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PubMed2000

Use of the Beck Depression Inventory-II with depressed geriatric inpatients.

To provide information about the clinical utility of the Beck Depression Inventory-II (BDI-II) [Beck, A.T., Steer, R.A., & Brown, G.K. (1996b). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation] with geriatric inpatients, the BDI-II was administered to 130 psychiatric inpatients who were 55 years old or above and who were diagnosed with principal DSM-IV major depressive disorders (MDD) (N = 85, 65%) or adjustment disorders with depressed mood (N = 45, 35%). The internal consistency of the BDI-II was high (coefficient alpha = 0.90), and its total score was not significantly related to sex, age, or ethnicity. An iterated maximum-likelihood factor analysis found the Cognitive and Noncognitive dimensions which have been reported for the BDI-II by Steer and co-workers (Steer R.A., Ball R., Ranieri W.F., & Beck A.T. (1999). Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. Journal of Psychopathology and Behavioral Assessment, 55, 117-128) in a younger sample of clinically depressed psychiatric outpatients. The mean BDI-II total score of the 85 geriatric inpatients with MDD was also comparable to that of 42 younger (< or = 54 years old) inpatients with MDD. The results were discussed as supporting the use of the BDI-II with clinically depressed geriatric inpatients.

Acute Disease↗
PubMed2000

Predicting inpatient mortality for pediatric trauma patients with blunt injuries: a better alternative.

PURPOSE: The aim of this study was to identify significant independent predictors of inpatient mortality rates for pediatric victims of blunt trauma and to develop a formula for predicting the probability of inpatient mortality for these patients. METHODS: Emergency department and inpatient data from 2,923 pediatric victims of blunt injury in the New York State Trauma Registry in 1994 and 1995 were used to explore the relationship between patient risk factors and mortality rate. A stepwise logistic regression model with P<.05 was developed using survival status asthe dependent variable. Independent variables included are elements of the Pediatric Trauma Score (PTS), additional elements from the Revised Trauma Score (RTS), the motor response and eye opening components of the Glasgow Coma Scale (GCS), age-specific systolic blood pressure, the AVPU score, and 2 measures of anatomic injury severity (the Injury Severity Score [ISS] and the International Classification of Disease, Ninth Revision-based Injury Severity Score [ICISS]). RESULTS: The only significant independent predictors of severity that emerged were the ICISS, no motor response (best motor response = 1) from the GCS, and the unresponsive component from the AVPU score. The statistical model exhibited an excellent fit (C statistic = .964). The specificity associated with the prediction of inpatient mortality rate based on the presence of 1 or more of these risk factors was .926, and the sensitivity was .944. CONCLUSION: The best independent predictors of inpatient mortality rate for pediatric trauma patients with blunt injuries include variables not specifically contained in the PTS or the RTS: ICISS, no motor response (best motor response = 1) from the GCS, and the unresponsive component of the AVPU score.

Child↗
PubMed2001

Transcervical Foley catheter for preinduction cervical ripening in an outpatient versus inpatient setting.

OBJECTIVE: To compare use of the Foley catheter for preinduction cervical ripening in an inpatient versus outpatient setting. METHODS: A randomized trial was conducted from May 1998 to December 1999. Women with a term gestation in the vertex presentation, a reactive nonstress test, an amniotic fluid index above the fifth percentile, and a Bishop score of no more than 5 were included. The primary outcome variable was a change in Bishop score. A Foley catheter with a 30-mL balloon was placed through the cervix on gentle traction in each group. The outpatient group was then discharged home with written instructions and returned in the morning for induction. The inpatient group was admitted to labor and delivery, with induction started upon extrusion of the Foley. RESULTS: Sixty-one women were randomized into the outpatient group, and 50 women into the inpatient group. Maternal age, gravidity, previous cesarean delivery, and gestational age did not differ between the groups. The median Bishop score at entry was 3.0 for each group (P =.97). The mean change in Bishop scores after catheter placement was not different between the inpatient and outpatient groups (3.0 versus 3.0; P =.74). The maximum dose of oxytocin, time of oxytocin, epidural rate, induction time, 1-minute and 5-minute Apgar scores, and cord pH were not significantly different. The outpatient group on average avoided 9.6 hours of hospitalization. There were no adverse events or maternal morbidity in either group. CONCLUSIONS: The Foley bulb is as effective in the outpatient as the inpatient setting for preinduction cervical ripening.

