Die Rehabilitation
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In Germany a number of patients who are suffering from acquired brain injury and chronic neurological disability are either undersupplied or exposed to inappropriate care in their social environment. The number of these patients is increasing due to the changes in the procedures of care and due to demographic factors. While acute medical care and early rehabilitative treatment is accessible throughout the German health care system the necessary multimodal and competent care is rare or absent in the social participative sites such as life and occupational environments of the patients. ⋯ What seems to be needed is (5) systematic orientation to the goal of individual social participation at all levels of support, (6) cross linking, cooperation and development of the existing medical and social structures on site, (7) expansion of the legal framework and (7a) especially control of the implementation of the existing rights of social benefits and (7b) surveillance (transparency and quality management not only in the area of caregivers but also for the administration of social insurances!). The recommendations of the authors integrate systematically into the phase model of neurorehabilitation (VDR/BAR) in Germany. The focus of this work is the needs-appropriate programming of phase E, i. e., the transition between inpatient and outpatient care, between the clinical facility-oriented and the community-based (domicile-oriented, occupational-oriented) sectors, between welfare and independency.
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Interventions in medical rehabilitation are often evaluated using a single-group pre-post study design with health-related quality of life (hrqol) as an outcome variable. Through comparison of mean values in hrqol subscales treatment effects are calculated. In many cases conclusions about changes in hrqol are made depending on the sizes of effects. ⋯ Investigations of measurement of invariance in longitudinal studies allow for conclusions regarding sensitivity to change of instruments examining hrqol changes. This is important for clinicians who make decisions about which scales are appropriate to detect hrqol changes. For scientific research it is relevant for further analysis of sensitivity to change of hrqol instruments.
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Subjective constructs like health-related quality of life are often investigated in scientific surveys in rehabilitation science, usually assuming that such constructs would be equally defined between different groups in case of cross-sectional control group designs or across time in longitudinal study designs with or without control-groups. Differences between measurements of these constructs were expected to occur only regarding quantity but not regarding quality. However, this assumption cannot be expected to apply in every case and it is discussed from a theoretical angle under the terms of invariance or equivalence of measurements. ⋯ The application of confirmatory factor analysis to test measurement invariance in a cross-sectional design will be described in this article on the example of quality of life data from inpatient rehabilitation. Methodological and substantive aspects which arise if measurement invariance is disproved will be discussed. In a companion article (Jelitte & Schuler, in press) the method will be described for a longitudinal study design and results will be discussed in the context of response shift research.