Die Rehabilitation
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Review Comparative Study
[Current appraisal of external quality assurance procedures in geriatric rehabilitation].
Seven standardized external quality assurance (QA) procedures are currently being applied in geriatric rehabilitation in Germany. Five of these procedures are case-based (Gemidas, GiB-DAT, KODAS, EVA-Reha, Evaluation Procedures of the Medical Review Board of Saxony), and two are institution-based (Quality Seal for Geriatric Rehabilitation in Rhineland-Palatinate, Quality Seal for Geriatrics BAG KGE). The institution-based procedures focus on the quality dimensions "structure" and "process", whereas the case-based procedures mainly focus on the collection of administrative data, and to a limited extent on the quality dimensions "outcomes" and "patient satisfaction". ⋯ In most procedures, data processing and analysis are performed independently of the participating service providers but only partly independently of the agency responsible for the procedure and the whole group of service providers. In the case-based procedures, risk adjustment techniques are not routinely applied in comparisons between institutions. Attempts to implement standardised QA procedures in geriatric rehabilitation may be based on existing procedures and should use this appraisal for developing them further, however taking more into account QA aspects specific to geriatrics.
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The WHODAS II (World Health Organization Disability Assessment Schedule II) is a questionnaire derived from the ICF classification system (International Classification of Functioning, Disability and Health) for the evaluation of disabilities and handicaps. Data on its validity and reliability with respect to the consequences of stroke are largely lacking. The present study aimed at measurements of reliability of the WHODAS II in its application to stroke patients and their closest others. ⋯ Our results demonstrate that the WHODAS II is a reliable instrument for the assessment of stroke patients, both as a self- and an observer-rating questionnaire. Whereas the correspondence between patient and relative may be disparate with respect to single items - especially those not directly observable -, subscale and total scores seem to allow predictions based on observer judgements. The assessment of stroke patients' disabilities and handicaps through relatives' judgements with the WHODAS II scales is reliable.
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Within rehabilitation research ratings are one of the most frequently used assessment procedures. For example, therapists frequently make categorical judgements aiming to get information whether specific patient characteristics prevail or not (dichotomous rating format) or which of several alternatives holds for a patient (polytomous rating format). Interrater agreement is an important prerequisite to ensure that reliable and meaningful information concerning patients' state can be inferred from the data obtained. ⋯ This is the case because the value of Cohen's kappa is affected by information aspects that are independent of the quality of the rating process. In order to avoid such misconceptions, alternative evaluation strategies are described for dichotomous rating formats which enhance agreement analysis and thus ensure a more valid interpretation. In addition, it is shown how weighted Cohen's kappa (omega) may be used to analyze polytomous rating formats.
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Multicenter Study
[SIMBO: a Screening Instrument for Identification of Work-Related Disabilities--analyses of construct and prognostic validity].
For a number of years, work-related interventions in medical rehabilitation (MBO) have been developed. Basically, these interventions concentrate on vocational problems of rehabilitees whose health disorders are strongly associated with contextual factors of the environment as well as personal factors. Previous studies showed a close relationship between the success of an intervention and identification of a specific demand. In fact there are several clinical concepts regarding specific demand. But there still is a lack of appropriate instruments for use in identification of occupational challenges. Therefore SIMBO (Screening Instrument for Identification of a Demand for Medical-Vocational Oriented Rehabilitation) has been developed recently. By using a scale for the intensity of work-related problems as well as a cut-off point, SIMBO is able to identify patients with and without a demand for work-related interventions. ⋯ Concerning its clinical as well as predictive quality, the validity of SIMBO-based ratings of work-related problems has been proven. Further, it has become obvious that SIMBO is suitable as an easy-to-handle tool for identification of a need for vocationally-focused interventions for use by the social insurance agencies which finance rehabilitation. Further interesting questions arise relative to application in different indications as well as potential uses as an outcome instrument.
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The legal foundations for provision and realization of geriatric rehabilitation benefits are contained in particular in Book 9 of the German social code, SGB IX (covering rehabilitation and participation of people with disabilities). This paper discusses claims foundations and benefit prerequisites of geriatric rehabilitation taking into consideration the relations between Book 5 (on health insurance) and Book 9 of the social code. ⋯ Responsibility for the content, extent and quality of geriatric rehabilitation lies with the benefit carriers, as is the case for the obligation to secure availability of the required numbers and quality of rehabilitation facilities and services. The article specifies the legal foundations of the various benefit types (ambulatory, mobile rehab, under a Personal Budget, integrated benefit provision, or early rehab), and discusses geriatric rehabilitation in the framework of an insurance-based medical care system as well as of activating care.