform the further development of institutional complaint and prevention structures.

Purpose: Improving out-of-home walking-related participation after stroke involves multiple stakeholders. Interprofessional diagnostics should constitute a prerequisite for outpatient therapeutic and assistive device provision. The overarching aim of this multi-methods study is the bottom-up development of a toolkit for this field. The aims of this sub-study were to identify challenges and co-creatively develop solution strategies for gaps in interprofessional collaboration.

Methods: A future workshop was conducted as a method of participatory action research in the Upper Bavaria District. Data analysis followed Mayring's qualitative content analysis and was guided by a model of interprofessional collaboration including interactional, organizational, and systemic determinants.

Results: Participants included people after stroke (n=5), relatives (n=1), and health professionals (n=17) from occupational and physical therapy, orthopaedic technology, general medicine, neuropsychology, nursing, statutory health insurance funds, counselling services, and foundations. They identified challenges extending beyond interprofessional diagnostics of out-of-home walking-related participation but related to it. Four action plans were developed for main points of criticism: (1) assessment toolbox, (2) interprofessional home visits, (3) digital communication, and (4) a participation roadmap. Shared core elements included participation-oriented person-centred care, the International Classification of Functioning, Disability and Health, and empowerment of people after stroke and their relatives.

Conclusion: The future workshop enabled the bottom-up development of solution strategies, which will be integrated into the design of a toolkit to support collaboration. Further development, evaluation, and sustainable implementation require reforms of legal frameworks, stronger cooperation between academia, service providers, and municipalities, improved digital infrastructure, and funding models for interprofessional collaboration.

Purpose: Knowledge about the development of functioning in older age is crucial to design targeted interventions to maintain good health in older adults. The aim of this study was to investigate the time-trajectories of functioning and its domains (Cognition, Mobility, Self-Care, Getting along, Life Activities, and Participation) over time in a community sample of older people with chronic health conditions. Additionally, the study sought to identify factors differentially associated with these trajectories.

Methods: A total of n=491 individuals aged 65 years and older with chronic health conditions answered the WHO Disability Assessment Schedule 2.0 questionnaire three times over a 1.5-year period (at T2 n=309). Linear Mixed Effects Models and pairwise comparisons of the slopes of the questionnaires different subscales were used to analyse trajectories over time and to identify associated factors.

Results: The results revealed a general decline in functioning over time across all domains, with the exception of Participation. Significant differences were observed between the trajectory coefficients of certain domains. While depressive symptoms displayed comparable associations with all domains of functioning, gender and age exhibited divergent associations with functioning across domains.

Conclusion: The results emphasize the importance of a nuanced understanding of how functioning develops across different domains in older age. This can contribute to targeted prevention and support programs for older adults at risk and help maintain good health in older age among those with chronic conditions.

Purpose: The treatment of sensorimotor disorders is a central component of neurological and neurosurgical early rehabilitation (NNER). To date, a comprehensive sensorimotor assessment for severely affected patients is not available. Therefore, the Sensorimotor Assessment Physiotherapie (SeMo-P) was developed at the Lurija Institut (Kliniken Schmieder in Germany). It comprises four independent components assessing different aspects of sensorimotor function: SeMo_Sensibility (sensitivity of the legs), SeMo_PM (passive joint mobility of the legs), SeMo_AM (active joint mobility of the legs), and SeMo_Mobility (patient mobility). The aim of this study was the systematic evaluation of the quality criteria reliability, validity, and responsiveness.

Methods: The sample consisted of 50 patients who completed the SeMo-P shortly after admission to the NNER (t1) and again four weeks later (t2). Appropriate psychometric methods were used to test reliability (internal consistency, inter-rater reliability), validity (convergent validity and concurrent/predictive criterion validity), responsiveness and the occurrence of floor or ceiling effects for each part.

Results: All parts of the SeMo-P showed overall good internal consistency (Cronbach's α: 0.72 - 0.97). In terms of inter-rater reliability, SeMo_Sensitivity, SeMo_AM, and SeMo_Mobility achieved excellent values (ICC_2,1: 0.98 - 0.99, p<0.001), while SeMo_PM fell within the moderate range (ICC_2,1: 0.71, p<0.001). Validity was only examined for the SeMo_Mobility, which had good construct (r_s: 0.91 - 0.95, p<0.001) and criterion validity (r_s: 0.68 - 0.73, p<0.001). All parts of the assessment record change over time (responsiveness), whereby the SeMo_Sensitivity could detect changes in fewer patients, which was presumably due to a ceiling effect at t1. The SeMo_PM also showed a ceiling effect. The SeMo_Mobility and the SeMo_AM showed very good results in terms of responsiveness and there were neither floor nor ceiling effects.

Conclusion: The study shows that the quality criteria of the SeMo-P items range from moderate to excellent. For clinical practice, the use of SeMo_AB and SeMo_Mobility is recommended. It should be noted that no investigation of validity has yet been conducted for the SeMo_AB. The other parts can be used optionally depending on the specific question.

Purpose: Chronic illnesses can significantly impair social participation and lead to disintegration, poverty and isolation. The aim is to trace the exclusion risks of people whose ability to work is at risk or already reduced due to illness.

Methods: The study is based on problem-centered interviews with 50 people insured by the German Pension Insurance (GPI) Bund or Nord who, according to GPI routine data, have a high risk of premature retirement due to illness. Recruitment and sampling were conducted using a letter and a questionnaire, which wer sent to a total of 4,000 insured persons. The analysis followed a mix of sequential-narrative and category-based approach, supplemented by a systematic-contrastive case comparison.

Results: People with reduced earning capacity are at risk of falling into a spiral of exclusion that can be accelerated or slowed down by various factors. Periods of incapacity to work, reductions in working hours and potential job loss and unemployment lead to financial losses, which can result in further restrictions on participation in the areas such as leisure, housing and consumption. Social participation can also suffer as a result. All of this, can further impair health and accelerate the spiral of exclusion.

Conclusion: In order to counteract disease-related social exclusions, comprehensive strategies are required that focus in particular on care and work-related exclusion factors without losing sight of "classic" categories of inequality.

Purpose: Accurate prediction models of individual psychosomatic rehabilitation success based on patient characteristics might help to identify potential non-responders and to optimize the fit between patients and treatment. The aim of the present study was to investigate the potential of machine learning in this context.

Methods: Random forest models were trained to predict treatment success in terms of the dimensions of symptom severity, health-related quality of life, interpersonal relationship building, and self-efficacy. In addition, relevant predictors were analyzed. Since random forest allows using both scale values and individual items as independent predictors, the present study utilized 555 potential predictors from 16 self-assessment instruments and 11 personal characteristics. This is a secondary data analysis of a dataset collected in a naturalistic single-group pre-post design. The random forest models were implemented using nested cross-validation. In the outer cross-validation, the final model was validated, and the included predictors were analyzed for their respective permutation importance.

Results: Depending on the dimension, between 30.02% and 38.94% of the variance in individual treatment success could be explained. In external cross-validation, between 29.33% and 37.83% of the variance was explained. Across all dimensions, a total of 45 predictors - 17 scale scores and 28 single items - were included. Only two predictors were relevant for all dimensions.

Conclusion: Using random forest models, large proportions of variance in individual treatment success could be explained for all investigated dimensions. In cross-validation, the large effect sizes and generalizability regarding new observations could be confirmed for all investigated dimensions. The analysis of relevant predictors provides additional evidence for predictors already associated with treatment success, while emphasizing the need of a nuanced consideration of psychosomatic rehabilitation success. A practical implementation of personalized treatments in the sense of personalized medicine does not seem feasible in the near future due to numerous limitations.