Adult↗
PubMedDate not supplied

Psychiatric characteristics of consecutively evaluated outpatient renal transplant candidates and comparisons with consultation-liaison inpatients.

The purpose of this study was to empirically define psychiatric characteristics of renal transplantation candidates and determine whether demographic, psychiatric predisposition, psychiatric impairment, and psychiatric diagnosis characteristics differ from those of consultation-liaison (C-L) service inpatients. Standard clinical information recorded by a C-L service for 66 consecutively evaluated renal transplant candidates and 134 C-L inpatients was compared. The results revealed that the transplantation evaluation patients differ demographically from the C-L inpatients. The C-L inpatients are more likely to report past history of mental health treatment, but the two groups are equally likely to report past substance use disorder treatment. Mean scores on the Global Assessment of Functioning Scale and Hamilton Anxiety and Hamilton Depression scales are less impaired in the transplant candidates. Mini-Mental State Exam mean scores are not significantly different. Five psychiatric diagnoses are significantly more likely in the C-L inpatients; only one is more likely in the transplant candidates. The authors conclude that the psychiatric characteristics of renal transplant candidates are distinct in many respects, confirming the unique skills needed by C-L psychiatrists who do pretransplant psychiatric evaluations.

Ambulatory Care↗
PubMed1992

Results of inpatient and outpatient cataract surgery. A historical cohort comparison.

PURPOSE: The transition from inpatient to outpatient cataract surgery during the last decade was not accompanied by prospective investigation of its effect on visual outcomes or surgical complications. The authors performed this study to assess the impact of this transition on surgical results. METHODS: The authors reviewed 600 extracapsular cataract extractions performed by 4 experienced ophthalmic surgeons during a 36-month period; in 300 cases, patients were hospitalized after surgery (inpatient group), and, in 300 cases, patients were never hospitalized (outpatient group). The same surgical techniques were used in all cases. Visual outcome and rates for operative and postoperative complications were compared. RESULTS: There were no statistically significant differences between the inpatient and outpatient groups for visual acuity. Excluding patients with pre-existing nonlenticular ocular disease, a best-corrected visual acuity of 20/40 or better was achieved in 93.1% of inpatient cases and in 97.2% of outpatient cases 6 months after surgery. Postoperative, clinically apparent cystoid macular edema was more common in the inpatient group (P = 0.03); however, after exclusion of patients with diabetes, hypertension, age younger than 65 years, and eyes with pre-existing nonlenticular disease, there was no statistically significant difference between groups. No significant differences in rates for other operative and postoperative complications were identified, including wound dehiscence, unplanned postoperative filtering blebs, infectious endophthalmitis, retinal detachment, persistent iridocyclitis, glaucoma, and corneal edema. CONCLUSION: This study does not demonstrate that the transition to outpatient cataract extractions has had an adverse effect on surgical outcomes.

Aged↗
PubMed1998

Emergency department observation unit: can it be funded through reduced inpatient admission?

STUDY OBJECTIVE: We sought to test the assumption that an emergency department observation unit can be funded through the reallocation of resources made available through the unit's impact in reducing inpatient admissions and facilitating bed closures. METHODS: We conducted our study in a tertiary care center ED with 46,000 visits annually. For a 3-month period, all patients admitted to the hospital through the ED were screened by an emergency physician for suitability for admission to an observation unit. Any patient in the hospital for 3 days or less who did not undergo surgery or other inpatient procedure, and who was admitted through the ED, was considered a candidate for the observation unit. RESULTS: Of 1,840 admissions, 147 patients met the admission criteria. Only 48 (32.2%) could have been treated in an observation unit, and these patients were not admitted to any single unit in high frequency. The potential savings from inpatient bed closures would only have amounted to 1.68 full-time equivalents-not enough to staff a 4-bed observation unit, which would require 5 full-time equivalents. CONCLUSION: Because of the diffuse and inconsistent effect such a unit had on inpatient bed use, funding for an ED observation unit at our institution could not be justified on the basis of the closure of inpatient beds and transfer of resources.

Adolescent↗
PubMed1994

Drug and alcohol abuse inpatients' attitudes about smoking cessation.

Attitudes about quitting cigarette smoking were assessed at admission to a substance abuse treatment program for homeless veterans. The majority were interested in quitting smoking, believed that inpatient drug/alcohol treatment was the best time to quit, and that quitting would not threaten their sobriety. Using cluster analysis, four subgroups of inpatients with different levels of interest, confidence, and motivation regarding quitting smoking were identified. Our inpatients' positive attitudes about quitting smoking stand in contrast with previously reported attitudes of many health professionals, and suggest that inpatient treatment could be an opportune time to provide stop-smoking interventions. Findings also suggest that different treatment approaches may be needed for subgroups of inpatients with varying attitudes about quitting.

