Die Rehabilitation
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Clinical Trial
[Influence of depressive symptoms and gender in chronic low back pain rehabilitation outcome: a pilot study].
Currently, little is known about the influence of depressive symptoms and gender-specific aspects in rehabilitation outcome of patients with chronic low back pain. Effects of gender and depressive symptoms on rehabilitation outcome were examined immediately after rehabilitation, as well as three and six months after rehabilitation in 116 patients with chronic low back pain (43 women, 73 men; M=48 yrs.; ICD-10 diagnoses: M45.4/M45.5, M54.4/M54.5). Immediately after rehabilitation, general improvements with medium effect sizes in all rehabilitation measures were found. ⋯ In contrast, especially male patients with severe depressive symptoms revealed regressive rehabilitation outcomes, both in pain-related variables as well as marginally in the coping with pain strategy of "cognitive restructuring". In post-hoc analyses, in the mid-term, they even showed a deterioration of functional capacity and somatisation compared to prior to rehabilitation. Our results suggest that the outcome of orthopaedic rehabilitation may be persistently improved by implementing gender-specific treatments in general and elements of depression treatments for the patients with severe but sub-clinical depressive symptoms.
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The SGB IX, book 9 of the German social code (Sozialgesetzbuch, SGB), which is the legal basis of rehabilitation in Germany, states "participation and self-determined conduct of life" as the ultimate ambition of rehabilitation. This concept of participation and disability is based on the WHO model expressed in the International Classification of Functioning, Disability and Health (ICF). In this model, participation after the onset of a health problem may not only be infringed by disturbances in body functions and structures and the resulting activity limitations but also by contextual factors such as environmental and personal factors. ⋯ Since contextual factors together contributed 41.6% (SD=17.2%) to the overall disability they have major relevance for the rehabilitation process, because they essentially decide on the extent to which abilities acquired by the rehabilitant during rehabilitation actually be transfered to his everyday life. Therefore, rehabilitation programmes need to include assessment and treatment of contextual factors. It hence is necessary to develop instruments to quantify contextual factors.
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Comparative Study Controlled Clinical Trial
[Conception and evaluation of a group therapy intervention for patients with chronic pain disorders and applications for early retirement pensions].
Patients with chronic pain disorder are generally thought to be difficult to treat in psychosomatic rehabilitation. On average, their disorders tend to take a more chronic course than those of other patients, and they develop a higher rate of additional socio-medical problems, all of which increase the probability of therapy failure. Most of the time, such failures are attributed solely to the desire for early retirement and disability pensions, that is, a characteristic of the patient. However, a lack of specific therapeutic offers for patients with predominant psycho-social problems has also to be considered. The project described was designed to evaluate a newly developed socio-medical therapy module. This module aimed at bringing more transparency to the process of assessing occupational capabilities and work performance, thus improving the patients' motivation to participate in the rehabilitation program as well as the overall therapy outcome. ⋯ The original and possibly too ambitious goal of the project, namely to increase the rehabilitation success for patients with pain disorder and current pension applications by means of the therapeutic module labeled "social medicine", was not achieved. Nevertheless it is to be noted that this module was well received by the patients. Moreover, the authors consider it to be of high value in itself that this therapeutic module helps patients to become better informed.
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Review Meta Analysis Comparative Study
[Efficacy of intensified inpatient rehabilitation in musculoskeletal disorders: systematic review and meta-analysis].
Previous reviews concerning inpatient orthopaedic rehabilitation in Germany stated no convincing evidence of its effectiveness. However, work-related and behavioural-medicine concepts of rehabilitation have for several years been established in order to intensify and broaden conventional rehabilitation. But so far none of the previous studies had compared intensified and conventional rehabilitation within the framework of a systematic review of randomized controlled trials and used a meta-analytic approach. ⋯ The relevant studies provide evidence that intensified rehabilitation improves self-rated state of health and reduces pain intensity in rehabilitants with musculoskeletal disorders.
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Rehabilitation, Physical Medicine, Naturopathic Treatment (Querschnittsbereich Q-12) was introduced as a compulsory interdisciplinary subject in the revised Federal Medical Licensing Regulations (Approbationsordnung für Arzte) in October 2003. This offered the opportunity to increase the students' interest in rehabilitation-related issues and to integrate current evidence of rehabilitation research. The implementation of the Q-12 in the German medical faculties was investigated by yearly questionnaires during a three-year-period. ⋯ During the three examinations, major differences concerning the implementation of Q-12 were found between the faculties. Therefore, it is recommended that all faculties verify whether they adequately cover the joint educational objectives recommended for Q-12 by two German scientific societies. Furthermore, the more frequent application of up-to-date practice-oriented teaching and examination methods, an intensified implementation of Q-12-related issues in teaching specific indications, the completion of curricula, enhanced offer of compulsory election subjects related to Q-12 issues, continued scientific investigations and symposia/workshops concerning the promotion of Q-12-related teaching as well as the generation and exchange of teaching and examination materials are recommended.