Die Rehabilitation
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Rehabilitation benefits provided under the German Pension Insurance scheme are of central importance to insureds, in terms of protection in cases of loss or reduction of their earning capacity. Due to this safeguarding effect for the gainfully employed population, rehabilitation benefits at the same time are important to the insured community and to society as a whole. In 2003, some 846 000 insured persons had received medical and other benefits for rehabilitation. ⋯ Among the possibilities for ensuring lasting success are follow-up measures or benefits arranged for already during the in-patient stay, a service field which until recently had hardly been known in Germany. A stock-taking carried out in 2004 by the author and supported by LVA Schleswig-Holstein, a regional pension insurance institute, has for the first time realized an overview of this kind. Its essential findings are presented in this article, supplemented by a partial update vis-à-vis completion of the initial investigation.
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The introduction of the new interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" based on the 9th revision of the Federal Medical Licensing Regulations (Approbationsordnung fur Arzte) implies new opportunities and challenges for teaching. In order to investigate the transfer of the new subject to teaching practise, a written questionnaire was sent to all German medical faculties. With regard to the implementation of new teaching structures and procedures in the subject, a range of different indicators was examined. 50 % of the medical faculties have been planning for comprehensive teaching sessions as compared to distribution over the whole semester. ⋯ However, in spite of increased demands, supplementary funds for additional equipment or manpower are rarely provided for. In the future, enhanced allocation of resources based on performance-related evaluation within the medical faculties and teaching competition between universities may provide significant stimuli for advances in medical training also in the new interdisciplinary subject. Further improvement of general teaching conditions is necessary in order to utilize all the opportunities offered by the new Federal Medical Regulations.
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In rehabilitation research patient questionnaires are widely used for evaluative purposes, i. e. to measure improvements or deteriorations over time. This is only possible if the questionnaires applied appropriately reflect "true" change over time, i. e. they have to be sensitive to change. ⋯ Various qualitative aspects, e. g. scaling of response options of assessment tools, are covered as well as quantitative methods, i. e. study designs and indices. Furthermore, recommendations for interpretation are given.
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The ninth book of the German social code, SGB IX, has intensified questions on the effectiveness and usefulness of medical rehabilitation, a multimodal multidisciplinary team care model, especially but not exclusively for chronic back pain. In 2002 back pain was the reported leading cause for 29 % of all medical and other rehabilitative services provided by German statutory pension funds. A previous systematic review of all available German studies (January 1980 to June 2001) analysed the effectiveness of inpatient rehabilitation for chronic back pain. The present report provides an update and critical appraisal of the review. ⋯ The small size of medium term effects indicates a basic problem of inpatient rehabilitation for chronic back pain in Germany. This becomes even greater when the results of international controlled studies are used as reference. Possible reasons for the disappointing situation (weak methodology, inappropriate selection of patients, weak intervention) are to be discussed. At present, we have no convincing evidence for a general effectiveness of Germany's system of inpatient rehabilitation for chronic back pain.