Adult↗
PubMed2003

Using tools to assess and prevent inpatient falls.

BACKGROUND: Inpatient falls and fall-related injuries continue to be a complex challenge that health care organizations face. Protecting patients from falls and injury and ensuring a safe environment are fundamental to providing high-quality care. FACING THE PROBLEM: In June 2000 NorthEast Medical Center (Concord, North Carolina) experienced an inpatient fall rate (6.1 falls/1,000 patient days) that exceeded the internal benchmark (4.1 falls/1,000 patient days). The interdisciplinary Fall Team developed the Fall Risk Assessment tool. Patients were given a fall risk score and were categorized as either low or high risk. Interventions were chosen by the caregiver and became part of each patient's overall safety plan of care. THE NEXT STEP: Root cause analyses were performed for each inpatient fall to expose possible relationships between assessed fall risks and root causes. For example, approximately 80% of the patients who fell were confused, had gait disturbance, and were attempting to toilet alone. Through use of Failure Mode and Effects Analysis, the team was able to review the fall process in a prospective fashion. FOCUS ON HIGH-RISK INPATIENT POPULATIONS: In January 2001 the Fall Team began to focus on preventing falls in this patient population. An action plan for fall prevention was implemented, resulting in a decrease from 67 to 28 falls per 1,000 patient days. RESULTS: From the team's inception in June 2000 to the first quarter of 2003, the inpatient fall rate decreased from 6.1 to 2.6 falls per 1,000 patient days--a 43% decrease. With increased patient acuity and specialization in care of new and more challenging patient populations, health care organizations must quickly identify patients' fall risks and develop innovative methods to prevent falls.

Accidental Falls↗
PubMed1997

Assessment and treatment selection for "revolving door" inpatients with schizophrenia.

GOALS: The goals of this study are 1) to determine causes and patterns of relapse for a cohort of "revolving door" schizophrenia inpatients, and 2) to assess the feasibility of starting a new psychopharmacologic intervention before discharge, either depot therapy or an atypical antipsychotic. METHODS: Consecutive admissions to an acute inpatient unit in New York City were screened for "revolving door" criteria. Patients had to have a primary diagnosis of schizophrenia or schizoaffective disorder and have either 1) two hospitalizations in the last year, or 2) three hospitalizations in the last three years. Patients were then assessed for probable causes of relapse for the index and prior two hospitalizations. Treatment selection, based on this information, was trichotomized to: 1) oral conventional antipsychotic, 2) depot conventional antipsychotic (either haloperidol or fluphenazine decanoate), or 3) atypical antipsychotic (either risperidone or clozapine). RESULTS: Sixty-three out of 131 screened admissions met the above revolving door criteria. They were indeed "revolving", having an average of 1.3 hospitalizations per year over the last 3 years and were only out of the hospital for five months (median) before index admission. The treatment selection process was hampered by lack of information about events leading to relapse, and by the lack of outpatient participation in the medication selection process. Of the 50 patients with complete histories about precipitants for the index episode, the most common reason for rehospitalization was judged to be medication noncompliance (n = 25; 50%), followed by medication nonresponse (n = 13; 26%). Not surprisingly, medication recommendations were closely linked to the assessed reason for relapse (depot therapy [n = 27; 49%] with medication noncompliance; atypical antipsychotic [n = 20; 37%] with medication nonresponse [X2 = 26.9, p < .001]). These two recommendations were implemented before discharge for about one-half of the cases. Patient refusal was a relatively greater problem for depot recommendation while constraints in the outpatient environment were more problematic for patients recommended for atypical antipsychotics. CONCLUSIONS: Medication noncompliance and medication nonresponse, in that order, were judged to be the most common causes of relapse for "revolving door" inpatients. Both depot therapy and atypical antipsychotics were commonly recommended and ultimately accepted by about 2/3rds of patients. Choice between depot and atypical was driven by the assessed cause of relapse. In summary, it seems possible to identify "revolving door" inpatients, and to target specific medication interventions within the time frame of an acute inpatient admission.

Acute Disease↗
PubMed2002

[Are inpatient rehabilitation or ambulatory physical therapy of patients with musculoskeletal problems effective and are patients referred to proper treatment?].

