Die Rehabilitation
-
Developed within the German Pension Insurance scheme's Guidelines programme, the Guideline for Rehabilitation in Coronary Artery Disease has been publicly available since January 2005. Pension Insurance routine data on the therapeutic benefits and services provided (based on the Classification of Therapeutic Procedures, KTL) were analyzed to assess the extent to which rehabilitation facilities had complied with Guideline requirements already in 2004. In January 2005, the results were disseminated together with the Guideline to the rehabilitation facilities which had participated in Pension Insurance rehabilitation of patients with coronary artery disease in 2004. In an accompanying survey information was requested concerning acceptability and applicability of the Guideline, of the presentation of KTL data, as well as reasons for non-adherence to Guideline requirements. ⋯ The Guideline for Rehabilitation in Coronary Artery Disease is acceptable and practicable, and it is moreover tied in with external quality assurance activities in place (i. e., the quality assurance programme of the statutory Pension Insurance scheme). The audit feedback given in this framework provides rehabilitation facilities participating in the programme not only with comparative analyses but also with input for their internal quality management actions. Future activities within the external quality assurance programme should inter alia focus on more targeted implementation activities and repeated KTL-based appraisals.
-
Patients with irritable bowel syndrome (IBS) report a significant impact of their symptoms on functional health. In outcome assessment of clinical studies on IBS, however, functional aspects other than gastrointestinal symptoms seem to be disregarded to a great extent. ⋯ Outcome assessment of clinical IBS studies is mainly based on gastrointestinal symptoms. The assessment of other health aspects like comorbid psychological symptoms or social consequences of the disease seems to be similarly important and should be considered in future trials. This would also facilitate the understanding of IBS as a biopsychosocial health condition, both in matters of aetiology and consequences.
-
Randomized Controlled Trial Multicenter Study Comparative Study
[Comparison of three outpatient therapy forms for treatment of chronic low back pain-- findings of a multicentre, cluster randomized study].
The AOK Baden-Württemberg health insurance fund initiated a study on the outpatient rehabilitation of patients with chronic low back pain, aimed at improving the treatment concept for its insurees with chronic low back pain (START). This model project was scientifically guided by the Hochrhein-Institute in Bad Säckingen. The paper compares the effectiveness of Enhanced Outpatient Physiotherapy (Erweiterte Ambulante Physiotherapie, EAP), Outpatient Rehabilitation (Ambulante Rehabilitation, AR) and Medical Training Therapy (Medizinische Trainingstherapie, MTT) in patients with low back pain. ⋯ MTT might represent a meaningful therapy element also in new forms of provision such as integrated services. Patients showing severe psychosocial strain should be assigned to an interdisciplinary therapy as it is provided by inpatient and outpatient rehabilitation facilities. For effective differential assignment to the various programmes, realization of a standardized rehab assessment is an important precondition.
-
Randomized Controlled Trial Multicenter Study
[Effects of a programme for structured outpatient follow-up care after inpatient rehabilitation of obese children and adolescents--a multicentre, randomized study].
Inpatient rehabilitation is an important contributor to the treatment of child and adolescent obesity with comorbidity in Germany. Thus far outpatient follow-up care has not been subject to research. The main goal of this study is the development and longer-term evaluation of a programme for structured outpatient follow-up care by primary care physicians after inpatient rehabilitation of obese children and adolescents. ⋯ This low-level outpatient intervention did not improve the demonstrated longer-term effectiveness of inpatient rehabilitation. An interdisciplinary outpatient follow-up care in groups with inclusion of the parents is recommended.
-
So far, the routine programmes of the statutory pension and health insurance institutes for quality assurance in medical rehabilitation have not included facilities for children and adolescents. Thus, a conjoint project of the statutory pension and health insurance institutes to assess and to describe the structure quality of in-patient medical rehabilitation clinics for children and adolescents was initiated. The aim of the project was a survey and an analysis of the currently existing clinic structures and the development of criteria for an evaluation of the structure quality. The Institute of Medical Psychology, University of Hamburg and the Department of Quality Management and Social Medicine, University of Freiburg were engaged to conduct the project. ⋯ The results allow an analysis of the current clinic structures as well as a first comparison of clinics on the basis of the assessed structure characteristics.