The aim of the present study was to investigate the effectiveness of an inpatient rehabilitation program and outpatient physiotherapy, respectively. Moreover, we wanted to know whether the referral to these two treatment paths was appropriate with regard to the patient's initial health status. According to the referring physician's indication patients with health problems in the cervical, lumbar spine, arm or leg were treated by an inpatient rehabilitation program or by outpatient physiotherapy. These two consecutively recruited patient cohorts were then compared. Those patients treated by the inpatient rehabilitation program differed from the outpatient group with regard to the initial health status and to age. Patients with musculoskeletal problems, who underwent an inpatient rehabilitation program, showed a significantly worse health and functional status than the outpatient group. Therefore, it can be concluded that the indication towards inpatient rehabilitation or outpatient physiotherapy was correctly given by the referring physicians. Patients treated by outpatient physiotherapy did also show a reduced health and functional status in comparison to the average population. Both types of treatment led to statistically significant and clinically relevant improvement of both the health and functional status in all patient groups.

Adult↗
PubMed2006

[How successful is inpatient treatment in child and adolescent psychiatry? Preliminary results of the Marburg Evaluation Project].

OBJECTIVES: From 1999 to 2006, the inpatient treatment of a complete clinical sample in a child and adolescent psychiatric hospital was evaluated in a naturalistic effectiveness study in order to obtain detailed information about the outcome of the therapies. METHODS: The project was realized as a longitudinal 1-sample design with measurements at three points in time (admission assessment; discharge assessment and 6-week follow-up; 1 1/2 year follow-up). An essential part of the assessments was conducted using standardized telephone interviews with the parents of the inpatients. The project included 1,321 inpatients; the 1 1/2 year follow-up was accomplished for 776 cases. RESULTS: In all repeated measurements, there were highly significant effects. The pre-post effect sizes were higher than 1. The effects which were achieved during inpatient treatment were stable over time with a slight improvement after treatment. The outcome of different diagnostic groups showed significant differences at the 1 1/2 year follow-up. CONCLUSIONS: The results should be used in the counselling of patients and their parents prior to starting therapy. It should be investigated whether the favourable results can be generalized for inpatient treatments in other hospitals of child psychiatry.

Adolescent↗
PubMed2002

Cost-effectiveness analysis of a psoriasis care instruction programme with dithranol compared with UVB phototherapy and inpatient dithranol treatment.

BACKGROUND: This study was part of a large national cost-effectiveness analysis, and was funded by the National Fund for Investigational Medicine of the Health Care Insurance Board. OBJECTIVE: To compare the costs of treatment of moderate to severe psoriasis by dithranol short contact therapy in a care instruction programme (short contact therapy) with ultraviolet B phototherapy (UVB) and inpatient dithranol treatment (inpatient treatment), and relate these costs to treatment effectiveness. METHODS: An open randomized controlled multicentre study was performed. The costs (both medical and non-medical) were calculated for the following periods: during treatment, per month during remission, after a relapse, and following an unsuccessful treatment. The effectiveness measures were the clinical response rate and the number of clearance days during follow-up. RESULTS: The data from 216 patients were analysed. The mean overall costs per patient during treatment were euro;1641, euro;1258 and euro;7706 for short contact treatment, UVB and inpatient treatment, respectively. During the clearance period the mean costs per month per patient were euro;19, euro;5 and euro;25, respectively. The clinical response rates were 57%, 57% and 85%, respectively. The mean number of clearance-days after short contact treatment was 160 [median 119; interquartile range (0-357)], which was not significantly different from the other two strategies: 211 clearance-days after inpatient treatment [241 (99-350)] and 136 clearance-days after UVB [81 (0-266)]. CONCLUSIONS: Short contact treatment is an attractive alternative for patients with moderate to severe psoriasis currently treated by inpatient treatment, as the costs of short contact treatment were significantly lower and the number of clearance days was comparable. Considering the higher costs, short contact treatment is not a first choice treatment when compared with UVB.

Administration, Topical↗
PubMed1999

Characteristics of people with intellectual disability admitted for psychiatric inpatient treatment.

The present prospective study describes the demographic, medical and psychosocial characteristics of 40 people with intellectual disability who were referred for psychiatric inpatient treatment in the special psychiatric unit of the Special Welfare District of Southwest Finland. Three different control groups were used to study: (I) demographic variables (n = 122); (2) medical history (n = 39); and (3) psychosocial factors (n = 20). The symptoms leading to an admission to inpatient care and the connections of these clinical signs with the discharge diagnosis were evaluated. The typical inpatients were young males with mild intellectual disability, psychosis and a previous psychiatric diagnosis. They had lived in several places during their lives and their economic situation was poor. Affective and/or disruptive symptoms were the most common causes of an admission to inpatient care. The largest diagnostic group at discharge consisted of patients with psychotic disorders. The people with intellectual disability who were admitted for inpatient care formed a subgroup with certain psychiatric symptoms and social problems. Specialist psychiatric expertise is absolutely necessary for the treatment of this subgroup.

Adolescent↗
PubMed2000

Staff development, anxiety and relaxation techniques: a pilot study in an acute psychiatric inpatient setting.

Psychiatric inpatients often complain of problems with anxiety, but a computerised search of the nursing literature failed to find any publications detailing nurse-led, individual or group anxiety management work specifically aimed at psychiatric inpatient populations. In the UK, psychiatric inpatient populations are characterized by people with clinical diagnoses of schizophrenia and major affective and personality disorders. This is a very different population from that treated in the vast majority of published trials of cognitive and other approaches to anxiety management. A pilot study was conducted on four psychiatric acute admission wards to determine the practicality of treating a convenience sample of psychiatric inpatients with self-reported anxiety problems along broadly cognitive lines. Patients attended a course of three anxiety management groups (AMGs) run by nurses and were given homework and other exercises to complete. Patients reported significant reductions in anxiety after completion of the treatment. The AMGs were facilitated by staff nurses under the supervision of a clinical nurse specialist, and not by fully trained therapists as in most treatment studies relating to anxiety. Further studies, particularly randomized controlled trials, are needed to explore the efficacy and practicality of nurses delivering brief psychological interventions to psychiatric inpatients.

Acute Disease↗
PubMed2001

Benefits of an inpatient pulmonary rehabilitation program: a prospective analysis.

OBJECTIVE: To examine the effect of an inpatient pulmonary rehabilitation program on functional outcome, supplemental oxygen use, quality of life (QOL), and rehospitalization. DESIGN: A prospective study. SETTING: Inpatient pulmonary rehabilitation unit. PATIENTS: One hundred fifty-seven patients with moderate to severe chronic obstructive pulmonary disease (COPD) admitted to an inpatient pulmonary rehabilitation program over a 3-year period. INTERVENTION: Comprehensive interdisciplinary inpatient pulmonary rehabilitation program with an average length of stay of 21 days. MAIN OUTCOME MEASURES: Improvements in QOL questionnaire scores, COPD knowledge questionnaire scores, 6-minute walking test (with 3 ambulation categories: bed-bound, household ambulators, community ambulators), and supplemental oxygen use. Rehospitalization 1 year after completion of the program was also assessed and compared with hospital days for the year before the program. RESULTS: On discharge from the program, 88% of individuals walked farther (p <.0001), and community ambulators doubled their walking distance, whereas bed-bound patients decreased 10-fold; supplemental oxygen use dropped 33% during the day (p <.0001) and 57% during the night (p <.0001); 82% showed improved QOL (p <.0001); 67% showed improved knowledge of COPD (p <.0001); and 67% of the sample spent less time in the hospital during the 12 months after program completion compared with the 12 months before admission (p <.001). CONCLUSIONS: An inpatient pulmonary rehabilitation program leads to improved endurance and functional ambulation, decreased supplemental oxygen use, and fewer hospitalizations 1 year after discharge for patients with COPD.

Aged↗
PubMed2001

Comparing stroke rehabilitation outcomes between acute inpatient and nonintense home settings.

OBJECTIVE: To compare outcomes in stroke survivors who received rehabilitation services in an acute inpatient rehabilitation setting (multidisciplinary rehabilitation team) with outcomes in survivors in a home-based setting (family caregivers, limited team supervision). DESIGN: Randomized clinical trial, with mean follow-up after 60 days. SETTING: Inpatient rehabilitation setting and home-based settings. PATIENTS: Sixty patients (age range, 43-80yr) who had a stroke between 1996 and 1999 and had been referred after medical stabilization, randomly divided into 2 groups: group 1, inpatient rehabilitation; group 2, home-based rehabilitation. INTERVENTIONS: Group 1: therapeutical and neuromuscular exercises with occupational therapy with professional supervision; group 2: conventional exercises with family caregiver and limited professional supervision. MAIN OUTCOME MEASURES: Spasticity was evaluated with the Ashworth Scale, motor status with Brunnstrom's stages, functional status with the FIM instrument, and cognitive status with the Mini-Mental State Examination before and after rehabilitation. RESULTS: Patients rehabilitated in acute inpatient settings had better motor, functional, and cognitive outcomes (p < .05). Spasticity changes did not differ between the groups. CONCLUSION: Intense inpatient rehabilitation services for stroke survivors provide significantly more favorable functional and cognitive outcomes with relatively low complications than did nonintense rehabilitation efforts in home settings.

Adult↗
PubMedDate not supplied

[Outpatient rehabilitation of alcohol dependent patients in a day clinic: initial results of a comparative follow-up study of day clinic and inpatient treatment].

This article describes the development of an outpatient concept for the day-clinic withdrawal treatment of alcohol dependent persons in a Hamburg institution for addiction aid. It reports the initial, selected results of a comparative follow-up study of patients discharged during the years 1998-2000, who either receive ambulatory treatment in the day clinic (n = 270) or inpatient treatment in the institution's special clinic (n = 462). Assessable questionnaires are available from 131 outpatients of the day-clinic treatment and 173 patients of the inpatient treatment form. The response rate - with reference to the group of those who were reachable - was 57.2 % for patients of the day clinic and 53.2 % for patients of the special clinic. The results of the study arrive at the conclusion that both treatment forms can be seen as thoroughly comparable with regard to primary outcome measurements (for example reduction of psychological stress, abstinence rates, reintegration into occupational life). Rehabilitants treated in the inpatient setting more frequently report that they had already contacted centres for further treatment and self-help groups during the rehabilitation phase, which however doesn't lead to a change of participation behaviour following the rehabilitation phase. This serves to confirm the assumption that an additional offer of a day-clinic service in the area of addiction rehabilitation provides a further, effective treatment concept that sensibly supplements the otherwise inpatient-oriented treatment landscape. The results indicate the quality of the work performed in the day clinic studied (as well as in the inpatient clinic) and should encourage the funding agencies and employees of other day clinic institutions in the field of addiction rehabilitation to participate in evaluation and quality assurance measures, thus continuing to bridge the gap between the (theoretical) state of knowledge concerning outpatient rehabilitation and the degree to which it can be successfully realized.

Adult↗
PubMed2003

[Efficacy of inpatient rehabilitation for chronic back pain in Germany: a systematic review 1980-2001].

BACKGROUND: Chronic back pain has a high personal impact, is frequent and of outstanding economical relevance. Analysis of the international literature indicates strong or moderate evidence for the effectiveness of multimodal multidisciplinary team care of chronic back pain. Our review aims at a complete review and critical appraisal of German studies of inpatient medical rehabilitation. METHODS: We conducted a systematic search for relevant German studies (1/1980 - 6/2001) using electronic data bases, manual search of congress abstracts and postal questionnaires of 712 German rehabilitation clinics. Relevant studies were categorized according to the recommendation of the Cochrane Back Review Group. For all studies, aims, participants, type of intervention, evaluation time, main outcomes and results were extracted and tabulated. The effect size for 6 central outcome parameters (pain intensity, functional status, catastrophizing, depression, vitality, days on sickness leave) were calculated using pre-post comparisons and were integrated into short and long term weighted means of intra-group effect sizes. RESULTS: 30 studies, both controlled and uncontrolled, report a multitude of positive changes with inpatient rehabilitation treatment. Improvements included both somatic and psychological parameters. However, methodological quality was often poor; only three studies fulfilled the criteria for high quality. Comparison of meta analyses of German and international studies indicates partly good agreement (e. g. changes in pain intensity), partly discrepancies (e. g. functional ability in daily activities). Taken together, inpatient rehabilitation treatment for chronic low back pain in Germany appears to be of low to moderate efficacy. DISCUSSION AND CONCLUSIONS: In the era of evidence based medicine, inpatient rehabilitation has to show its usefulness, necessity and efficiency as any other type of health care. For the German system of inpatient rehabilitation of chronic back pain available evidence is not conclusive, due to a lack of randomised controlled studies. The prevailing design of observational cohort studies has severe limitations in proving a causal relationship between outcomes and intervention. The international literature however provides more valid evidence in favour of the multimodal multidisciplinary intervention in chronic back pain. Under the assumption of a "class effect" of medical rehabilitation the German data seem to corroborate the conclusions drawn from international studies.

Germany↗